Date: Mon, 9 Mar 2020 21:15:32 +0100 (MET)

Kinshasa, March 9, 2020 (AFP) - DR Congo health officials said Monday they were "keeping fingers crossed" to declare a deadly 19-month Ebola epidemic over next month, while monitoring former patients for signs of the virus.   While the world's attention has been focused on the coronavirus, the last patient under treatment for Ebola in the Democratic Republic of Congo was discharged on Tuesday.

If no more cases are diagnosed, the epidemic will officially end on April 12, or 42 days from the date of the last confirmed patient's second negative test.   "Today, March 9 is the 21st day without any new confirmed case," said Jean-Jacques Muyembe, who is in charge of the Ebola fight.   "We are keeping our fingers crossed that until then, there are no incidents," he told a news conference.   "The greatest challenge for us today is to follow up on survivors because some continue to secrete the virus in their seminal fluids," he said, adding that they were being treated to avoid infecting their partners.

Traces of the virus were present in the sperm of men between one and 18 months after they were infected, The British medical journal, The Lancet, said in January 2017.   World Health Organization chief Tedros Adhanom Gebreyesus stressed the importance of monitoring while addressing a news conference in Geneva.   "During the last Ebola epidemic, we saw new cases even after the end of the epidemic," he said. "That is why we are continuing to follow up on more than 1,100 survivors."

DR Congo's most recent Ebola outbreak was first identified in August 2018, and WHO declared it a "public health emergency of international concern" last July.   It has killed 2,264 people and is the vast central African country's 10th Ebola epidemic since 1976.

It is also the second-most deadly Ebola epidemic in history, after an outbreak killed more than 11,000 people in West Africa from 2013 to 2016.   Since that time, health authorities have gained a more powerful weapon against the disease: vaccination. Nearly 320,00 people have been vaccinated so far in DR Congo.
Date: Fri, 6 Mar 2020 14:52:42 +0100 (MET)
By Junior KANNAH

Seke-Banza, DR Congo, March 6, 2020 (AFP) - As the world grapples with the spread of novel coronavirus, in remote western DR Congo, officials are fighting a deadly outbreak of measles.   More than 6,000 people have died from measles in the Democratic Republic of Congo in a year, the world's worst outbreak and triple the toll of the country's Ebola epidemic. It is also nearly double the 3,404 people who have died from the coronavirus so far.

Last year, more than 18 million children under the age of five were vaccinated for measles across DR Congo and around 310,000 suspected cases were reported.   The UN agency World Health Organisation had said more emergency funds were needed from donors for a six-month immunisation plan for children to help curb the epidemic.    A second stage of vaccinations just started this week. Vaccines are loaded onto motorbikes in the villages around Temba, a six-hour drive along dirt roads from the western community of Seke-Banza.   Around 73,000 children from six months to 15 years old will be vaccinated in the Kongo Central province as part of the second phase.

Efforts to halt the spread of both Ebola and measles in DR Congo are hampered by a lack of access, weak health care and unrest across the country, especially in the east.   Several hours into the remote bush by motorbike from the regional capital of Matadi in western DR Congo, measles has killed six people in Seke-Banza, a small part of this forgotten epidemic.

The latest victim was a small boy who died during the week in hospital.   "There are two categories of patients: those who are in the acute phase of measles, with respiratory signs, conjunctivitis, fevers," says Mederic Monier with Doctors Without Borders (MSF).   "A few months later, as their immune system is weak, they can trigger other diseases like malaria so we also take care of them."

Adolphe Kiakupuati, a hunter like most men in the region, came with his three children for a vaccination. Lack of information is a problem in this area in the middle of the forest, on the borders of the two Congos.    "During the vaccination period for the children, I was busy in the forest and I was not aware of it. But now they are on treatment," the father said.

Logistics are a major challenge, especially trying to keep vaccines at the required temperature as they are transported.    "The big challenge is to be able to supply all of these vaccines in all of these villages, while respecting quality," says MSF logistics manager Jean Pletinckx.     The DRC recorded more than 335,413 suspected cases and 6,362 deaths from January 1, 2019 to February 20, 2020, according to WHO statistics.

Measles has killed more than the Ebola epidemic declared on August 1, 2018 in the east of the country, which has caused 2,264 deaths.    Measles is a highly-contagious disease caused by a virus that attacks mainly children. The most serious complications include blindness, brain swelling, diarrhoea, and severe respiratory infections.
Date: Mon 24 Feb 2020
Source: Outbreak News Today [abridged, edited]
<http://outbreaknewstoday.com/drc-reports-252-measles-deaths-since-beginning-of-the-year-81463/>

The measles outbreak that affected more than 300,000 people, killing more than 6000, in the Democratic Republic of the Congo (DRC) last year [2019] continues into 2020, albeit slowing.

Since the beginning of the year [2020], 20,475 measles cases and 252 deaths have been reported. The World Health Organization (WHO) says while the overall situation remains serious, the weekly incidence of cases and deaths has continued to reduce in the past 10 weeks.  Children under the age of 5 years remain the most affected in all provinces, accounting for 71% of all confirmed cases.
Reactive vaccination campaigns have reached 5 789 008 children aged 6-59 months in 179/261 health zones. In addition, 18 million children aged 6-59 months have been vaccinated in supplementary vaccination activities.

WHO [cautions against complacency] as multiple operational challenges confound the ongoing response: mobilization of resources, issues around provision of free medical care in affected areas, and communication issues.
Date: Tue 25 Feb 2020
From: Anne Laudisoit, PhD [edited]
<laudisoit@ecohealthalliance.org>

A suspect plague outbreak cluster has been noted in the the Godjoka health area as of 19 Feb 2020. The chief medical officer of the Rethy Health zone, the head nurse and the laboratory team from the Rethy General reference hospital investigated the outbreak site. The Godjoka village is located in the Linga health zone, Djugu territory, Ituri province, in the Congo DR (N 02.01'47.9'' and E030.44'56.6'', 1940m) in the plague endemic area.
 
There have been 6 suspected cases of plague, including 5 deaths and 1 recovering patient. The index case is a young boy who died on 19 Feb 2020. His mother, the neighbour and her child all died on 21 Feb 2020 and were buried the night of 24 Feb 2020, under pressure from the villagers. Finally the traditional healer ["tradipraticien"] who took care of the mother (who was the 2nd case) died in turn on 25 Feb 2020, and samples were taken that same day. The rapid diagnostic test was positive for plague.  Because of their rapidly fatal course, pneumonic plague is suspected for one or more of the 5 fatal cases. 

The only survivor has been under treatment at the Godjoka Health center since 22 Feb; he is the 20 year-old brother of the index case. The test on the sputum of this patient was negative.
-------------------------------------
Francoise Ngave Nyisi, Rethy General Reference Hospital, DR Congo
Mandro Michel, Provincial Division of Health, Bunia, DR Congo
Adroba Pascal, Provincial Division of Health, Bunia, DR Congo
Laudisoit Anne, Ecohealth Alliance, New York, USA
laudisoit@ecohealthalliance.org
=====================
[ProMED thanks Dr Laudisoit and her hardworking Congolese colleagues for this important report.  Thus far the diagnosis of plague rests on the single positive diagnostic test obtained from the traditional healer, as it appears that the first 4 fatal cases were buried before diagnostic tests could be obtained. Following this logic, It is possible that the sole survivor thus far has the bubonic form of the disease, and thus a negative sputum result.  We seek and hope to obtain further information on all of these cases, including age, nature and duration of symptoms, presence or absence of buboes, etc.

This putative plague cluster is in a known historic plague-endemic region, where there were 31 cases and 8 deaths between Jan - Oct 2019, as previously reported by ProMED (Plague - Congo DR (02): (IT) fatal http://promedmail.org/post/20191016.6731137).  The Ituri district, of course, has also been affected by the still smouldering North Kivu-Ituri Ebola outbreak that began in July 2018.  This district has also been, and continues to be, a region of great civil unrest, with multiple armed insurgency groups operating near and across the Ugandan border.

The following background information on plague by Mod.LL is copied from our most recent ProMED post on plague [see below under See Also]:

"The bacterium that causes plague is _Yersinia pestis_. Most cases of plague are due to bubonic plague following the bite of an infected rodent flea causing a swollen and very tender lymph gland. The swollen gland is called a "bubo." Bubonic plague should be suspected when a person develops a swollen gland, fever, chills, headache, and extreme exhaustion, and has a history of possible exposure to infected rodents, rabbits, or fleas. A person usually becomes ill with bubonic plague 2-6 days after being bitten. At this point in the illness, there is no risk of person-to-person spread, so if this was indeed a case of bubonic plague, no isolation or quarantine is necessary.

When bubonic plague is left untreated, plague bacteria invade the bloodstream. As the plague bacteria multiply in the bloodstream, they spread rapidly throughout the body and cause a severe and often fatal condition. Infection of the lungs with the plague bacterium causes the pneumonic form of plague, a severe respiratory illness. The infected person may experience high fever, chills, cough, and breathing difficulty and may expel bloody sputum. If plague patients are not given specific antimicrobial therapy, the disease can progress rapidly to death. At this stage, as appears to have happened in this case, person-to-person spread can occur, causing other cases of "primary" plague pneumonia. - ProMED Mod.LL]

[A ProMED/HealthMap of DR Congo is available at: DR Congo:
<http://healthmap.org/promed/p/194> - ProMED Mod.LXL]
Date: Sun 16 Feb 2020, 5:00 PM
Source: WHO, Weekly Bulletin on Outbreaks and Other Emergencies, page 9 [abridged, edited]
<https://apps.who.int/iris/bitstream/handle/10665/331023/OEW07-1016022020.pdf>

During week 4 [week ending 26 Jan 2020], a total of 73 suspected cases including one death were reported across the country, compared to 46 suspected cases and no deaths in the previous week. The majority of cases in week 4 were reported from Sankuru province (78%).

In the past 4 weeks (weeks 1 to 4 of 2020) a total of 222 suspected cases with 4 deaths (CFR: 1.8%) were notified in the country, with the majority of cases being reported from the provinces of Sankuru (31%), Bas-Uele (18%), Equateur (15%) and Mai-Ndombe (9%). There has been an increase in the weekly case incidence since week 2 of 2020.

Between weeks 1 and 52 of 2019 a cumulative total of 5288 monkeypox cases, including 107 deaths (CFR 2%) were reported from 133 health zones in 19 provinces.
======================
[Monkeypox (MPX) virus is endemic and widespread geographically in the DR Congo, with cases occurring sporadically in several provinces. January 2020 is off to a similar start with 222 suspected cases and 4 deaths reported in 4 provinces. The 2% CFR is relatively low for the clade of MPX that occurs in the DRC, which can reach 10% or more. The 222 cases are suspected, and there is the possibility that without laboratory confirmation some of them may be varicella cases misdiagnosed as MPX. There is no additional information about the circumstances under which these cases acquired their infection. Monkeys are not the reservoirs of the virus, despite the name that the virus has received. Studies of prevalence of MPX virus in populations of rodent hosts are not mentioned in this or previous reports. The main reservoirs of MPX virus are suspected to be rodents, including rope squirrels (_Funisciurus_ spp., an arboreal rodent) and terrestrial rodents in the genera _Cricetomys_ and _Graphiurus_. Halting the bushmeat trade and consumption of wild animals to halt MPX virus exposure will be culturally and economically difficult, so continued occurrence of cases can be expected. MPX virus can be transmitted between people but not readily. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
DR Congo: <http://healthmap.org/promed/p/194>]
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