#Spatial #variability in the #Reproduction Number of #Ebola virus disease, #DRC, January–September 2019 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Spatial variability in the reproduction number of Ebola virus disease, Democratic Republic of the Congo, January–September 2019

Kenji Mizumoto1,2,3, Amna Tariq3, Kimberlyn Roosa3, Jun Kong4,5,6, Ping Yan7, Gerardo Chowell3,8

Affiliations: 1 Graduate School of Advanced Integrated Studies in Human Survivability, Kyoto University Yoshida-Nakaadachi-cho, Sakyo-ku, Kyoto, Japan; 2 Hakubi Center for Advanced Research, Kyoto University, Yoshidahonmachi, Sakyo-ku, Kyoto, Japan; 3 Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, United States of America; 4 Department of Mathematics and Statistics, Georgia State University, Atlanta, Georgia, United States of America; 5 Department of Computer Science, Georgia State University, Atlanta, Georgia, United States of America; 6 Department of Computer Science, Emory University, Atlanta, Georgia, United States of America; 7 Public Health Agency of Canada, Ottawa, Canada; 8 Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America

Correspondence:  Kenji Mizumoto

Citation style for this article: Mizumoto Kenji, Tariq Amna, Roosa Kimberlyn, Kong Jun, Yan Ping, Chowell Gerardo. Spatial variability in the reproduction number of Ebola virus disease, Democratic Republic of the Congo, January–September 2019. Euro Surveill. 2019;24(42):pii=1900588. https://doi.org/10.2807/1560-7917.ES.2019.24.42.1900588

Received: 22 Sep 2019;   Accepted: 17 Oct 2019

 

Abstract

The ongoing Ebola virus disease epidemic (August 2018─October 2019) in the Democratic Republic of the Congo, has been exacerbated by deliberate attacks on healthcare workers despite vaccination efforts. Using a mathematical/statistical modelling framework, we present the quantified effective reproduction number (Rt) at national and regional levels as at 29 September. The weekly trend in Rt displays fluctuations while our recent national-level Rt falls slightly above 1.0 with substantial uncertainty, which suggests improvements in epidemic control.

© This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Ebola; DRC; Epidemiology.

——

Advertisements

Pan- #Filovirus #Serum Neutralizing #Antibodies in a Subset of #Congolese #Ebolavirus Infection #Survivors (J Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Pan-Filovirus Serum Neutralizing Antibodies in a Subset of Congolese Ebolavirus Infection Survivors.

Bramble MS1,2, Hoff N1, Gilchuk P3, Mukadi P4, Lu K5, Doshi RH1, Steffen I5, Nicholson BP6, Lipson A1, Vashist N2, Sinai C1, Spencer D1, Olinger G7, Wemakoy EO8, Illunga BK9, Pettitt J10, Logue J10, Marchand J10, Varughese J10, Bennett RS10, Jahrling P10, Cavet G11, Serafini T11, Ollmann Saphire E12,13, Vilain E2, Muyembe-Tamfum JJ4, Hensely LE10,14, Simmons G5, Crowe JE Jr3,15, Rimoin AW1.

Author information: 1 Department of Epidemiology, School of Public Health, University of California, Los Angeles. 2 Department of Genetic Medicine Research, Children’s Research Institute, Children’s National Medical Center, Washington, District of Columbia. 3 Vanderbilt Vaccine Center, and Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee. 4 Institut National de Recherche Biomedicale, Kinshasa, Democratic Republic of the Congo. 5 Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco. 6 Institute for Medical Research, Durham Veterans Affairs Medical Center, North Carolina. 7 Boston University, School of Medicine, Department of Medicine, Massachusetts. 8 Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo. 9 Direction de la Lutte Contre les Maladies, Ministère de la Sante, Kinshasa, Democratic Republic of the Congo. 10 Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland. 11 Atreca, Inc, Redwood City. 12 Skaggs Institute for Chemical Biology, La Jolla, California. 13 Department of Immunology and Microbial Science, Scripps Research Institute, La Jolla, California. 14 Emerging Viral Pathogens Section, NIAID, NIH, Frederick, Maryland. 15 Departments of Pediatrics and Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.

 

Abstract

One year after a Zaire ebolavirus (EBOV) outbreak occurred in the Boende Health Zone of the Democratic Republic of the Congo during 2014, we sought to determine the breadth of immune response against diverse filoviruses including EBOV, Bundibugyo (BDBV), Sudan (SUDV), and Marburg (MARV) viruses. After assessing the 15 survivors, 5 individuals demonstrated some degree of reactivity to multiple ebolavirus species and, in some instances, Marburg virus. All 5 of these survivors had immunoreactivity to EBOV glycoprotein (GP) and EBOV VP40, and 4 had reactivity to EBOV nucleoprotein (NP). Three of these survivors showed serologic responses to the 3 species of ebolavirus GPs tested (EBOV, BDBV, SUDV). All 5 samples also exhibited ability to neutralize EBOV using live virus, in a plaque reduction neutralization test. Remarkably, 3 of these EBOV survivors had plasma antibody responses to MARV GP. In pseudovirus neutralization assays, serum antibodies from a subset of these survivors also neutralized EBOV, BDBV, SUDV, and Taï Forest virus as well as MARV. Collectively, these findings suggest that some survivors of naturally acquired ebolavirus infection mount not only a pan-ebolavirus response, but also in less frequent cases, a pan-filovirus neutralizing response.

PMID: 30107445 PMCID: PMC6217721 DOI: 10.1093/infdis/jiy453 [Indexed for MEDLINE]  Free PMC Article

Keywords: Ebola; Filovirus; Marburg; Serology.

—–

The #impact of Infection Prevention and control (#IPC) bundle implementationon IPC compliance during the #Ebola virus #outbreak in Mbandaka / #DRC: a before and after design (BMJ Open., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMJ Open. 2019 Sep 5;9(9):e029717. doi: 10.1136/bmjopen-2019-029717.

The impact of Infection Prevention and control (IPC) bundle implementationon IPC compliance during the Ebola virus outbreak in Mbandaka/Democratic Republic of the Congo: a before and after design.

Ousman K1, Kabego L2,3, Talisuna A4, Diaz J5, Mbuyi J6, Houndjo B4, Ngandu JP6, Omba G6, Aruna A6, Mossoko M6, Djingarey MH4, Balde T4, Abok P4, Diallo B4, Dovlo D7, Yao M4, Fortin A5, Formenty P5, Fall IS4.

Author information: 1 World Health Organization Regional Office for Africa, Brazzaville, Congo ousmank@who.int. 2 Infection Control Africa Network, Bukavu, Democratic Republic of the Congo. 3 Microbiology, Universite Catholique de Bukavu Faculte de Medecine, Bukavu, Democratic Republic of the Congo. 4 World Health Organization Regional Office for Africa, Brazzaville, Congo. 5 World Health Organization, Geneva, Switzerland. 6 Ministry of Health, Kinshasa, Democratic Republic of the Congo. 7 International Health System Services Expert, Accra, Ghana.

 

Abstract

OBJECTIVES:

To assess the impact of refresher training of healthcare workers (HCWs) in infection prevention and control (IPC), ensuring consistent adequate supplies and availability of IPC kits and carrying out weekly monitoring of IPC performance in healthcare facilities (HCFs)

DESIGN:

This was a before and after comparison study

SETTINGS:

This study was conducted from June to July 2018 during an Ebola virus disease (EVD) outbreak in Equateur Province in the Democratic Republic of the Congo (DRC).

PARTICIPANTS:

48 HCFs

INTERVENTIONS:

HCWs capacity building in basic IPC, IPC kit donation and IPC mentoring.

PRIMARY OUTCOME MEASURES:

IPC score

RESULTS:

48 HCFs were evaluated and 878 HCWs were trained, of whom 437 were women and 441 were men. The mean IPC score at baseline was modestly higher in hospitals (8%) compared with medical centres (4%) and health centres (4%), respectively. The mean IPC score at follow-up significantly increased to 50% in hospitals, 39% in medical centres and 36% in health centres (p value<0.001). The aggregate mean IPC score at baseline for all HCFs, combined was 4.41% and at follow-up it was 39.51% with a mean difference of 35.08% (p-value<0.001).

CONCLUSIONS:

Implementation of HCW capacity building in IPC, IPC kit donation to HCF and mentoring in IPC improved IPC compliance during the ninth EVD outbreak in the DRC.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

KEYWORDS: Democratic Republic of the Congo; Ebola virus disease; infection prevention and control

PMID: 31492782 DOI: 10.1136/bmjopen-2019-029717

Keywords: Ebola; DRC; IPC.

—–

#Dengue and #chikungunya among outpatients with acute undifferentiated #fever in #Kinshasa, #DRC: A cross-sectional study (PLoS Negl Trop Dis., abstract)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Dengue and chikungunya among outpatients with acute undifferentiated fever in Kinshasa, Democratic Republic of Congo: A cross-sectional study

Sam Proesmans , Freddy Katshongo, John Milambu, Blaise Fungula, Hypolite Muhindo Mavoko, Steve Ahuka-Mundeke, Raquel Inocêncio da Luz, Marjan Van Esbroeck, Kevin K. Ariën, Lieselotte Cnops, Birgit De Smet, Pascal Lutumba, Jean-Pierre Van geertruyden, Veerle Vanlerberghe

Published: September 5, 2019 / DOI: https://doi.org/10.1371/journal.pntd.0007047 / This is an uncorrected proof.

 

Abstract

Background

Pathogens causing acute fever, with the exception of malaria, remain largely unidentified in sub-Saharan Africa, given the local unavailability of diagnostic tests and the broad differential diagnosis.

Methodology

We conducted a cross-sectional study including outpatient acute undifferentiated fever in both children and adults, between November 2015 and June 2016 in Kinshasa, Democratic Republic of Congo. Serological and molecular diagnostic tests for selected arboviral infections were performed on blood, including PCR, NS1-RDT, ELISA and IFA for acute, and ELISA and IFA for past infections.

Results

Investigation among 342 patients, aged 2 to 68 years (mean age of 21 years), with acute undifferentiated fever (having no clear focus of infection) revealed 19 (8.1%) acute dengue–caused by DENV-1 and/or DENV-2 –and 2 (0.9%) acute chikungunya infections. Furthermore, 30.2% and 26.4% of participants had been infected in the past with dengue and chikungunya, respectively. We found no evidence of acute Zika nor yellow fever virus infections. 45.3% of patients tested positive on malaria Rapid Diagnostic Test, 87.7% received antimalarial treatment and 64.3% received antibacterial treatment.

Discussion

Chikungunya outbreaks have been reported in the study area in the past, so the high seroprevalence is not surprising. However, scarce evidence exists on dengue transmission in Kinshasa and based on our data, circulation is more important than previously reported. Furthermore, our study shows that the prescription of antibiotics, both antibacterial and antimalarial drugs, is rampant. Studies like this one, elucidating the causes of acute fever, may lead to a more considerate and rigorous use of antibiotics. This will not only stem the ever-increasing problem of antimicrobial resistance, but will–ultimately and hopefully–improve the clinical care of outpatients in low-resource settings.

Trial registration ClinicalTrials.gov NCT02656862.

 

Author summary

Malaria remains one of the most important causes of fever in sub-Saharan Africa. However, its share is declining, since the diagnosis and treatment of malaria have improved significantly over the years. Hence leading to an increase in the number of patients presenting with non-malarial fever. Often, obvious clinical signs and symptoms like cough or diarrhea are absent, probing the question: “What causes the fever?” Previous studies have shown that the burden of arboviral infections–like dengue and chikungunya–in sub-Saharan Africa is underestimated, which is why we screened for four common arboviral infections in patients presenting with ‘undifferentiated fever’ at an outpatient clinic in suburban Kinshasa, Democratic Republic of Congo. Among the patients tested, we found that one in ten presented with an acute arboviral infection and that almost one in three patients had been infected in the past. These findings suggest that clinicians should think about arboviral infections more often, thereby refraining from the prescription of antibiotics, a practice increasingly problematic given the global rise of antimicrobial resistance.

___

Citation: Proesmans S, Katshongo F, Milambu J, Fungula B, Muhindo Mavoko H, Ahuka-Mundeke S, et al. (2019) Dengue and chikungunya among outpatients with acute undifferentiated fever in Kinshasa, Democratic Republic of Congo: A cross-sectional study. PLoS Negl Trop Dis 13(9): e0007047. https://doi.org/10.1371/journal.pntd.0007047

Editor: Stuart D. Blacksell, Mahidol Univ, Fac Trop Med, THAILAND

Received: November 28, 2018; Accepted: August 6, 2019; Published: September 5, 2019

Copyright: © 2019 Proesmans et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: This study was co-funded by the framework agreement between the Institute of Tropical Medicine and the Belgian development cooperation (https://www.itg.be/E/cooperation) to VV and Vlaamse Interuniversitaire Raad – Universitaire Ontwikkelingssamenwerking (https://www.vliruos.be/en) (VLIR-UOS, Grant reference ZRDC2014MP083) to JPVG. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Arbovirus; Dengue fever; Chikungunya fever; Malaria; Serology; Seroprevalence; DRC.

——

The #monetary value of #human lives lost through #Ebola virus disease in the #DRC in 2019 (BMC Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMC Public Health. 2019 Sep 3;19(1):1218. doi: 10.1186/s12889-019-7542-2.

The monetary value of human lives lost through Ebola virus disease in the Democratic Republic of Congo in 2019.

Kirigia JM1, Muthuri RNDK2, Muthuri NG3.

Author information: 1 African Sustainable Development Research Consortium (ASDRC), P.O. Box 6994 00100 GPO, Nairobi, Kenya. muthurijoses68@gmail.com. 2 Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa. 3 School of Business, United States International University, Nairobi, Kenya.

 

Abstract

BACKGROUND:

Between 8 May 2018 and 27 May 2019, cumulatively there were 1286 deaths from Ebola Virus Disease (EVD) in the Democratic Republic of Congo (DRC). The objective of this study was to estimate the monetary value of human lives lost through EVD in DRC.

METHODS:

Human capital approach was applied to monetarily value years of life lost due to premature deaths from EVD. The future losses were discounted to their present values at 3% discount rate. The model was reanalysed using 5 and 10% discount rates. The analysis was done alternately using the average life expectancies for DRC, the world, and the Japanese females to assess the effect on the monetary value of years of life lost (MVYLL).

RESULTS:

The 1286 deaths resulted in a total MVYLL of Int$17,761,539 assuming 3% discount rate and DRC life expectancy of 60.5 years. The average monetary value per EVD death was of Int$13,801. About 44.7 and 48.6% of the total MVYLL was borne by children aged below 9 years and adults aged between 15 years and 59 years, respectively. Re-estimation of the algorithm with average life expectancies of the world (both sexes) and Japanese females, holding discount rate constant at 3%, increased the MVYLL by Int$ 3,667,085 (20.6%) and Int$ 7,508,498 (42.3%), respectively. The application of discount rates of 5 and 10%, holding life expectancy constant at 60.5 years, reduced the MVYLL by Int$ 4,252,785 (- 23.9%) and Int$ 9,658,195 (- 54.4%) respectively.

CONCLUSION:

The EVD outbreak in DRC led to a considerable MVYLL. There is an urgent need for DRC government and development partners to disburse adequate resources to strengthen the national health system and other systems that address social determinants of health to end recurrence of EVD outbreaks.

KEYWORDS: Democratic Republic of Congo (DRC); Ebola virus disease (EVD) deaths; Gross domestic product; Human capital; Monetary value of life; Years of life lost

PMID: 31481050 DOI: 10.1186/s12889-019-7542-2

Keywords: Ebola; DRC; Society.

——

#Ebola virus disease and #breastfeeding: time for #attention (Lancet, summary)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Ebola virus disease and breastfeeding: time for attention

Mija Ververs, Akanksha Arya

Published: August 27, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)32005-7

___

This year’s Global Nutrition Cluster meeting in July, 2019, offered a platform on which to discuss all nutrition-related humanitarian emergencies. Ebola virus disease (EVD) and breastfeeding in DR Congo was an obvious topic. More than 2800 cases have been confirmed in the ongoing outbreak in DR Congo; most cases are adults, and 56% of cases are women.1 Ample information is available on the presence of Ebola virus in bodily fluids such as blood, urine, and semen, and on the prevention of transmission from these fluids. However, information on EVD and breastmilk is limited.

(…)

We declare no competing interests.

Keywords: Ebola; DRC; Breastfeeding.

——

#Ebola virus #outbreak in North Kivu and Ituri provinces, #DRC, and the potential for further #transmission through commercial #air #travel (J Travel Med., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Travel Med. 2019 Aug 15. pii: taz063. doi: 10.1093/jtm/taz063. [Epub ahead of print]

Ebola virus outbreak in North Kivu and Ituri provinces, Democratic Republic of Congo, and the potential for further transmission through commercial air travel.

Tuite AR1,2, Watts AG2,3, Khan K2,3,4, Bogoch II4,5.

Author information: 1 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. 2 BlueDot, Toronto, Canada. 3 Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada. 4 Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Canada. 5 Divisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Canada.

 

Abstract

BACKGROUND:

The 2018-2019 Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of Congo (DRC), continues to spread. The recent discovery of cases in Uganda and in Goma, a major city in the eastern DRC, raises concern for potential EVD transmission in distant locales via commercial air travel.

METHODS:

We examined air travel patterns from the affected region with itinerary-level data from the International Air Transport Association for the year 2018 between July through October, inclusive. We focused on three scenarios; 1) travel from Beni airport, 2) travel from Beni, Goma and Bunia airports, and 3) travel from Beni, Goma, and Bunia, and Kigali airports. We evaluate country-level Infectious Disease Vulnerability Index (IDVI) scores for traveler destinations.

RESULTS:

There were 2,255 commercial air passengers departing from Beni Airport during the specified time frame, all with domestic destinations, and 55% of which were to Goma. 29,777 passengers traveled from Beni, Bunia, and Goma airports during this time frame, with most travel (94.6%) departing from Goma airport. 72.4% of passengers’ final destination from these three airports were within the DRC, primarily to Kinshasa. There were 166,281 outbound passengers from Beni, Bunia, Goma, and Kigali airports with the majority (82.1%) of passengers departing from Kigali. The most frequent destinations from these airports were Nairobi, Kinshasa, and Entebbe. Eight of the 10 destinations with greatest passenger volumes are to countries with IDVI scores less than 0.4.

CONCLUSION:

There is little commercial airline connectivity from the current EVD-affected area, however larger cities in DRC and throughout East Africa should be aware of the low potential for EVD importation through this route. Most countries at greatest risk for EVD importation have limited capacity to manage these cases.

© International Society of Travel Medicine 2019. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

KEYWORDS: Democratic Republic of Congo; Ebola; air travel; epidemic; outbreak; travel

PMID: 31414699 DOI: 10.1093/jtm/taz063

Keywords: Ebola; DRC.

——