Ebola fever epidemic 2018 to 2020

from Wikipedia, the free encyclopedia
Democratic Republic of the Congo (darker brown) and Uganda (lighter brown)
The affected provinces of Ituri (green), North Kivu (orange) and Sud-Kivu (ocher) in the east of the Democratic Republic of the Congo

The Ebola fever epidemic 2018 to 2020 was an outbreak of Ebola fever in the provinces of North Kivu , Ituri and since August 2019 in Sud-Kivu in the east of the Central African Democratic Republic of the Congo for two years at the latest from July 2018 for two years until June 2020 . It is globally and historically the second most serious documented outbreak of the disease at all. Several thousand cases of illness and over a thousand deaths are recorded. In June 2019, the first cases of illness and death occurred in neighboring East African Uganda . About a month later and more than a year after the outbreak of the epidemic , in July 2019, the World Health Organization (WHO) declared a health emergency of international concern . At the end of June 2020, after no new infections could be detected, the WHO officially declared the outbreak to be over.

course

Incidence and deaths from 2018 to 2020
Cases of illness Deaths Survivors Lethality
secured likely
Lich		 total secured likely
Lich		 total total %
3,317 153 3,470 2.134 153 2,287 1,180 currently 61.6%
As of June 21, 2020, published on June 23, 2020, WHO
The WHO assumes that around 25 percent of cases remain undetected and are therefore not statistically recorded.
Disease and deaths broken down by state, province and region
country Province /
Region		 Cases of illness Deaths
secured likely
Lich		 total secured likely
Lich		 total
Congo Democratic RepublicDemocratic Republic of Congo Democratic Republic of the Congo * North Kivu 2,908 124 3,032 1,882 124 2.006
Ituri 508 29 537 249 29 278
Sud-Kivu 6th 0 6th 3 0 3
UgandaUganda Uganda ** Western region 3 0 3 3 0 3
total*** 3,317 153 3,470 2.134 153 2,287
* As of June 21, 2020, published on June 23, 2020, WHO
** published on June 23, 2020, WHO
*** the cases documented in Uganda were statistically determined by the Ministère de la Santé de la République Démocratique du Congo
in the course of the Democratic Republic of the Congo included; no double entry under "total"

Since July 2018 in the Democratic Republic of the Congo

Map of documented Ebola virus outbreaks in Africa (1976-2020)

Since the first documented occurrence of Ebola fever in 1976, the Democratic Republic of the Congo has been repeatedly affected by local outbreaks of disease, sometimes with several hundred sick and dead people. Before 2018, there were eight documented outbreaks of the infectious disease in humans in the country . The Congo is endemic to Ebola fever. The natural reservoir of the Ebola virus , the reservoir host , is so far unknown, but it is suspected to be found in native fruit bats. Diseases have been demonstrated in various primates . Ebola fever is a zoonosis . Finally, the consumption of bushmeat , i.e. hunted, infected wild animals such as monkeys or fruit bats from rainforests , is assumed to be an important source of infection for the introduction into a human population . Between May and July 2018 there was a local outbreak with 54 diseases and 33 deaths in the west of the Democratic Republic of the Congo around the Wangata community , regardless of the epidemic that occurred only a short time later in the east of the country.

The first confirmed case of the epidemic in Eastern Congo was recorded by the World Health Organization (WHO) in North Kivu in July 2018. However, cases of the disease probably already occurred in April or May of that year in Mabalako . The Zaire Ebolavirus (ZEBOV), a species of the Ebolavirus genus , was detected as the causative agent . Initially, Mabalako was mainly affected. On August 12, 2018, 41 of 52 cases of illness were registered in the village. In the following months, the epidemic in Mabalako itself initially subsided, but instead spread to nearby towns. The city of Beni, east of Mabalako, with a clear peak in October 2018, and Butembo, with its suburb Katwa, with a first peak in January 2019 and another in April 2019, were particularly affected. From April 2019, Mabalako also occurred the Ebola fever rises again after there had been no cases of the disease there for weeks. Between May 1 and June 1, 2019, 484 new cases and 345 deaths were registered in the affected provinces of North Kivu and Ituri within one month. In August 2019, the Ebola virus first appeared in a third Congolese province, in Sud-Kivu.

Official total number of illnesses (blue) and deaths (red); As of August 28, 2019, Ministère de la Santé de la République Démocratique du Congo

According to the Congolese ministère de la santé ( Ministry of Health ) (as of September 8, 2019) 3,099 statistically recorded cases of illness (2,988 confirmed, 111 probable) and 2,074 deaths (1,963 confirmed, 111 probable) in the country, the outbreak after the Ebola epidemic was 2014 to 2016 saw the world's second-most serious documented outbreak in West Africa to date. 938 people survived the disease. The mortality rate ( 100 percent: (deaths + healthy) * deaths ) was almost 69 percent. 157 and thus around 5 percent of all confirmed and probable cases of illness concerned health workers by August 19, 2019. 41 of the sick employees died of Ebola fever by July 19, 2019. That was about 2.5 percent of all deaths. The number of unreported cases of illness and death is higher in the war zone of eastern Congo, where armed rebels repeatedly attack . The WHO assumes that only about three out of four cases are recorded, so the real numbers are about a third higher.

There was a relatively high percentage of children among those affected. More than a third of all Ebola patients in the epidemic were under 18 years of age. As of May 28, 2019, 15 percent of the reported cases were children under 5 years and 6 percent were children under 1 year. The mortality of children under 5 years of age was significantly higher than that of persons over 5 years of age, which can be explained by a delay in admission to the treatment and isolation centers, where they are given adequate therapy. A clearly disproportionate proportion of female patients among the cases of illness was also noticeable in people over 14 years of age. Overall, including cases under the age of 15, as of January 4, 2019, 61 percent of those affected were female and 39 percent male. This was mainly due to the care of relatives who were already ill, mainly by women.

Ebola fever broke out in the city of Mbandaka in the north-west of the country in May 2020 . Four people died in the city after being infected. According to UNICEF , four people were isolated in hospitals. It is assumed that it is an isolated new outbreak, the eleventh, which has no connection to the epidemic in eastern Congo, which has been rampant since 2018.

  • Spread in the epidemic area

  • New cases per week in Mabalako between July 16, 2018 and December 31, 2018

  • New cases per week in Beni between July 23, 2018 and January 28, 2019

  • New cases per week in Butembo (brown) and Katwa (yellow) between July 23, 2018 and February 4, 2019

In Uganda since June 2019

Kasese District (darker red) in the Western Region (lighter red) in Uganda

Before 2019, between 2000 and 2013 there were five outbreaks of Ebola fever that were restricted to Uganda. On June 11, 2019, a first case of the disease outside the Democratic Republic of the Congo was confirmed in the eastern neighboring country. This made the epidemic the second to affect several countries after the one in West Africa from 2014 to 2016, and the first in various large regions of Africa (Central Africa and East Africa). The district of Kasese in the Western Region was affected .

The disease was first diagnosed in a five-year-old boy who had entered the Congo two days earlier with five relatives past border controls. The family of the sick boy lives in Uganda in the Kasese district. She had traveled to the Congo in May without her father to look after her grandfather who had Ebola. First of all, the boy was examined and treated in a hospital in the village of Kagando and after a possible Ebola fever was determined, he was transferred to the Bwera Ebola Treatment Unit . The Uganda Virus Institute (UVRI) confirmed the disease. One day after the official discovery of the disease or infection, on June 12, 2019, it was published that the boy died of the disease. An infection or illness was also detected in two relatives, the grandmother and a brother. The grandmother died the following evening.

On June 13, 2019, the Ugandan Ministry of Health announced in a press release and on Twitter that five relatives of the deceased had been transferred to the Democratic Republic of the Congo for treatment. These are the mother, the father, who has Ugandan citizenship, the three-year-old boy who has been confirmed to have Ebola, a six-month-old baby and a maid . According to the WHO, the three-year-old boy died on June 13, 2019. The illnesses and deaths were then statistically assigned to the Mabalakos health zone in North Kivu by the Congolese Ministère de la santé .

Another case of illness was recorded at the end of August 2019. A nine-year-old girl who had crossed the border from Congo to Uganda with her mother on August 28, 2019, was diagnosed with Ebola, as was officially announced on August 29.

activities

Democratic Republic of Congo

Total number of people vaccinated with rVSV-ZEBOV over the course of the campaign started on August 8, 2018 in eastern Congo; As of August 17, 2019, Ministère de la Santé de la République Démocratique du Congo

In the epidemic area of ​​eastern Congo and adjacent to it, 117 so-called points d'entrée (PoE) (entry points ) and points de contrôle sanitaire (PoC) ( hygiene checkpoints) were set up to check people for diseases on public roads and access points to various places. For example, the metropolis of Goma was surrounded by several points d'entrée , which operated 24 hours a day, to protect against the introduction of diseases . In total, over 93 million identity checks were carried out in the Democratic Republic of the Congo (as of September 8, 2019).

The sick are treated in Ebola centers in the epidemic area. Patients who show symptoms of an illness are specifically tested twice every 48 hours in quarantine . The centers consist of sturdy tent sections with a shower and toilet and a visiting wing. In the visiting wing, family members can get within two meters of their sick relatives. The deceased are packed in virus-proof body bags, stored separately and buried .

On August 8, 2018, a large-scale vaccination campaign started in eastern Congo . Since the start of this campaign (as of September 9, 2019) 217,172 people have been given the Ebola vaccine . By June 23, 2019, 34,466 were in Katwa, 27,730 in Beni, 18,696 in Butembo and 13,220 in Mabalako. According to the decision of an ethics committee on May 19, 2018, only the rVSV-ZEBOV vaccine from Merck is used . The vaccine was shown to be highly effective according to accompanying studies. The effectiveness should be around 97 percent.

In addition to vaccinations, drugs that have not yet been established are used experimentally therapeutically in the treatment of Ebola fever, accompanied by clinical studies . Four drug therapies are used. Two are medicated with antibodies and the other two are treated with antiviral drugs. In July 2019, it was not yet possible to estimate how well these new therapies would work, as no reliable figures were yet available on how many patients were treated and what the treatment success or survival rates were in the respective treated patients.

The Congolese Ministry of Health has initiated a campaign Ebola pas chez moi (Ebola not with me) to educate and sensitize the population about the disease and, for example, its routes of infection.

The vaccinations and the implementation of other medically necessary measures are often associated with difficulties due to disinformation and ignorance in the population, which undermine trust in the institutions , stir up fears and thus make work sometimes impossible. In social networks and other media accusations are against the central government in Kinshasa widespread and against various groups. It is assumed that Ebola fever is being misused as a political tool. The vaccine used is said to cause infertility or to be fatal. Other common conspiracy theories state that Ebola is deliberately spread in order to generate profits for the pharmaceutical industry , vitamin C is suitable to cure Ebola fever and the causative pathogen is not a virus, but the epidemic is caused by witchcraft . The disinformation has repeatedly led to attacks against health care workers and aid organizations. Thus, an important part of the measures to combat Ebola fever is to fight speculation and rumors and to provide information. Among other things, those media are used for this, via which the false rumors and conspiracy theories are spread, such as the Internet . Visits are also made on site and people go door to door in order to speak directly to the people in the villages.

During the epidemic, various non-approved specific drugs were used in trials in studies in coordination with the WHO. In August 2019, the WHO announced that two of these drugs, which work on the basis of artificially produced or obtained antibodies , were found to be highly effective. These are the drugs REGN-EB3 and mAB114. These drugs could cure up to 90 percent of the patients they were used on. Two other trial drugs were found to be insufficiently effective and treatment with them was discontinued.

After the outbreak in the Congo was officially declared over on April 12 after more than 50 days without new cases, a 26-year-old man was confirmed as a new case on April 10, 2020. Two days later, an 11-month-old girl died of Ebola in the same treatment center as the 26-year-old.

Uganda

Since November 7, 2018 , vaccinations have been carried out in Uganda as part of preventive preparatory measures in areas where there is a particular risk of Ebola spreading, for example health care workers. As of June 13, 2019, 4699 employees in 165 healthcare facilities had been vaccinated in this context.

After the first cases appeared, the Ugandan Ministry of Health sent a crisis response team to the Kasese district. This should identify people at risk and ensure that they are monitored and cared for if they become ill. In the districts bordering the Congolese provinces of North Kivu and Ituri, nine Ebola treatment units (ETU) had already been set up. The Ministry of Health carried out educational work in the communities and, if necessary, offered psychosocial support .

The border crossings to the Democratic Republic of the Congo have been monitored and travelers checked since 2018. Body temperatures are measured and special attention is paid to symptoms of the disease. The district administrations and the municipal councils in the affected area were also instructed to ensure that people with symptoms of Ebola fever should be reported to the medical facilities immediately and that those affected should be informed.

After the illness in June 2019, a so-called ring vaccination was carried out from June 14th. In this vaccination campaign, first the contact persons of the proven infected and then the contact persons of the contact persons were immunized. Furthermore, the public in Uganda was called upon to avoid physical contact such as shaking hands or hugs and to wash their hands regularly with soap and clean water. In the border region to the Democratic Republic of the Congo, there should be no markets or other gatherings of people, such as services and weddings, until further notice.

Other countries

After several Ebola cases resulting in death occurred in the megacity of Goma near the border, Rwanda decided on August 1, 2019 to close the borders with the Democratic Republic of the Congo. The closure was lifted a few hours later.

In August 2019, Burundi began preventive vaccination with the rVSV-ZEBOV-GP vaccine. Vaccination campaigns had also been launched in Rwanda and South Sudan beforehand.

WHO

The World Health Organization (WHO) has been providing support and advice in the Democratic Republic of the Congo since the epidemic began. Precautionary measures have also been taken in neighboring countries since 2018. The WHO classified the neighboring countries into two focus groups: Priority 1 countries with a higher risk of the epidemic spreading due to their geographical proximity were Uganda, Rwanda , South Sudan and Burundi , Priority 2 countries Angola , Zambia , Tanzania , the Central African Republic and the Republic of the Congo .

The WHO carried out risk assessments several times. For example, one took place after the Ebola fever spread to Uganda. The World Health Organization decided in June 2019 for the third time that there was no international emergency. By contrast, the national and regional risk level for the Democratic Republic of the Congo was rated as very high. The reason for the decision to rate the global risk as low was the fact that the cases confirmed in Uganda were epidemiologically linked and infected with the Democratic Republic of the Congo, all three cases belonged to a family with a common risk, the Ugandan Provide sufficient and demonstrable evidence that they have the necessary skills and experience to treat Ebola and the speed at which Ebola is detected in a limited geographical area, the Kasese district. The overall risk at the international level remained low in the assessment of the WHO. Furthermore, the WHO expressly advised against restricting travel to and trade with the Democratic Republic of the Congo.

After a first case of illness and death had previously occurred in the metropolis of Goma near the border with Rwanda, the WHO finally decided on July 17, 2019 to determine a health emergency of international concern , but continued to speak of a regional threat. A travel warning or border closings were still refrained from despite the reassessment.

Funding for the WHO mission in the epidemic area is repeatedly difficult to effectively combat the viral disease. Tedros Adhanom Ghebreyesus , WHO Director General , stated in June 2019 that by that time only around half of the money needed to finance the operation had been made available. The total cost of the deployment from February to July 2019 were about 98 million US dollars estimated. If the funding is not covered in full by the donor countries, expenditure must be minimized, which would mean scaling back the deployment. As early as April 2019, only around half of the 150 million US dollars budgeted at the time had been collected, so that there was a financing gap of 104 million US dollars due to calculated additional requirements.

World bank

On December 10, 2019, the World Bank approved a $ 250 million project to fight pandemics, including Ebola, with which the Africa Centers for Disease Control and Prevention will set up laboratories, a health record system and emergency mechanisms .

Effects

Postponement of the presidential elections in the DR Congo

Due to the epidemic, the 2018 presidential and parliamentary elections in the Democratic Republic of the Congo were repeatedly postponed. The election, which had already been postponed to December 23, 2018, was initially rescheduled for another week to December 30. On December 26, 2018, the elections for the areas around Beni and Butembo were rescheduled to March 2019 due to Ebola .

After the elections were rescheduled, demonstrations took place in Beni on December 27, 2018. A treatment center in the city was attacked in the course of these demonstrations. According to the Ministry of Health, the attacked treatment center was not the one where the confirmed cases were isolated. It was the Center de Transit de Beni , in which suspected cases were treated that were waiting for laboratory test results, to be attacked. According to the standards, every suspected case is tested twice for Ebola within 48 hours and isolated as a precaution during this time. The attack caused considerable material damage, so that the center was temporarily inoperable or non-functional. At the time of the attack, 24 people were being treated as suspected cases at the center, 3 of whom were in a serious condition that prevented them from escaping. After the destroyers had withdrawn, this was moved to the Center de Traitement d'Ebola , to the treatment center for confirmed cases of illness, in order to await the results of the laboratory tests there. The other 21 suspected cases fled. Of these, 17 had already tested negative for Ebola once and were waiting for the second laboratory test before being released. As a result, around the election date of December 30, 2018, the work of the medical teams in the centers, such as testing suspected cases or vaccinations, was partially temporarily suspended or reduced. For example, the aid organization Oxfam interrupted its operation.

More attacks

Again and again, facilities and employees of organizations and authorities active in the fight against the Ebola epidemic are victims of violent attacks. On the night of February 24-25, 2019, there was an attack against the local treatment center operated by Doctors Without Borders ( Médecins Sans Frontières ) in Katwa, east of the Butembo health zone . This was first attacked with stones and then burned down. Treatment center inventory destroyed. The brother of a patient at the center was killed while trying to escape. The four patients with confirmed Ebola and six suspected cases treated at the center were transferred from Katwa to the Butembo treatment center. Doctors Without Borders then stopped helping in Katwa.

On February 27, 2019, gunmen attacked the treatment center in Butembo and set it on fire. A week after the treatment center in Butembo reopened after the attack, it was attacked again on March 9, 2019. Armed rebels killed a police officer. A medical worker at the center was shot injured. The police and army were able to catch an attacker. It is said to be a member of May-May . Officials spoke of an act of terrorism .

Another fatal attack occurred on April 19, 2019, when the Cameroonian epidemiologist Richard Valery Mouzoko Kiboung, a WHO employee, was murdered by rebels during an attack on the transit center in Butembo. Two other employees were injured. Only a few hours later, gunmen armed with machetes attacked the treatment center in Katwa and tried to burn it down. One assailant was shot dead by the police and five were arrested.

On May 7, 2019, an undertaker was murdered in Vuhovi and on May 8, 2019, fighting broke out in Butembo between armed attackers and soldiers of the Forces Armées de la République Démocratique du Congo (FARDC). A fire broke out at the Masaki Health Center in the Katwa Health Zone. One person died on May 13, 2019 at around 1 a.m. when a militia attacked the treatment center in Katwa. The person killed is said to be an attacker who was shot by security forces. One night later, the emergency room at Kayna Hospital was attacked with stones and a fire was started. There have been repeated attacks in various places by relatives against employees of the health authorities who wanted to take samples or bury the dead in a dignified and safe manner.

In total, in the course of the Ebola outbreak in the Democratic Republic of the Congo between August 1, 2018 and May 20, 2019, there were 132 attacks on medical staff or facilities, in which 4 people (employees, patients or their relatives) were killed and 38 injured . Another death occurred when residents of the village of Vusahiro in the health zone of Mabalako attacked the local Ebola response team on May 25, 2019. One of the team's hygienists died of his injuries.

After the death of a patient of Ebola fever, a vaccination team in Tamende and a team for psychosocial support in Madrandelle attacked young motorcyclists near Beni on June 24, 2019 . In the weeks before, there were several cases of Ebola fever in both health areas. Two employees were injured and taken to the Hôpital Général de Référence de Beni , to the hospital in Beni, for treatment . A vehicle was also burned down.

At the end of June 2019, the WHO reported that by this time in 2019 there had already been 174 attacks on health care facilities and measures such as medical centers, health workers, patients and transports in the Democratic Republic of the Congo. There was no decrease in the number of attacks. It was the highest figure worldwide compared, for example, with Afghanistan with 41 and Syria with 35 attacks.

Despite knowledge of the problem and efforts to contain the violence, the attacks continued. On the night of July 13-14, 2019, two employees of the Ebola response team in Beni were murdered in the town of Mukulia near Butembo, after they had been threatened and repeatedly victims of attacks for months because of their activities.

See also

Web links

Individual evidence

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