14 Aug 2018

Ebola virus disease (EVD) in Democratic Republic of Congo

Update on case numbers and advice for travellers Ebola virus disease (EVD) in Democratic Republic of Congo

On 1 August 2018, a new outbreak of Ebola virus disease (EVD) was confirmed in North-Kivu Province, Democratic Republic of Congo (DRC) [1]. This EVD outbreak is not thought to be linked to the previous EVD epidemic that occurred in Equator Province, DRC earlier this year [2]. 

Confirmed and probable cases are currently localised in six health zones in North Kivu Province and in one health zone in Ituri Province [3,4].

As of 12 August 2018, a total of 57 EVD cases are reported (30 confirmed and 27 probable) with 41 deaths (14 among confirmed cases and 27 among probable cases). Four healthcare workers have been affected [4].

Response to this latest EVD outbreak is still in the very early stages and the extent (both total case numbers and geographical range) has yet to be fully understood. Total case numbers are likely to fluctuate on a daily basis while investigations and laboratory testing are ongoing.

EVD is a severe, often fatal illness in humans and is introduced into human populations by close contact with the blood, secretions, organs or other bodily fluids of infected wild animals such as antelopes, bats, chimpanzees, gorillas and monkeys. The virus then spreads from person to person by direct contact with blood, faeces, vomit, secretions, organs or other bodily fluids of infected persons. People can also become infected by contact with objects, like contaminated needles or soiled clothing. Outbreaks have been fuelled by traditional burial practices, when mourners have direct contact with the deceased. Hospital workers have been infected through close contact with infected patients and insufficient use of correct infection control precautions and barrier nursing procedures. Sexual transmission has been documented, as the virus can be present in semen for months after recovery [5].

DRC is concurrently experiencing several epidemics of other diseases and a long-term humanitarian crisis, with large numbers of displaced people. Cross-border movement of people and trade occurs with both Rwanda and Uganda [3]. The World Health Organization states that the security situation in North Kivu and Ituri provinces may hinder implementation of response activities. Based on this context, WHO considers the public health risk as high at national level in DRC, and in neighbouring regions. However, WHO advises that at a global level, the risk is low [3].

This outbreak presents a negligible to very low risk to the UK public [1].

On 8 August 2018, the Ministry of Public Health of the DRC announced the use of an Ebola vaccine in North Kivu province [6]. The use of this investigational vaccine, using both a ring vaccination and a geographical targeted approach to reach high risk populations, has recently been approved by the WHO [7]. Surveillance, diagnostic and case management facilities, including contact tracing, are being expanded in the affected areas [3].

WHO advises against any restriction of travel and trade to the DRC based on the currently available information. WHO continues to monitor travel and trade measures in relation to this event [3].

The Foreign and Commonwealth Office (FCO) has restrictions on travel to some areas of DRC: travellers are recommended to review the current information prior to departure [8]. 

Humanitarian and other aid workers

  • risk to UK personnel (non-clinical) working outside the affected areas in DRC is very low
  • for those working in affected areas, risk will vary, depending on activities undertaken
  • exposure risk for those working directly with infected individuals, such as in treatment centres, would be low, assuming that strict barrier techniques have been implemented and all staff are provided with and trained in use of appropriate personal protective equipment [9].

More detailed advice can been found on the Public Health England guidance: Ebola virus disease: information for humanitarian aid workers.

Individuals planning to go to outbreak areas for humanitarian activities should follow advice from their deploying organisation before they travel. PHE is operating a returning workers scheme for humanitarian and healthcare workers who will be residing in England, Wales, Scotland or Northern Ireland after they have completed their deployments. Deploying organisations are asked to register their workers with the scheme in advance of their return to the UK. Further information on the returning workers scheme is available from PHE.

This outbreak is being closely monitored and the risk will re-evaluated if the epidemiological situation changes. 

Advice for travellers

Visitors to EVD-affected areas face a low risk of becoming infected if the precautionary measures below are followed:

  • Avoid contact with symptomatic patients/their bodily fluids; corpses and/or bodily fluids from deceased patients, and all wild animals, alive and dead
  • Avoid handling or eating bush/wild meat (the meat of wild or feral mammals, killed for food)
  • Wash and peel fruit and vegetables before consumption
  • Wash hands regularly and carefully using soap and water (or alcohol gel when soap is unavailable)
  • Practice safer sex

Travellers should also monitor NaTHNaC and FCO updates on a regular basis for more information.

There is no UK-licensed vaccine for general use in travellers to prevent EVD. An investigational, currently unlicensed vaccine may be available for high risk populations in EVD risk regions in DRC [6, 7].

Travellers returning from recently affected areas who develop symptoms compatible with EVD after their return should self-isolate and contact health services and mention potential exposure to EVD.

Secondary transmission to caregivers in the family and in health facilities cannot be ruled out if no measures for infection prevention and control are taken [10].

Currently, no exit screening is in place in DRC [10]. Some African countries may start screening travellers who have visited Ebola-affected areas at ports of entry and further assessing those who have a raised temperature or report other symptoms compatible with EVD.

Advice for health professionals

In the event of a symptomatic person with a relevant travel history presenting for health care, the Imported Fever Service should be contacted via your local infectious disease clinicians or microbiologists in order to discuss testing. The Rare and Imported Pathogens Laboratory will test patient samples if appropriate. Infection control recommendations and other clinical management advice are provided in the national viral haemorrhagic fever guidelines.

Resources

  1. Public Health England. Ebola and Marburg haemorrhagic fevers: outbreaks and case locations. Information about incidents and outbreaks of Ebola and Marburg, both viral haemorrhagic fevers (VHF). Last updated 6 August 2018. [Accessed 14 August 2018]
  2. Ministère de la Santé. République Démocratic du Congo. Directorate General for Disease Control. Epidemiological Situation in North Kivu Province. 7 August 2018. [Accessed 14 August 2018]
  3. World Health Organization. Ebola virus disease – Democratic Republic of the Congo. Disease outbreak news. 4 August 2018. [Accessed 15 August 2018]
  4. Ministère de la Santé. République Démocratic du Congo. Directorate General for Disease Control. Epidemiological Situation in North Kivu Province. 12 August 2018. [Accessed 14 August 2018]
  5. Public Health England. Guidance. Ebola: overview, history, origins and transmission. Last updated 15 December 2017. [Accessed 14 August 2018]
  6. World Health Organization. Ebola vaccination begins in North Kivu. 8 August 2018. [Accessed 14 August 2018]
  7. World Health Organization. Strategic Advisory Group of Experts (SAGE) Immunization. Interim recommendation Ebola vaccines. 1 August 2018. [Accessed 14 August 2018]
  8. Foreign and Commonwealth Office. Foreign travel advice. Democratic Republic of Congo. Last updated 7 August 2018. [Accessed 14 August 2018]
  9. Public Health England. Ebola: Information for humanitarian aid and other workers intending to work in Ebola affected countries in Africa. Last updated 18 June 2018. [Accessed 14 August 2018]
  10. European Centre for Disease Prevention and Control. Rapid Risk Assessment. Ebola virus disease outbreak in North Kivu and Ituri Provinces, Democratic Republic of the Congo. 9 August 2018. [Accessed 14 August 2018]

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