Ebola outbreak: In second week, cases and deaths in North Kivu have surpassed those of three-month Equateur outbreak just ended

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With Ebola confirmation in seven health workers, hospital staff of 74 on leave, replaced, WHO leader says

With 57 apparent Ebola cases — 30 of which are confirmed — and 41 deaths so far from the outbreak that was recognized in the Democratic Republic of Congo’s North Kivu province two weeks ago, the toll of the current spread of the disease in a war zone nestled against the borders of two neighboring nations already exceeds the toll, over the course of three months, of the just-ended outbreak on the other side of the country, World Health Organization officials have confirmed. During that outbreak, in the DRC’s Equateur province, 54 people became sick and 33 died, before the spread of disease ended.

In a press conference today, World Health Organization Director-General Tedros Adhanom Ghebreyesus said conditions, including armed conflict, kidnappings, displacement, and population density that challenge responses to the current outbreak concerned him before his visit to the region over the last several days. He is more worried now, he said. Active fighting, in which at least four civilians were killed and more kidnapped, took place in one night during his visit less than 10 miles from where he was staying in Beni, he said.

Longstanding armed conflict in the area that has led to closed areas — keeping health workers out, and people who need health services in — “red zones” on the map, as well as the displacement of more than a million people in the area severely complicate efforts to identify, diagnose, treat, and isolate people in the area, and will challenge the “ring” strategy of vaccinating people who have had contact with infected people, as well as their contacts, health officials have said. In addition, Tedros (who goes by his first name) said, the density of population in Mangina, currently the most affected area, as well as population mobility, including across the borders of neighboring countries could further fuel the spread of the disease. During his visit to the region, Tedros said, he met with health officials in Uganda, one of the neighboring countries, and found their preparedness for potential cross border spread “good,” but, he added, their measures need to be “strengthened further.” He has been in contact with officials in Rwanda, which also borders the North Kivu province at the south end at its southern end, as well as in Burundi which borders the DRC’s South Kivu province, and , Sudan, which lies against DRC’s northern border.

The World Health Organization is calling for a “cessation of hostilities” in the area, is working with community leaders to reach those involved in the conflict, and asking for access to all potentially affected areas. WHO also is calling on international leaders to quickly and robustly fund responses.

Still, Tedros said, while the risk of the outbreak spreading within the Democratic Republic of Congo, and in the region, remain high, the risk for global spread of the virus remain low, and plans are not currently underway to convene a committee to declare the outbreak a Public Health Emergency of International Concern.

At the same time, responses in the immediate area faced further obstacles with confirmation of Ebola in seven health workers at Mangina’s health facility, which led officials to ask the entire staff of 74 health workers to stay home and avoid contact with others, Tedros said. New workers have been brought in he said. Of concern as well, Tedros said, has been a disproportionate impact of the outbreak among women and children, a reversal of the pattern seen in earlier outbreaks, he said. While he cited women’s role as caregivers and children’s dependence on their mothers as possible reasons for that finding, he could not point to a characteristic unique to the present situation that explains it.

At least 216 health workers have been vaccinated so far, and plans for a ring vaccination campaign continue. If, however, violence and security concerns make that impossible, other strategies have been discussed, including, conceivably, vaccinating the entire population of 1,200 people in Mangina, Tedros said. Remaining from the response to the previous outbreak are 3,000 immediately available Ebola vaccine doses. If needed, another 300,000 could be quickly secured and deployed, Tedros said.

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