2018 Équateur province Ebola outbreak
Initial case: 8 May 2018[1][2] Declared over: 24 July 2018[3] | |
Confirmed cases | 38[4] |
---|---|
Probable cases | 16[5] |
Deaths | 33[5] |
The 2018 Équateur province Ebola outbreak occurred in the north-west of the
The outbreak began on 8 May 2018, when it was reported that 17 people were suspected of having died from EVD near the town of
Subsequent to the end of this outbreak, the Kivu Ebola epidemic commenced in the eastern region of the country on 1 August 2018;[17] it was declared over on 25 June 2020 with 2,280 deaths recorded.[18] A further separate outbreak in the Province of Équateur was announced on 1 June 2020 by the Congolese health ministry, described as the eleventh Ebola outbreak since records began.[19] This eleventh outbreak was declared over as of 18 November following no reported cases for 42 days,[20] having caused 130 cases and 55 deaths.[21]
Epidemiology
Early cases
The earliest cases are believed to have occurred in early April 2018.
After his funeral, eleven family members became ill, and seven of them died. All of the seven deceased had attended the man's funeral or cared for him while he was sick.[22] The identification of this individual as the index case has not yet been confirmed.[23]
Équateur province's Provincial Health Division reported 21 cases with symptoms consistent with
On 10 May, the World Health Organization (WHO) stated that the Democratic Republic of the Congo had a total of 32 cases of EVD,[2] and a further two suspected cases were announced on the following day, bringing the total cases to 34, all located in the Bikoro area of DRC.[26]
Date | Cases | Deaths | CFR | Contacts | |||
---|---|---|---|---|---|---|---|
Confirmed | Probable | Suspected | Total | ||||
2018-05-11[28] | 2 | 18 | 14 | 34 | 18 | 52.9% | 75 |
2018-05-14[29] | 2 | 22 | 17 | 41 | 20 | 48.8% | 432 |
2018-05-18[24] | 14 | 21 | 10 | 45 | 25 | 55.6% | 532 |
2018-05-20[23] | 28 | 21 | 2 | 51 | 27 | 52.9% | 628 |
2018-05-23[25] | 31 | 13 | 8 | 52 | 22* | 42.3% | >600[30] |
2018-05-27[31] | 35 | 13 | 6 | 54 | 25 | 46.3% | 906 |
2018-05-30[32] | 37 | 13 | 0 | 50* | 25 | 50% | >900[33] |
2018-06-03[34] | 37 | 13 | 6 | 56 | 25 | 44.6% | 880 |
2018-06-06[35] | 38 | 14 | 10 | 62 | 27 | 43.6% | 619 |
2018-06-10[36] | 38 | 14 | 3 | 55* | 28 | 50.9% | 634 |
2018-06-17[37] | 38 | 14 | 10 | 62 | 28 | 45.1% | 289 |
2018-06-20[15] | 38 | 14 | 9 | 61* | 28 | 45.9% | 179 |
2018-06-24[38] | 38 | 14 | 3 | 55* | 28 | 51% | 179 |
2018-06-29[39] | 38 | 15 | 0 | 53* | 29 | 54.7% | 0 |
2018-07-09[40] | 38 | 15 | 0 | 53 | 29 | 54.7% | 0 |
2018-07-24[7] | 38 | 16 | 0 | 54 | 33 | 61% | 0 |
* numbers are subject to revision both up, when new cases are discovered, and down, when tests show cases were not Ebola-related. |
Spread to Mbandaka
In the eight previous Ebola outbreaks in DRC since 1976, the virus had never before reached a major city. In May 2018, for the first time, four cases were confirmed in the city of Mbandaka.[41][25]
On 14 May, suspected cases were reported in the Iboko and Wangata areas in Équateur province, in addition to Bikoro. The WHO reported on 17 May 2018 that the first case of this outbreak in an urban area[22] had been confirmed in the Wangata district of Mbandaka city, the capital of Équateur province, about 100 miles north of Bikoro.[22][29][12] Mbandaka is a busy, densely populated port on the Congo River with a population of 1.2 million,[42] leading to a high risk of contagion.[24][22] The following day, the WHO raised the health risk in DRC to "very high" due to the presence of the virus in an urban area.[13]
The DRC government was particularly concerned about the virus spreading by boat transport along the Congo between Mbandaka and the capital, Kinshasa.[43] The WHO also considered that there was a high risk of the outbreak spreading to nine other countries in the region,[24] including the bordering Republic of the Congo and Central African Republic.[43][42]
As of 23 May 2018[update], the focus of the outbreak was split between Bikoro and Iboko; Iboko had 55% of the confirmed cases of EVD
According to the fifth situation report released by the WHO, the case fatality rate (CFR) was 42.3%.[25] Demographics had been reported for 44 cases as of 22 May; there were 26 cases of EVD in men and 18 in women; 7 cases were in children 14 years and under, and 9 were in those over 60 years.[25] By 23 May, there had been 5 reported cases in health-care workers, including two who died.[25] Contact tracing was being employed to identify contacts with infected individuals.[23][44] On 29 May, it was reported that 800 contacts had been identified in the city of Mbandaka;[45] the next day it was reported that 500 people in the city had been vaccinated.[46]
Health zone |
Cases | Deaths | CFR | |||
---|---|---|---|---|---|---|
Confirmed | Probable | Suspected | Total | |||
Bikoro | 10 | 11 | 0 | 21 | 18 | 85.7% |
Iboko | 24 | 5 | 0 | 29 | 12 | 41.3% |
Wangata | 4 | 0 | 0 | 4 | 3 | 75% |
Ingende[37] | 0 | 0 | 0 | 0 | 0 | - |
Total | 38 | 16 | 0 | 54 | 33 | 61% |
On 29 May, the WHO indicated that nine neighbouring countries had been alerted for being at high risk of spread of EVD,[47] On 4 June, it was reported that Angola had closed its border with the DRC due to the outbreak.[48]
End of the outbreak
This outbreak in the Democratic Republic of the Congo was declared over on 24 July 2018 after 42 days passed without any new confirmed cases.[49][16][41] Although it was noted that a new outbreak occurred only one week later in the eastern region of Kivu; and it has been established that they are not linked.[17]
Containment challenges
The Bikoro area had three hospitals, but the area's health services were described by WHO as predominantly having "limited functionality";
Adherence was another challenge: on 20–21 May, three individuals with EVD in an isolation ward of a treatment center in Mbandaka fled; two later died after attending a prayer meeting, at which they may have exposed 50 other attendees to the virus.[50][51][52][53] Bushmeat was believed to be one vector of infection, but bushmeat vendors at the Mbandaka market told reporters that they did not believe Ebola was real or serious.[54] Hostility towards health workers trying to offer medical assistance was also reported.[55] On 29 May, the WHO forecast that there would be 100–300 cases by the end of July.[56]
Virology
The virus was named for the Ebola River, which runs as a tributary of the Congo River in the Democratic Republic of the Congo; the Zaire strain was first identified in 1976 in Yambuku.[58][59]
Response
US President
Surveillance
Surveillance of travelers at Mbandaka's port and airport was performed.
Burials were organized by MSF and the Red Cross of the Democratic Republic of the Congo to minimize the risk of transmission.[24] The United Nations Radio broadcast EVD awareness information, and posters and leaflets were prepared and distributed.[24] UNICEF warned 143 churches across Mbandaka of the risks of prayer meetings.[25]
Treatment
Ring vaccination with rVSV-ZEBOV
Health authorities including DRC's
A ring vaccination strategy was used, which involves vaccinating only those most likely to be infected: direct contacts of infected individuals, and contacts of those contacts.[22][74][75][76][77] Other groups targeted included health workers, laboratory personnel, surveillance workers and people involved with burials.[64][78] People who were vaccinated were followed up for 84 days to assess whether they were protected from infection and to monitor any adverse events.[6] A total of 4,320 doses of the rVSV-ZEBOV vaccine were delivered to DRC's capital Kinshasa by WHO on 16 May, and a further 3,240 doses arrived three days later;[23] with another 8,000 doses to be made available.[79] The vaccine must be transported and stored at between −60 and −80 °C.[64] A cold chain was established in Kinshasa by 18 May and has been extended to Mbandaka. WHO planned to concentrate on vaccinating three sets of contacts of confirmed EVD cases, two in Bikoro and one in Mbandaka.[24]
Vaccination started on 21 May among health workers in Mbandaka,[66] with 7,560 vaccine doses ready for immediate use, according to WHO.[23][64] The DRC health minister Oly Ilunga Kalenga stated that vaccination of health workers and Ebola case contacts in the Wangata and Bolenge areas of Mbandaka would take five days, after which vaccination would start in Bikoro and Iboko.[66] As of 24 May 2018[update], 154 people in Mbandaka had been vaccinated, and preparations were started for vaccinating in Bikoro and Iboko.[25] Up to 1,000 people were expected to have been vaccinated by 26 May, according to WHO.[23] It was the first time that vaccination had been attempted in the early stages of an Ebola outbreak.[6]
The rVSV-ZEBOV vaccine proved effective for the strain of the Ebola virus in this outbreak, having via ring vaccination protected some 3,481 individuals.[7]
Experimental therapeutic agents
Health officials considered trialing experimental treatments, including the antiviral agents
The
Prognosis
History
The Democratic Republic of the Congo (formerly Zaire) has had several previous EVD outbreaks since 1976,[86][87] which are summarised in the Table below. All have been located in the west or north of the country.[79] Three previous outbreaks (in 1976, 1977 and 2014) occurring in former province of Équateur, of which the current Équateur province forms part.[2]
In 2014, the WHO considered that the DRC was lagging behind the rest of Africa in
For the 2017 Democratic Republic of the Congo Ebola virus outbreak, the DRC regulatory authorities approved the use of the experimental rVSV-ZEBOV vaccine, but logistical issues delayed its implementation until the outbreak was already under control.[6][80][90]
Shortly before the first cases of the 2018 Ebola outbreak, the country experienced a widespread cholera epidemic (June 2017 – spring 2018), which was the most serious in the country since 1994.[91][92][93]
Date | Country | Major location | Outbreak information | Source | |||
---|---|---|---|---|---|---|---|
Strain | Cases | Deaths | CFR | ||||
Aug 1976 | Zaire | Yambuku | EBOV | 318 | 280 | 88% | [94] |
Jun 1977 | Zaire | Tandala | EBOV | 1 | 1 | 100% | [87][95] |
May–Jul 1995 | Zaire | Kikwit | EBOV | 315 | 254 | 81% | [96] |
Aug–Nov 2007 | Democratic Republic of the Congo | Kasai-Occidental | EBOV | 264 | 187 | 71% | [97] |
Dec 2008–Feb 2009 | Democratic Republic of the Congo | Kasai-Occidental | EBOV | 32 | 14 | 45% | [98] |
Jun–Nov 2012 | Democratic Republic of the Congo | Orientale | BDBV |
77 | 36 | 47% | [87] |
Aug–Nov 2014 | Democratic Republic of the Congo | Tshuapa | EBOV | 66 | 49 | 74% | [99] |
May–Jul 2017 | Democratic Republic of the Congo | Likati | EBOV | 8 | 4 | 50% | [100] |
Apr–Jul 2018 | Democratic Republic of the Congo | Équateur Province | EBOV | 54 | 33 | 61% | [101] |
Aug 2018–June 2020 |
Democratic Republic of the Congo | Kivu | EBOV | 3,470 | 2,280 | 66% | [102] |
June–Nov 2020 | Democratic Republic of the Congo | Équateur Province | EBOV | 130 | 55 | 42% | [103] |
Feb 2021–May 2021 | Democratic Republic of the Congo | North Kivu | EBOV | 12 | 6 | 50% | [104] |
April 2022 | Democratic Republic of the Congo | Équateur Province | EBOV | 5 | 5 | 100% | [105][106] |
August 2022 | Democratic Republic of the Congo | North Kivu | EBOV | 1 | 1 | 100% | [107] |
See also
- 2017 Democratic Republic of the Congo Ebola virus outbreak
- 2014 Democratic Republic of the Congo Ebola virus outbreak
- West Africa Ebola virus epidemic
- 2018 Kivu Democratic Republic of the Congo Ebola virus outbreak
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Further reading
- Maganga, Gaël D.; Kapetshi, Jimmy; Berthet, Nicolas; Kebela Ilunga, Benoît; Kabange, Felix; Mbala Kingebeni, Placide; Mondonge, Vital; Muyembe, Jean-Jacques T.; Bertherat, Eric; S2CID 96459830.
- Laupland, Kevin B; Valiquette, Louis (May 2014). "Ebola Virus Disease". The Canadian Journal of Infectious Diseases & Medical Microbiology. 25 (3): 128–9. PMID 25285105.
- Kadanali, Ayten; Karagoz, G (2016). "An overview of Ebola virus disease". Northern Clinics of Istanbul. 2 (1): 81–86. PMID 28058346.
- Nanclares, Carolina; Kapetshi, Jimmy; Lionetto, Fanshen; de la Rosa, Olimpia; Tamfun, Jean-Jacques Muyembe; Alia, Miriam; Kobinger, Gary; Bernasconi, Andrea (September 2016). "Ebola Virus Disease, Democratic Republic of the Congo, 2014". Emerging Infectious Diseases. 22 (9): 1579–1586. PMID 27533284.
- "Experimental Ebola vaccines elicit year-long immune response/NIH reports final data from large clinical trial in West Africa". National Institutes of Health (NIH). NIH.gov. 11 October 2017. Retrieved 20 May 2018.
- Kuhn, Jens; Andersen, Kristian; Baize, Sylvain; Bào, Yīmíng; Bavari, Sina; Berthet, Nicolas; Blinkova, Olga; Brister, J.; Clawson, Anna; Fair, Joseph; Gabriel, Martin; Garry, Robert; Gire, Stephen; Goba, Augustine; Gonzalez, Jean-Paul; Günther, Stephan; Happi, Christian; Jahrling, Peter; Kapetshi, Jimmy; Kobinger, Gary; Kugelman, Jeffrey; Leroy, Eric; Maganga, Gael; Mbala, Placide; Moses, Lina; Muyembe-Tamfum, Jean-Jacques; N'Faly, Magassouba; Nichol, Stuart; Omilabu, Sunday; Palacios, Gustavo; Park, Daniel; Paweska, Janusz; Radoshitzky, Sheli; Rossi, Cynthia; PMID 25421896.
- Chippaux, Jean-Philippe (2014). "Outbreaks of Ebola virus disease in Africa: the beginnings of a tragic saga". Journal of Venomous Animals and Toxins Including Tropical Diseases. 20 (1): 44. PMID 25320574.
- Mulangu, Sabue; Alfonso, Vivian H; Hoff, Nicole A; Doshi, Reena H; Mulembakani, Prime; Kisalu, Neville K; Okitolonda-Wemakoy, Emile; Kebela, Benoit Ilunga; Marcus, Hadar; Shiloach, Joseph; Phue, Je-Nie; Wright, Linda L; Muyembe-Tamfum, Jean-Jacques; Sullivan, Nancy J; Rimoin, Anne W (15 February 2018). "Serologic Evidence of Ebolavirus Infection in a Population With No History of Outbreaks in the Democratic Republic of the Congo". The Journal of Infectious Diseases. 217 (4): 529–537. PMID 29329455.
- "Ebola Treatment Research | NIH: National Institute of Allergy and Infectious Diseases". www.niaid.nih.gov. National Institutes of Health. Retrieved 28 May 2018.
- "WHO | WHO Regional Strategic EVD Readiness Preparedness Plan Regional Preparedness Plan for EVD in 9 Countries 31 May: follow up discussions". WHO. Archived from the original on 10 June 2018. Retrieved 8 June 2018.
- Barry, Ahmadou; et al. (June 2018). "Outbreak of Ebola virus disease in the Democratic Republic of the Congo, April–May, 2018: an epidemiological study" (PDF). The Lancet. 392 (10143): 213–221. S2CID 51719460.
- Mbala Kingebeni, Placide; Villabona-Arenas, Christian-Julian; Vidal, Nicole; Likofata, Jacques; Nsio-Mbeta, Justus; Makiala-Mandanda, Sheila; Mukadi, Daniel; Mukadi, Patrick; Kumakamba, Charles; Djokolo, Bathe; Ayouba, Ahidjo; Delaporte, Eric; Peeters, Martine; Muyembe Tamfum, Jean-Jacques; Ahuka Mundeke, Steve (2018). "Rapid confirmation of the Zaire Ebola Virus in the outbreak of the Equateur province in the Democratic Republic of Congo: implications for public health interventions". Clinical Infectious Diseases. 68 (2): 330–333. PMID 29961823.
- "Consultation on Monitored Emergency Use of Unregistered and Investigational Interventions for Ebola Virus Disease (EVD)". ReliefWeb. World Health Organization. 9 July 2018. Retrieved 9 July 2018.
External links
- World Health Organization Democratic Republic of the Congo crisis information
- World Health Organization Ebola situation reports
- "Ebola (Ebola Virus Disease) | CDC". www.cdc.gov. Centers for Disease Control and Prevention. 23 May 2018. Retrieved 28 May 2018.