WHO notes Ebola shift to rural areas, posing new challenges

In its latest snapshot of the Democratic Republic of the Congo (DRC) Ebola outbreak, the World Health Organization (WHO) said there's a clear shift away from densely populated urban areas toward sparsely populated rural areas.

And in other developments, Tanzanian health officials again denied covering up Ebola cases, Hong Kong health officials have isolated a patient with a suspected Ebola infection while testing is under way, and global officials marked the 1,000th survivor of the outbreak.

Further case decline

Over the past week, 20 new cases were reported, down from 29 the week before, the WHO said. It added, however, that the continuing drop in cases should be interpreted cautiously, given that security and response challenges in some health zones is making it difficult to detect cases.

Of the past week's cases, 55% were from Mambasa and Mandira, signaling a clear shift away from high-density urban settings such as Butembo, Katwa, and Beni toward more rural areas. The developments lead to a change in transmission dynamics, resulting in more community-based transmission and less hospital-based transmission, the WHO said. Earlier in the outbreak, nosocomial transmission was one of the key features and part of what has led to high numbers of healthcare worker infections.

"Conversely, this may introduce new issues in terms of accessibility and logistical challenges to reach affected villages, especially as we enter the rainy season," the WHO said.

Regarding security issues and related obstacles, the WHO said it is addressing community mistrust in Mambasa health zone by working with partners in the area to engage women's groups and shore up community-based surveillance.

Meanwhile, in the Lwemba area of Mandima health zone where low Ebola awarness and armed conflict have presented serious response hurdles, responders have had a hard time investigating community deaths. Response activities in that hot spot have been at a standstill for 2 full weeks, with contacts lost to follow-up and cases and deaths likely underreported.

Tanzania denial

Tanzanian health officials yesterday denied hiding Ebola cases, according to a Reuters report.

At a media briefing, health minister Ummy Mwalimu said Ebola is a fast-spreading disease that the country would be unable to hide and that reports that Tanzania wasn't sharing information with the WHO are false and should be ignored.

On Sep 21 the WHO, in a rare step, raised concerns about undiagnosed febrile illnesses in the country, following an unofficial report that initial tests were positive for one of the affected patients.

Hong Kong tests suspected case

Elsewhere, Hong Kong said today that a 54-year-old woman who was hospitalized yesterday with possible Ebola symptoms after returning from Kinshasa, the DRC's capital, tested negative for Ebola in initial tests. Based on WHO guidelines, repeat tests will be done 2 days later to confirm the findings.

The woman was in the DRC between May 27 and Sep 14. She had no contact with sick people and had not been in any health facilities or in outbreak-affected provinces. No symptoms have been detected so far in any of her contacts.

Agencies celebrate 1,000 survivors

The WHO today on its online Ebola dashboard reported 3 new cases in the DRC, raising the total to 3,201, according to the WHO's online dashboard. The number of suspected cases under investigation is at 427, down 3 from yesterday.

Also, no new deaths were reported, holding the fatality count at 2,137.

An a more optimistic note, today, in a joint news release, the WHO, European Emergency Response Capacity (EERC), World Food Programme (WFP), UNICEF, and Save the Children noted that 1,000 people have now recovered from the disease in the DRC.

"Every survivor gives us reason and motivation to continue to enhance our fight against Ebola, but every survivor is also a reminder that there are lives we were not able to save," said David Gressly, JD, the WHO's emergency Ebola response coordinator. "We have to continue gaining access through improved security for health workers and populations alike, along with continuous efforts to engage communities to be empowered with the response."

"We have the tools, vaccines and treatments, but we still need to find and support every person who has been in contact with someone infected with Ebola," said Ibrahima Soce Fall, MD, MPH, WHO assistant director-general for emergency response.

The director of the US Centers for Disease Control and Prevention (CDC) also highlighted the milestone.

"The recent introduction of new medical interventions continues to lead to more Ebola survivors, many of whom are now caring for others with the virus," said CDC Director Robert R. Redfield, MD, in a CDC news release. "The survivors stepping forward are providing a deeper understanding of the Ebola virus and they are performing a critical role in their communities, helping to bring this outbreak to an end."

The DRC's multisector Ebola technical committee, in its latest daily report today, added a location for the one case reported yesterday: Mandima.

See also:

Oct 3 WHO update

Oct 3 Reuters story

Sep 23 CIDRAP News story "WHO pushes Tanzania on suspected Ebola cases; DRC OKs use of 2nd vaccine"

Oct 4 Hong Kong government press release

WHO Ebola dashboard

Oct 4 WHO/EERC/WFP/UNICEF/Save the Children news release

Oct 4 CDC news release

Oct 3 CMRE update

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