Ebola outbreak in DRC: update
The World Health Organization (WHO) announced an Ebola outbreak in the Democratic Republic of the Congo (DRC) in August 2018. As of 11 April 2019, 1186 confirmed and probable cases, including 751 deaths, have been reported in the North Kivu and Ituri provinces. A total of 87 health workers have been infected. This makes it the second largest outbreak of Ebola since the 2014-2016 outbreak in West Africa. A disproportionate number of women and children have been infected during this outbreak.
The WHO rate the risk of national and regional spread as very high, but the global risk level is low. The affected areas share borders with Rwanda and Uganda, and the WHO notes that the prolonged humanitarian crisis and deterioration of security in this area sometimes limits the implementation of response activities. There has been increased violence reported recently, including large-scale, organized attacks on Ebola treatment centers. The country is also experiencing other epidemics (e.g., malaria, cholera, vaccine-derived poliomyelitis).
Ring vaccination in health care workers and contacts of Ebola patients using the rVSV-ZEBOV vaccine is ongoing. Experimental treatments (mAb114, remdesivir, ZMapp, favipiravir, and REGN3470-3471-3479) have been approved for use in the current outbreak under the framework of compassionate use/expanded access. A randomized controlled trial has begun to evaluate the safety and efficacy of these drugs. It is the first multi-drug trial for an Ebola treatment.
The WHO advises against any restriction of travel and trade to the DRC based on the currently available information. As of 12 April 2019, the WHO confirmed that this outbreak does not constitute a Public Health Emergency of International Concern.
Summary
Definition
History and exam
Key diagnostic factors
- exposure to Ebola virus in previous 21 days
- fever
- myalgia
- conjunctival injection
Other diagnostic factors
- fatigue
- diarrhea
- nausea/vomiting
- severe headache
- abdominal pain or heartburn
- cough, dyspnea, chest pain
- sore throat
- prostration
- tachypnea
- maculopapular rash
- bleeding
- hepatomegaly
- lymphadenopathy
- hiccups
- tachycardia
- hypotension
- neurological signs
Risk factors
- living or working in, or arrival from, endemic area in previous 21 days
- contact with infected body fluids
- occupational exposure
- butchering or consumption of meat from infected (or potentially infected) animals
- bioterrorism
Diagnostic investigations
1st investigations to order
- reverse transcriptase-polymerase chain reaction (RT-PCR)
- malaria investigations
Investigations to consider
- serum electrolyte levels
- BUN/serum creatinine
- blood lactate
- ABG
- CBC
- coagulation studies
- urinalysis
- LFTs
- serum amylase level
- serum blood glucose
- blood cultures
- antigen-capture enzyme-linked immunosorbent assay (ELISA)
- IgM and IgG antibodies
- CXR
Treatment algorithm
Contributors
Authors VIEW ALL
Senior Lecturer (Honorary Consultant)
Liverpool School of Tropical Medicine and Royal Liverpool University Hospital
Liverpool
UK
Disclosures
NJB is an author of several references cited in this monograph. NJB is partially supported by the National Institute of Health Research Health Protection Unit in Emerging and Zoonotic Infections at the University of Liverpool and Public Health England. He is affiliated with the Liverpool School of Tropical Medicine. Views expressed in this monograph are those of the contributor and do not necessarily represent the official position of the National Health Service, the National Institute for Health Research, the Department of Health, or Public Health England.
Specialist Trainee in Infectious Diseases
Royal Liverpool University Hospital
Liverpool
UK
Disclosures
MF declares that he has no competing interests.
Wellcome Trust/MoD Research Fellow
Liverpool School of Tropical Medicine
Liverpool
UK
Disclosures
TEF is an author of a number of references cited in this monograph. TEF is a consultant to the World Health Organization, and is funded by the UK Surgeon General and the Wellcome Trust.
Clinical Lecturer
University College London
Honorary Clinical Lecturer
London School of Hygiene and Tropical Medicine
London
UK
Disclosures
CFH declares that she has no competing interests.
Dr Nicholas J. Beeching, Dr Manuel Fenech, Dr Tom E. Fletcher, and Dr Catherine F. Houlihan would like to thank Dr Colin Brown (Infectious Disease Lead, Kings Sierra Leone Partnership) for his helpful comments and insights. CB declares that he has no competing interests.
Peer reviewers VIEW ALL
Wade Hampton Frost Professor of Epidemiology
Professor of Medicine, Microbiology, and Pathology
Chief
Division of Infectious Diseases and International Health
University of Virginia
Charlottesville
VA
Disclosures
WAP declares that he has no competing interests.
Professor of Medicine and Epidemiology
UT Health Medical School
Medical Director of Epidemiology
Memorial Hermann Texas Medical Center
Houston
TX
Disclosures
LO-Z declares that he has no competing interests.
Consultant in Microbiology and Infectious Diseases
Royal Free London NHS Foundation Trust
London
UK
Disclosures
SM declares that he has no competing interests.
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