Update on Ebola outbreak in DRC
The World Health Organization (WHO) announced an Ebola outbreak in the Democratic Republic of the Congo (DRC) in August 2018. This new outbreak in the northeastern provinces comes soon after an outbreak in the western part of the country was declared over. WHO rate the risk of national and regional spread as very high.
As of 9 October 2018, 194 cases (159 confirmed and 35 probable) and 122 deaths have been reported in the North Kivu and Ituri provinces. This includes 20 cases in health care workers (with 3 deaths). Nearly 3000 contacts remain under active surveillance.
The affected areas share borders with Rwanda and Uganda. WHO notes that the prolonged humanitarian crisis and deterioration of security in this area may hinder the response to the outbreak. The response is becoming increasingly undermined by security challenges in at-risk areas, particularly Beni.
Ring vaccination in health care workers and contacts of Ebola patients using the rVSV-ZEBOV vaccine has started; 90 vaccination rings have been defined (in addition to 31 rings of health and frontline workers), and 15,828 contacts have been vaccinated including 6327 frontline health care workers and 3439 children.
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.
WHO advises against any restriction of travel and trade to the DRC based on the currently available information.
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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