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08 Jun 18 08 Jun 18

Ebola: MSF responds to the outbreak in Democratic Republic of Congo

The Ebola outbreak continues in the Equateur province of Democratic Republic of Congo (DRC). Unlike previous outbreaks in DRC, where cases have been concentrated in remote villages, four patients have now been diagnosed in Mbandaka, a busy port city on the Congo River with more than one million inhabitants.

As of June 5, 60 cases with symptoms of hemorrhagic fever (FHV) have been identified. Thirty-seven of those have been confirmed as Ebola, and 27 have died. Twenty-three patients have recovered from the disease and have been discharged. To tackle the epidemic and limit its risk of spreading, Doctors Without Borders/Médecins Sans Frontières (MSF) is stepping up its response in the affected areas of Mbandaka and Bikoro.

As of June 5, MSF has 75 international and 360 national staff on the ground responding to Ebola in DRC. So far 19 patients have been treated for the disease. 

 

MSF Pulse: Ebola outbreak in Democratic Republic of Congo

Watch the latest episode of the MSF video series Pulse on efforts to contain the spread of Ebola in DRC.

“This is the ninth Ebola outbreak in Congo in the last 40 years. So far, [the majority of] them have occurred in remote and isolated areas, as was the case last year in Likati, when the epidemic didn’t spread,” explains Henry Gray, MSF Emergency Coordinator in Mbandaka. “With the new case confirmed in Mbandaka, the scenario has changed, and it has become most serious and worrying, since the disease is now affecting an urban area. It is paramount to trace the suspect case in order to have a clearer view on how it reached the city. We are working closely with the Ministry of Health and the other organizations in the field to implement a coordinated, tailored and rapid response to stop the spread of Ebola.”

Ebola is a highly contagious and deadly viral disease. As part of their daily ritual, workers don a special suit, double-layered gloves, and goggles. Kampungu village, Western Kasai province, Democratic Republic of the Congo (DRC).

Moreover, MSF and its research arm Epicentre are working closely with the Ministry of Health and the World Health Organization (WHO) on the implementation of the Ebola vaccine rVSVDG-ZEBOV-GP as an additional measure to control the outbreak. While the strategy is being put in place, the “pillars” of an Ebola intervention must continue in order to stem the spread of the disease. These pillars include early treatment and isolation of people who are sick, tracing and following up contacts, informing people about disease prevention and treatment, supporting existing healthcare frameworks, and temporarily changing cultural behaviour around funerals.

MSF’s vaccination activities started on May 28 and targeted Bikoro, Itipo, Bokongo, Butela, Ikoko Impenge and Bolendo. The vaccination has been administered according to a ring approach (targeting contacts and contacts of contacts of confirmed Ebola cases), which ensures that the vaccination of persons who are in the ‘ring’ create a buffer zone — or protective ring — to prevent the spread of infection. Front-line workers who are deemed to be most at risk of Ebola infection including health workers and hygienists working in Ebola treatment centres, religious leaders and traditional healers have also been offered the vaccine. As of June 6, 670 people have been vaccinated by MSF, and 1,737 overall.

 

 

MSF’s Ebola response in DRC started on 5 May, with an epidemiological alert in the Equateur region. A small team from MSF’s Congo Emergency Pool (PUC) assessed the situation, together with teams from the MoH and WHO. When the Ebola epidemic was officially declared on 8 May, experts from MSF’s emergency pools arrived in the field to deploy a rapid response in the Ebola hotspots. Among the MSF staff on the ground are some of the organization’s most experienced Ebola field workers, including medical personnel, experts in infection control and logisticians.

To tackle the Ebola epidemic and limit the spread of the virus, MSF emergency teams are present in four locations where suspect and confirmed patients have been identified, and are working in collaboration with DRC’s Ministry of Health (MoH) and WHO. The organization currently operates three Ebola Treatment Centres (ETC) (Mbandaka, BIkoro and Iboko) with a total of 45 beds in isolation, and one transit centre with 14 beds in Itipo. As of 6 June, MSF is caring for 1 confirmed patient and four suspect patients.

Almost 100 tons of supplies have been shipped to Kinshasa and dispatched to the affected areas since the beginning of the epidemic.

Mbandaka

At the beginning of the outbreak, MSF set up an isolation zone with five beds in Mbandaka’s main hospital (Wangata hospital). An MSF ETC with 12 beds was also built, and has been operational since 28 May. The bed capacity in the ETC can be upgraded to 40 if needed. At the moment there are no patients in the ETC. In addition to the treatment and isolation of suspected and confirmed Ebola cases, the focus of MSF’s response is on surveillance, investigation of new cases and their contacts, infection control and prevention, health promotion and training activities.

Bikoro

The team is also intervening in Bikoro, where an MSF ETC with 20 beds has been built, and continues to reinforce outreach activities including investigation on contact cases, monitoring and surveillance. 

Itipo/Iboko

MSF teams are present in the remote areas of Itipo and Iboko, where suspected and confirmed Ebola cases have been identified. In Itipo, a 14 bed transit centre with isolation capacity is already functional. In this transit centre, suspected cases are isolated and tested for Ebola. If they are confirmed and well enough to be transported, they are taken to BIkoro for treatment. In Iboko, teams are finalising the building of an ETC in the main hospital. In addition, MSF teams takes part to other activities of the Ebola response, such as ambulance services, contact tracing, active cases finding, health structure support, communication, safe burial and disinfestation of health centers and houses.

MSF has worked in DRC since 1981, and today has regular and emergency projects in 20 of the country’s 26 provinces, offering medical care to the victims of conflict and violence, to displaced people and to those suffering from epidemics like hemorrhagic fever, cholera, measles and HIV/AIDS.

 

Q&A

How many cases have been confirmed?

On May 16, the first case in Mbandaka, capital of the Equateur province, was laboratory confirmed by the Congolese Ministry of Health (INRB - National Institute for Biological Research).

As of June 5, 60 cases with symptoms of hemorrhagic fever (FHV) have been identified. Thirty-seven of those have been confirmed as Ebola, and 27 have died. Twenty-three patients have recovered from the disease and have been discharged. 

How was the situation for the previous epidemics in DRC?

This is the ninth Ebola epidemic in DRC. All of previous epidemics have occurred in similar areas: remote and relatively isolated. These epidemics never spread beyond a few villages, and during no outbreak in DRC have more than a few hundred people been infected. The last Ebola outbreaks in DRC occurred in May 2017, in Likati (Bas-Uele province), with 3 biologically confirmed cases and 15 patients treated, and in the village of Boende (Thsuapa province) in 2014, affecting 66 people, of whom there were 49 mortalities.

What are the chances of the virus spreading?

The health zone identified the epicentre of the outbreak in Equateur province, in the north-west of the country, in a region covered in dense forest and criss-crossed by rivers.

Previous Ebola epidemics in DRC haven't spread beyond a handful of villages because they have been in remote and isolated areas, where the population had very little contact with neighbouring communities.

This time there is a greater risk; in spite of its remoteness, Mbandaka is close to the Congo River and Lake Tumba, two main transport channels used by the local communities for travel and trade.

What are the risks now that there is one case confirmed in Mbandaka?

On May 16 we received confirmation from the INRB (National Institute for Biological Research) that there is one confirmed case in Mbandaka. This means that all surveillance measures must be reinforced, and suspect cases isolated. Identifying cases before they spread is paramount in a city of over one million inhabitants, especially one along a trade and transport route for the region.

MSF teams are already on site and have set up an isolation zone in the city’s main hospital. In the next few days around 50 tons of supply material will arrive in Mbandaka, as teams build two Ebola Treatment Centres  with 20 beds each in Mbandaka and Bikoro.

What can be done to contain the epidemic?

Containing an Ebola epidemic requires coordinated efforts across several fields, the so-called six pillars:

  • 1. Treatment of diagnosed patients
  • 2. Outreach activities to find patients
  • 3. Tracing and following-up of people who have had contact with diagnosed patients
  • 4. Health promotion activities to inform people about the risks and how to avoid them
  • 5. Support of existing healthcare frameworks, to make sure they are accessible to anyone
  • 6. Safe burials to avoid infections

Vaccination might very soon become a seventh one, providing protection from the virus and limiting the risk of transmission. If all these so-called ‘pillars’ of an Ebola intervention are well-implemented, an epidemic can be often contained in a relatively short period of time. 

Medical staff working in the High-risk zone of Boende Ebola management centre. The areas and procedures in the treatment centeres are clearly marked to prevent infections inside the facilities. Boende, Democratic Republic of the Congo (DRC).

What is MSF doing right now?

Together with experts from the Ministry of Health and the WHO, MSF has been on-site since  May 5 to surveil the epidemic.

  • A team from the MSF Emergency Pool in Europe left on May 15 for Mbandaka and Bikoro, totaling 24. Among the staff are some of our most experienced Ebola field workers, including medical personnel, experts in infection control and logisticians. They will open Ebola Treatment Centres in Mbandaka and Bikoro to coordinate activities in the field.
  • Inpatient clinics and isolation wards: MSF is operating a 10-bed facility in Bikoro and a 5-bed facility at Wangata hospital in Mbandaka. Teams are also building two Ebola Treatment Centres (ETCs) with 20 beds each in Mbandaka and Bikoro.
  • By the end of this week, almost 50 tons of supply materials will arrive in DRC. The material will include: medical kits; protection and disinfection kits (isolation items such as gloves, boots and protective clothing, etc..); logistic and hygiene kits (plastic sheets, jerry cans, water distribution modules, chlorine spray kits, water treatments kits, etc…); palliative drugs.

What lessons were learned from the West African epidemic, and how will they be applied in the response?

The situation in DRC is very different from that in West Africa in 2014–2015, and not everything learned in that setting may be applicable this time. However, we have learned some key lessons:

  • The structure of an Ebola Treatment Centre will be better adapted so that patients can have visual contact with visiting family members.
  • Both technical and medical tools have been improved (such as protective clothing for staff, diagnostic tools, etc)
  • Better coordination between all parties involved on the messages for health promotion.

Will MSF use vaccines to stop the epidemic?

MSF and its research arm Epicentre are working closely with the Ministry of Health and the WHO on the implementation of the Ebola vaccine rVSVDG-ZEBOV-GP as an additional measure to control the outbreak. This investigational vaccine has not yet been licensed and will therefore be implemented through a study protocol, which has been accepted by national authorities and the Ethical Review Board in Kinshasa, as well as the MSF Ethical Review Board. The participants will receive information on the vaccine itself and the vaccine strategy before consenting to the vaccination, and they will be carefully monitored. Participation is voluntary.

While the strategy is being put in place, the 'pillars' of an Ebola intervention will continue in order to stem the spread of the disease. MSF is coordinating these activities with the Ministry of Health, the WHO and other actors in the field.

Bolakofo Konga Yule survived the infection after treatment in the Lokolia Ebola center. Coming back to the community is a very sensitive step, and family support is essential. Lokolia, Democratic Republic of the Congo (DRC).

Are national and international health authorities ready to respond to a new Ebola epidemic?

There have been 17 other Ebola epidemics worldwide, and this is the ninth in DRC. All of the epidemics in DRC thus far have occurred in remote and relatively isolated areas, so it has been fairly easy to limit their spread. However, with the new case confirmed in Mbandaka the scenario could change rapidly. Thankfully both the Ministry of Health and the WHO are deploying their expertise in Ebola response; MSF is working in coordination with them to react as quickly as possible to any development of the disease.

 

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