Two new cases in Goma as DRC Ebola outbreak reaches 1-year mark

Two more Ebola cases were confirmed in the provincial capital city of Goma today, marking the first active transmission there, a development that prompted reports of a border closure with Rwanda.

The quickly evolving developments come on the 1-year anniversary of the Democratic Republic of the Congo's (DRC's) outbreak declaration.

New cases involve man's family members

Both of the new cases in Goma in the DRC's hard-hit North Kivu province are family members of a man recently identified as the city's second case, the Associated Press (AP) reported today, citing Ebola response workers. One is the man's 1-year-old daughter, and the other case—confirmed shortly after—is his wife.

The man, reportedly a miner who had traveled to Ituri province, died Wednesday after having spent several days at home with his large family, according to the AP report. The family members are considered high-risk contacts. Goma has now reported four Ebola cases, two imported from the main outbreak areas, plus two secondary cases.

Reinforced screening in Rwanda

Earlier today Rwanda's foreign affairs minister announced a border closure, which the World Health Organization (WHO) advised against in the temporary recommendations it made when declaring the DRC's Ebola outbreak a Public Health Emergency of International Concern.

Goma borders the Rwandan city of Gisenyi, where tens of thousands of people cross each day. Travel or trade restrictions could hurt the DRC's economy and slow the flow of response sources that are needed to fight Ebola, the WHO has warned.

After condemning the reported border closure, the DRC president's office said the border had reopened.

Meanwhile, Rwanda's health ministry issued a statement today that said the border is open, following a traffic slow-down in the morning to allow officials to reinforce screening and public safety at entry points. The ministry also advises no unnecessary travel to Goma and the eastern part of the DRC.

With the outbreak pushing into its second year and with cases now popping up in Goma, the WHO has recently praised Rwanda's Ebola preparedness efforts.

Transmission persists in Beni; 13 new cases

Without daily updates from the health ministry, it has been difficult to closely track developments with the DRC outbreak hot spots, but a new situation report from the WHO that includes data as of July 28 said sustained transmission continues in Beni. Ebola infections from that health zone make up 61% of new cases in the previous 7 days and a number of cases and contacts from the hot spot traveled to other areas.

Mandima is another hot spot, especially the Some area in the north part of the health zone. Cases from that focal area have seeded cases to Mambasa in recent weeks, the WHO noted. "The response has poor access to this health area due to community resistance, and this leads to more cases."

Overall, incidence rates haven't changed since the WHO's last weekly report. There were 79 new cases in the most recent week, along with 47 more deaths. The number of health workers infected in the outbreak has risen to 146.

Meanwhile, the WHO's online Ebola dashboard today shows that the DRC reported 13 new confirmed cases yesterday, raising the outbreak total to 2,714. Health officials are still investigating 293 suspected cases.

Two more people died from their infections, putting the outbreak's fatality count at 1,813.

US officials note 1-year mark

Federal officials from the US Department of Health and Human Services (HHS) today observed the outbreak's 1-year mark by updating reporters on agency efforts to assist with the outbreak.

Henry Walke, MD, MPH, director of the CDC's division of preparedness and emerging infections and its incident manager, said 12 Centers for Disease Control and Prevention (CDC) experts are on the ground in Goma, with others in the DRC capital Kinshasa and in neighboring countries. Plans include doubling those staff numbers over the next month, and he said dozens more at the CDC's Atlanta headquarters are involved in supporting the Ebola response.

Walke had a few more details about Goma's second case, a 46-year-old man whose illness was detected earlier this week and who has since died. The man lived on the outskirts of Goma and was treated at home during most of his illness before he was transferred to Goma's Ebola treatment center. As such, the man's household members are considered high-risk contacts.

During West Africa's outbreak, he said the CDC had hundreds of experts on the ground. The security situation in the affected parts of the DRC has made it difficult for the CDC and other response groups to assist in the hot spots and has driven some nongovernmental organizations out of the hard hit areas.

So far, the risk to the United States remains low, Walke said. There are no direct flights into the United States from the DRC, and only about 16,000 people arrive in the United States from the DRC each year.

In a press release today, the CDC said at the 1-year mark, it remains committed to the fight against Ebola in the DRC. Robert Redfield, MD, the CDC's director, said, "As the WHO PHEIC declaration makes clear, this Ebola outbreak continues to be a complex and serious public health threat."

The CDC added that it is also committed to strengthening the DRC's health system to help reduce the risk of future outbreaks, not only Ebola, but other threats such as HIV, measles, tuberculosis, and malaria. "CDC's commitment to global health goes hand in hand with CDC’s commitment to the safety and security of the American public," the agency said in its statement.

Other HHS officials spotlighted the US government's role in developing and testing medical countermeasures, including vaccines and experimental treatments. Rick Bright, PhD, director of the HHS Biomedical Advanced Research and Development Authority (BARDA) said officials believe the Ebola vaccine and experimental therapies have had a significant impact on the trajectory of the outbreak.

Meanwhile, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said the group's researchers are still involved in Ebola vaccine and treatment trials. He noted that randomized control trial of four Ebola treatments under way in the DRC's outbreak region was recently amended to increase enrollment from 500 to 545 participants to 725 participants.

Currently, there are 631 patients enrolled, and Fauci said he expects the trial will reach that number before the outbreak winds down.

See also:

Aug 1 AP story

Aug 1 Rwanda health ministry statement

WHO online Ebola dashboard

Jul 30 WHO situation report

Aug 1 CDC press release

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