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The '''2018 Kivu Democratic Republic of the Congo Ebola virus outbreak'''{{refn|group=note|Ituri province was added to N. Kivu province, in terms of viral infection, when the first case of EVD was confirmed on 13 August per |
The '''2018 Kivu Democratic Republic of the Congo Ebola virus outbreak'''{{refn|group=note|Ituri province was added to N. Kivu province, in terms of viral infection, when the first case of EVD was confirmed on 13 August per<ref name=cit/> }} began on August 1, 2018, when it was confirmed that four cases had tested positive for [[Ebola virus]] in the eastern region of [[Kivu]] in the [[Democratic Republic of the Congo]] (DRC).<ref>{{cite web |last1=Editorial |first1=Reuters |title=Congo declares new Ebola outbreak in eastern province |url=https://www.reuters.com/article/us-health-ebola/congo-declares-new-ebola-outbreak-in-eastern-province-idUSKBN1KM59B?il=0 |website=U.S. |accessdate=1 August 2018}}</ref><ref>{{cite web |title=Congo announces 4 new Ebola cases in North Kivu province |url=https://www.washingtonpost.com/world/africa/congo-announces-4-new-ebola-cases-in-north-kivu-province/2018/08/01/d911b7dc-959c-11e8-818b-e9b7348cd87d_story.html?utm_term=.c411bc3e1e98 |website=Washington Post |accessdate=1 August 2018 |language=en}}</ref><ref name="pre">{{cite web |title=Cluster of presumptive Ebola cases in North Kivu in the Democratic Republic of the Congo |url=http://www.who.int/news-room/detail/01-08-2018-cluster-of-presumptive-ebola-cases-in-north-kivu-in-the-democratic-republic-of-the-congo |website=World Health Organization |accessdate=2 August 2018}}</ref> |
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The affected province and general area are [[Kivu conflict|currently undergoing a military conflict]], which is seen as possibly hindering treatment and [[Ebola vaccine|vaccination]] attempts against the [[Ebola virus disease]] (EVD), once they begin.<ref name=sc/> |
The affected province and general area are [[Kivu conflict|currently undergoing a military conflict]], which is seen as possibly hindering treatment and [[Ebola vaccine|vaccination]] attempts against the [[Ebola virus disease]] (EVD), once they begin.<ref name=sc/> |
Revision as of 23:19, 3 September 2018
Initial case: 1 August 2018 | |
![]() Location of North Kivu province in the Democratic Republic of the Congo | |
![]() Location of the Democratic Republic of the Congo in Africa | |
Confirmed cases | 91[1] |
---|---|
Probable cases | 30[1] |
Suspected cases | 14[1] |
Total cases | 135[1] |
Deaths | 81[1] |
The 2018 Kivu Democratic Republic of the Congo Ebola virus outbreak[note 1] began on August 1, 2018, when it was confirmed that four cases had tested positive for Ebola virus in the eastern region of Kivu in the Democratic Republic of the Congo (DRC).[3][4][5]
The affected province and general area are currently undergoing a military conflict, which is seen as possibly hindering treatment and vaccination attempts against the Ebola virus disease (EVD), once they begin.[6]
Vaccination is possible in certain areas, however on 24 August an Ebola-stricken physician had been in contact with 97 individuals in an inaccessible military area; hence those 97 contacts cannot be diagnosed or treated.[7]
Epidemiology
First cases
The Democratic Republic of Congo declared an Ebola outbreak on 1 August, when four cases had tested positive for the Ebola virus in the province of North Kivu. Additionally, 26 individuals with haemorrhagic signs, and 20 deaths were reported in the area.[8][9] On 2 August, Oxfam indicated it would be taking part in the response to this latest outbreak in the DRC.[10]
The virus has developed in multiple locations as of 3 August; cases have been reported in five health zones – Beni, Butembo, Oicha, Musienene and Mabalako – in North Kivu province and additionally, Mandima and Mambasa in Ituri Province.[11]
The DRC Ministry of Public Health confirmed late on 2 August that the new Ebola outbreak is caused by the Zaire ebolavirus species. This is the same strain that was involved in the early 2018 outbreak in western DRC.[12] Health authorities will use the ZEBOV vaccine once again.[12]
On 4 August, the World Health Organization (WHO) indicated that the current situation in the DRC, due to several factors, warranted a "high risk assessment" at the national and regional level for public health.[13]
Date | Cases # | Deaths | CFR | Contacts | Sources | |||
---|---|---|---|---|---|---|---|---|
Confirmed | Probable | Suspected | Total | |||||
2018-08-01 | 4 | 22 | 0 | 26 | 20 | - | - | [15]† |
2018-08-03 | 13 | 30 | 33 | 76 | 33 | 76.7%‡ | 879 | [16][17] |
2018-08-07 | 16 | 27 | 31 | 74 | 34 | 79%‡ | 966 | [18][19] |
2018-08-10 | 25 | 27 | 48 | 100 | 39 | 75%‡ | 953 | [20] |
2018-08-14 | 30 | 27 | 58 | 115 | 41 | - | 997 | [21] |
2018-08-17 | 64 | 27 | 12 | 103 | 50 | 55.6%‡ | 1,609 | [22] |
2018-08-20 | 75 | 27 | 9 | 111 | 59 | - | 2,408 | [23] |
2018-08-24 | 83 | 28 | 6 | 117 | 72 | 65%‡ | 3,421 | [24] |
2018-08-26 | 83 | 28 | 10 | 121 | 75 | 67.6%‡ | 2,445 | [25] |
2018-08-31 | 90 | 30 | 8 | 128 | 78 | 65%‡ | 2,462 | [26] |
# numbers are subject to revision both up, when new cases are discovered, and down, when tests show cases were not Ebola-related. |
The Uganda Ministry of Health has issued an alert for extra surveillance as the neighboring outbreak in the DRC is just 100 kilometres (62 mi) away from its border.[27] On 7 August, the DRC Ministry of Public Health indicated that the total count had climbed to almost 90 cases;[28] two days later, on 9 August, it was nearly 100 cases.[29] On 16 August, the United Kingdom indicated it would help with EVD diagnosis and monitoring in the DRC.[30]
On 17 August, the WHO reported that "contacts" numbered about 1500 individuals, however there could be more in certain conflict zones in the DRC that can not be reached.[31]
Some 954 contacts were successfully followed up on 18 August, however, Mandima Health Zone indicated resistance; as a consequence, contacts were not followed up there per WHO.[22]
Military conflict
![](https://upload.wikimedia.org/wikipedia/commons/thumb/c/cb/Goma_-_North_Kivu_%2821070159821%29.jpg/140px-Goma_-_North_Kivu_%2821070159821%29.jpg)
The area in question, North Kivu, is also currently in the middle of the Kivu Conflict, a military conflict with thousands of displaced refugees.[32][33] The affected area has about one million uprooted people and shares borders with Rwanda and Uganda, with cross border movement because of trade activities. The humanitarian crisis and deterioration of the security situation is expected to affect any response to the outbreak.[34][35]
There are about 70 armed military groups, among them the Alliance of Patriots for a Free and Sovereign Congo and the Mai-Mayi Nduma défense du Congo-Rénové, in North Kivu. The armed fighting has apparently displaced thousands of individuals.[36] According to WHO, health care workers will be accompanied by military personnel for protection; additionally, ring vaccination may not be possible.[6] On 11 August, it was reported that seven individuals were killed in Mayi-Moya due to a military group, about 24 miles from Beni where there are several EVD cases.[37][38] The WHO is asking for safe passage to those areas that are within conflict zones, so that possible EVD cases may be found.[39]
On 24 August, it was reported that an Ebola-stricken physician had been in contact with some 97 individuals in an inaccessible military area, hence those 97 contacts cannot be diagnosed.[40][41]
Uganda border
![](https://upload.wikimedia.org/wikipedia/commons/thumb/7/75/Un-uganda.png/80px-Un-uganda.png)
On 11 August a U.N. agency indicated that steps were being taken to assure that those leaving DRC into Uganda are not infected with Ebola; this is being done via active screening.[2][42]
On 13 August the DRC reported a total of 115 cases of the virus within its borders so far.[2][42] Three individuals in Uganda that were suspected of contracting the virus were tested, with negative results.[43]
On 22 August it was reported that Uganda had opened two Ebola treatment centers at the border with the Democratic Republic of the Congo, though there are, as yet no confirmed cases in the country of Uganda.[44][45]
Virology
![](https://upload.wikimedia.org/wikipedia/commons/thumb/9/96/Rousettus_aegyptiacus_1.jpg/160px-Rousettus_aegyptiacus_1.jpg)
Zaire ebolavirus strain is the most lethal of the five known (now six with Bombali);[46] it is fatal in up to 90% of cases.[47] Both Ebola and Marburg virus are part of the Filoviridae family.[48]
The filovirus genome contains seven genes, including VP40.[49] The natural reservoir of the virus is thought to be the African fruit bat,[50] which is used in many parts of Africa as bushmeat.[51]
Treatment
For the first time Mab 114 (which is a monoclonal antibody) was used to treat infected individuals during this EVD outbreak; ZMapp, however, has not been used because it requires a −20 °C (−4 °F) storage.[2][52] On 14 August it was reported that the Mangina Ebola Treatment Center was now operational.[53]
Vaccine
On 8 August, the process of vaccination began with rVSV-ZEBOV Ebola vaccine.[54] Although the Ebola vaccine has had efficacy, a review by Medaglini et al. indicates "long-term protection is undefined" via the vaccine mechanism.[55] The DRC Ministry of Public Health reported on 16 August that 316 individuals had been vaccinated.[56]
On 24 August, the Democratic Republic of the Congo Ministry of Public Health indicated it had vaccinated 2,957 individuals, including 1,422 in Mabalako against the Ebola virus.[57] On 29 August it was reported that women who are pregnant are not being given the vaccine.[58]
Prognosis
Aside from the possible effects of post-Ebola syndrome,[59] there is also the reality of survivors returning to communities where they might be shunned due to the fear many have in the respective areas of the virus (and EVD).[60]
History
![](https://upload.wikimedia.org/wikipedia/commons/thumb/0/07/Ebola_Virus_-_Electron_Micrograph.tiff/lossy-page1-70px-Ebola_Virus_-_Electron_Micrograph.tiff.jpg)
The Ebola virus disease outbreak in Zaire (Yambuku) started in late 1976, and was the second outbreak after the earlier one in Sudan the same year.[61][62] On 1 August 2018 the 10th Ebola outbreak was declared in the Democratic Republic of Congo, only a few days after the prior outbreak in the same country had been declared over on 24 July.[63][64]
World Health Organization chief Tedros Adhanom Ghebreyesus indicated on 15 August that the current outbreak in DRC may be worse than the West Africa outbreak of 2013-2016,[65], due to several factors.[66]
The table below indicates the 10 outbreaks that have occurred since 1976:
Date | Country | Major location | Outbreak information | Source | |||
---|---|---|---|---|---|---|---|
Strain | Cases | Deaths | CFR | ||||
Aug 1976 | Zaire | Yambuku | EBOV | 318 | 280 | 88% | [67] |
Jun 1977 | Zaire | Tandala | EBOV | 1 | 1 | 100% | [68][69] |
May–Jul 1995 | Zaire | Kikwit | EBOV | 315 | 254 | 81% | [70] |
Aug–Nov 2007 | Democratic Republic of the Congo | Kasai-Occidental | EBOV | 264 | 187 | 71% | [71] |
Dec 2008–Feb 2009 | Democratic Republic of the Congo | Kasai-Occidental | EBOV | 32 | 14 | 45% | [72] |
Jun–Nov 2012 | Democratic Republic of the Congo | Orientale | BDBV | 77 | 36 | 47% | [68] |
Aug–Nov 2014 | Democratic Republic of the Congo | Tshuapa | EBOV | 66 | 49 | 74% | [73] |
May–Jul 2017 | Democratic Republic of the Congo | Likati | EBOV | 8 | 4 | 50% | [74] |
Apr–Jul 2018 | Democratic Republic of the Congo | Équateur Province | EBOV | 54 | 33 | 61% | [75] |
Aug 2018–June 2020 | Democratic Republic of the Congo | Kivu | EBOV | 3,470 | 2,280 | 66% | [76] |
June–Nov 2020 | Democratic Republic of the Congo | Équateur Province | EBOV | 130 | 55 | 42% | [77] |
Feb 2021–May 2021 | Democratic Republic of the Congo | North Kivu | EBOV | 12 | 6 | 50% | [78] |
April 2022 | Democratic Republic of the Congo | Équateur Province | EBOV | 5 | 5 | 100% | [79][80] |
August 2022 | Democratic Republic of the Congo | North Kivu | EBOV | 1 | 1 | 100% | [81] |
See also
- rVSV-ZEBOV
- 2014 Democratic Republic of the Congo Ebola virus outbreak
- 2017 Democratic Republic of the Congo Ebola virus outbreak
- Filoviridae
- Haemorrhagic fever
Notes
References
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- ^ Editorial, Reuters. "Congo declares new Ebola outbreak in eastern province". U.S. Retrieved 1 August 2018.
{{cite web}}
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- ^ "DRC: Doctor stricken with Ebola in rebel stronghold". www.aljazeera.com. Retrieved 24 August 2018.
- ^ Burke, Jason (24 August 2018). "Ebola: medics brace for new cases as DRC outbreak spreads". the Guardian. Retrieved 24 August 2018.
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- ^ "Three alert cases in western Uganda tested negative for Ebola - Xinhua | English.news.cn". www.xinhuanet.com. Retrieved 16 August 2018.
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{{cite book}}
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- ^ Khan, A. S.; Tshioko, F. K.; Heymann, D. L.; Le Guenno, B.; Nabeth, P.; Kerstiëns, B.; Fleerackers, Y.; Kilmarx, P. H.; Rodier, G. R.; Nkuku, O.; Rollin, P. E.; Sanchez, A.; Zaki, S. R.; Swanepoel, R.; Tomori, O.; Nichol, S. T.; Peters, C. J.; Muyembe-Tamfum, J. J.; Ksiazek, T. G. (1999). "The reemergence of Ebola hemorrhagic fever, Democratic Republic of the Congo, 1995". The Journal of Infectious Diseases. 179 Suppl 1: S76–86. doi:10.1086/514306. ISSN 0022-1899. PMID 9988168. S2CID 12364499.
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Further reading
- Dokubo, Emily Kainne; Wendland, Annika; Mate, Suzanne E.; Ladner, Jason T.; Hamblion, Esther L.; Raftery, Philomena; Blackley, David J.; Laney, A. Scott; Mahmoud, Nuha; Wayne-Davies, Gloria; Hensley, Lisa; Stavale, Eric; Fakoli, Lawrence; Gregory, Christopher; Chen, Tai-Ho; Koryon, Augustine; Roth Allen, Denise; Mann, Jennifer; Hickey, Andrew; Saindon, John; Badini, Mehboob; Baller, April; Clement, Peter; Bolay, Fatorma; Wapoe, Yatta; Wiley, Michael R.; Logue, James; Dighero-Kemp, Bonnie; Higgs, Elizabeth; Gasasira, Alex; Williams, Desmond E.; Dahn, Bernice; Kateh, Francis; Nyenswah, Tolbert; Palacios, Gustavo; Fallah, Mosoka P. (23 July 2018). "Persistence of Ebola virus after the end of widespread transmission in Liberia: an outbreak report". The Lancet. Infectious Diseases. doi:10.1016/S1473-3099(18)30417-1. ISSN 1474-4457. Retrieved 13 August 2018.
- Nanclares, Carolina; Kapetshi, Jimmy; et al. (2016). "Ebola Virus Disease, Democratic Republic of the Congo, 2014". Emerging Infectious Diseases. 22 (9): 1579–1586. doi:10.3201/eid2209.160354. ISSN 1080-6040. PMC 4994351.
- "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.
- Kuhn, Jens H.; et al. (24 November 2014). "Nomenclature- and Database-Compatible Names for the Two Ebola Virus Variants that Emerged in Guinea and the Democratic Republic of the Congo in 2014". Viruses. 6 (11): 4760–4799. doi:10.3390/v6114760. ISSN 1999-4915. PMC 4246247.
{{cite journal}}
: CS1 maint: unflagged free DOI (link) - Jones-Konneh, Tracey Elizabeth Claire; Suda, Tomomi; Sasaki, Hiroyuki; Egawa, Shinichi (2018). "Agent-Based Modeling and Simulation of Nosocomial Infection among Healthcare Workers during Ebola Virus Disease Outbreak in Sierra Leone". The Tohoku Journal of Experimental Medicine. 245 (4): 231–238. doi:10.1620/tjem.245.231. ISSN 1349-3329. Retrieved 13 August 2018.
- "International travel and health". World Health Organization. WHO. Retrieved 16 August 2018.
- "Rising to the Ebola challenge, again". Nature Microbiology. 16 August 2018. doi:10.1038/s41564-018-0243-2. ISSN 2058-5276. Retrieved 16 August 2018.
- Lévy, Yves; Lane, Clifford; Piot, Peter; Beavogui, Abdul Habib; Kieh, Mark; Leigh, Bailah; Doumbia, Seydou; D'Ortenzio, Eric; Lévy-Marchal, Claire; Pierson, Jerome; Watson-Jones, Deborah; Nguyen, Vinh-Kim; Larson, Heidi; Lysander, Julia; Lacabaratz, Christine; Thiebaut, Rodolphe; Augier, Augustin; Ishola, David; Kennedy, Stephen; Chêne, Geneviève; Greenwood, Brian; Neaton, James; Yazdanpanah, Yazdan (August 2018). "Prevention of Ebola virus disease through vaccination: where we are in 2018". The Lancet. 0 (0). doi:10.1016/S0140-6736(18)31710-0. ISSN 0140-6736. Retrieved 17 August 2018.
- Dhama, Kuldeep; Karthik, Kumaragurubaran; Khandia, Rekha; Chakraborty, Sandip; Munjal, Ashok; Latheef, Shyma K.; Kumar, Deepak; Ramakrishnan, Muthannan Andavar; Malik, Yashpal Singh; Singh, Rajendra; Malik, Satya Veer Singh; Singh, Raj Kumar; Chaicumpa, Wanpen (2018). "Advances in Designing and Developing Vaccines, Drugs, and Therapies to Counter Ebola Virus". Frontiers in Immunology. 9: 1803. doi:10.3389/fimmu.2018.01803. ISSN 1664-3224. Retrieved 28 August 2018.
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: CS1 maint: unflagged free DOI (link)
External links
- World Health Organization Democratic Republic of the Congo crisis information
- World Health Organization Ebola situation reports
- "Ebola outbreak: timeline". Médecins Sans Frontières/Doctors Without Borders.