Medical teams have confirmed Ebola in six more people in the Democratic Republic of the Congo (DRC) outbreak, all from the hot spot in Beni where violence over the weekend has slowed vaccination activities, the country's health ministry said today.
Also, the World Health Organization (WHO) detailed renewed concerns about fresh violence undermining the response and the increasing numbers of Ebola infections in children.
Cases in Beni surpass 100
Of the six new confirmed cases reported today, two involved patients who died in the community, which raise the risk of further spread, given that viral loads are highest when the illness is severe and at the time of death and that people who die outside of health settings were likely to have been cared for by family members and others who weren't adequately protected.
Getting sick people into isolation and treatment is a key part of the outbreak response, and continued reports of community deaths are a sign that responders are having a tough time identifying all active transmission chains.
The 6 new cases boost the outbreak total to 244 cases, including 209 confirmed and 35 probable cases. The new deaths bring the fatality total to 155.
In its daily update, the health ministry said cases in Beni health zone now stand at 102.
As feared following another round of rebel violence over the weekend, immunization activities in Beni are slowing owing to insecurity in some parts of the city, according to the health ministry. So far, 20,939 people have been vaccinated, including 9,853 in Beni.
Security challenges, illnesses in children
In its regular situation report, the WHO said top concerns are the spike in cases over the past 4 weeks, especially in Beni, and the security challenges response teams are facing in Beni and Butembo.
"Continued security incidents severely impact both civilians and frontline workers, forcing suspension of EVD response activities and increasing the risk that the virus will continue to spread," it said. Vaccination in Beni could not take place in Beni on Oct 21 because of community demonstrations in the wake of attacks the day before, the WHO added. It also said investigations continue into the steady stream of confirmed cases that aren't from known transmission chains, a sign that the virus continues to spread undetected.
According to a Stat report today, the increasing number of cases confirmed in patients who aren't on known contact lists threatens measures to contain the outbreak and undermines the effectiveness of the vaccine campaign, which depends on a ring-based strategy to vaccinate contacts of confirmed cases and their contacts.
Also, the WHO said recent cases from Beni include a disproportionate number of illnesses in children age 16 and younger. Of 70 cases reported since Oct 1, 30 (43%) involved children, 13 of them infants and kids younger than 5. The agency added that investigations are under way to identify the sources of infection in children and to interrupt transmission.
In another development, the WHO said Ebola was confirmed in a health worker from Beni on Oct 20, raising the total number of healthcare workers infected in the outbreak to 21, 20 of the cases confirmed. Three health workers have died from their illnesses.
CDC director pushed to keep Ebola experts on-site
Centers for Disease Control and Prevention (CDC) Director Robert Redfield, MD, said he tried to make the case to keep US experts in the outbreak zone but was overruled by Trump administration officials due to security concerns, Stat reported today.
According to earlier reports, the State Department recommended that the CDC experts be withdrawn, which occurred several weeks ago.
Redfield told Stat during the opening session of the Milken Institute Future of Health Summit that he believes health officials are at a disadvantage not having CDC expertise on the ground in the DRC and that he'd like to see a "small footprint of CDC employees there."
Oct 23 DRC update
Oct 23 WHO situation report
Oct 23 Stat story on vaccination challenges
Oct 23 Stat story on Redfield comments