As the Democratic Republic of the Congo (DRC) reached the 6-month mark since declaring its latest Ebola outbreak, some top World Health Organization (WHO) officials expressed guarded optimism about the battle against the disease, while acknowledging ongoing challenges.
And in the latest developments, the country's health ministry announced four new cases, and the WHO expressed sadness over the death of a member of the outbreak response in Beni, where early indications suggest the man's death was not caused by Ebola or violence.
On guard against complacency
Speaking at a media briefing in Geneva, Matshidiso Moeti, MD, the WHO's regional director for Africa, praised the WHO staff on the ground and the leadership of the DRC's health ministry. "We can clearly see the strategies that have been successful in controlling the outbreak in some of the affected areas, such as Mangina, Beni, Komanda, and Oicha, though we continue to face flareups in some of these areas and outbreaks in others."
She said the different outbreak locations involve different drivers of transmission, with response actions tailored accordingly. For example, she said a combination of interventions in Beni and Mangina, including investments in community engagement, have almost brought the Ebola situation almost under control.
"We have been very pleased with the support of local leaders," she said. "Clearly, we can't become complacent. We understand very well that we still have a lot to do to stabilize and bring the situation under control."
Worry over nosocomial spread
A big ongoing concern is healthcare-related Ebola infections linked to visits at private and public health clinics, Moeti said.
The WHO addressed that issue yesterday in its weekly snapshot of the outbreak, noting that the latest outbreaks in Katwa and Butembo are partly driven by nosocomial infections. Since Dec 1, 86% of patients infected in the two areas (125 of 145) had visited or worked at a healthcare facility before or after they got sick. And, of those, 21% reported having been at a health facility before their Ebola symptoms began, suggesting nosocomial transmission.
Over the past 3 weeks in Katwa, confirmed Ebola patients had been treated in 49 different health settings, including 9 where nosocomial transmission may have occurred. Over the same period, 8 new Ebola infections were reported in Katwa's healthcare workers, pushing the overall outbreak total in medical staff to 65.
"Response teams are following up with the identified healthcare facilities to address gaps around triage, case detection and infection prevention and control measures," the WHO said in the update.
Some signs of calming
Mike Ryan, MD, WHO's assistant director-general for emergency preparedness and response, just returned to Geneva from the North Kivu province outbreak area. He told reporters that the area seems to be entering a period of relative calm, following unrest owing to the recent election and other social issues and from general mistrust about Ebola and the outbreak response.
He said health officials are seeing some success in having people from local communities lead the response, and though workers are seeing much lower levels of the reactive type of resistance, security is still a big issue. Responders, he said, still need security escorts and special protocols to stay safe in many areas.
Ryan emphasized that teams are working in all active Ebola transmission zones and that, despite surge staffing because of recent disease spikes in Butembo and Katwa and security challenges, health officials have been able to sustain and increase the number of responders in other area.
Though there are still concerns about pockets of disease in remote locations, a large number of areas haven't seen any new cases in 21 or 42 days and that the geographic scope of the disease is less than before, Ryan said.
The immediate challenge in Butembo and Katwa is containing the virus before it moves again. "We're working against the clock," he said, noting that the disease can move from a rural area back to an urban area. "It's really important that we chase the tail of this thing and we don't leave any chain of transmission untouched. And that's why we're operating very much deep in the field with our colleagues to chase the virus."
Experimental treatment update
At today's briefing Moeti said about 350 people with Ebola have been treated with experimental drugs.
Ryan added that, anecdotally, when looking at the results, doctors are seeing higher rates of survival. "But we have to be extremely careful. There are lots of biases in there regarding the condition of the patient when they arrive—there are so many other factors at play," he said. "But we're certainly encouraged by the data we've seen."
Randomized controlled trials are under way to more definitively interpret the clinical experience with patients, Ryan said, adding that officials are also seeing that patients who come early for treatment are surviving in much higher numbers. "We're really trying to work with communities to encourage suspect cases and families to bring their loved ones as soon as possible to the treatment units."
Latest case details
In its daily update today the DRC's health ministry reported four new cases: two from Butembo, one from Katwa and one from Biena. The illnesses boost the overall outbreak total to 763, which includes 709 confirmed and 54 probable infections. Investigators are still following up on 168 suspected cases.
Also, three more people died from Ebola, one in community in Butembo and two in the city's Ebola treatment center. The deaths put the outbreak's overall fatality count at 471.
In other outbreak developments, the ministry said a new surveillance strategy has been put in place at entry points. The surveillance operates 24 hours a day with police support.
Health officials have identified seven priority locations, and the strategy is already in place at four of them. The outbreak area has 77 entry points where screening is underway, and so far authorities have screened 30 million travelers.
Response worker's death likely not Ebola
Moeti said the Ebola responder who died in Beni was a financial administrator who had been deployed from the Central African Republic. He apparently died in his sleep, a tragedy for the local team and the man's family, she added.
Medical authorities are working to establish the cause of death, but so far, the early indications don't point to Ebola or violence.
In a statement on the man's death today, the WHO's African regional office said, "Our hearts go out to the family of our colleague. We pay tribute to the many dedicated men and women from across the African region and beyond for their work towards ending the Ebola outbreak in the DRC."
Jan 31 WHO update
Feb 1 DRC update
Feb 1 WHO media briefing audio file
Feb 1 WHO African regional office statement