Ebola toll reaches 115 cases, 97 deaths in Cuvette-Ouest Region

By 8 March 2003, 115 probable cases of the highly contagious and often-lethal Ebola virus were reported in the Republic of Congo (ROC), with the death toll rising to 97, according to the World Health Organisation (WHO) representative in the ROC, Dr Lamine Sarr. Sarr said in the capital, Brazzaville, on Monday that a breakdown of the latest figures showed that the disease had so far claimed 86 lives in 10 villages in Kelle District, and killed 11 others in three villages in Mbomo District, located 100 km further north. Kelle and Mbomo districts are in the ROC's Cuvette-Ouest Region, which borders Gabon. "Case search and case management are continuing apace, and suspected cases and contacts are being systematically monitored," said Dr Paul Lusamba-Dikassa, the Regional Adviser for Communicable Diseases Surveillance and Response at the WHO Regional Office for Africa, who recently returned to Brazzaville from a visit to the outbreak area. "It is true that fewer cases are being reported now than five weeks ago. But we would be cautious in reporting a tapering off of new infections at this time, given the difficulty in accessing remote villages, the mode of transmission of the disease, and the fact that there are more than 100 "contacts" [persons who have had direct contacts with suspected or confirmed Ebola cases] under surveillance," Lusamba-Dikassa continued. "Remember, even one case of Ebola is to be considered an outbreak." An isolation centre had been set up at Kelle District Hospital, and another at Mbomo District Hospital to contain the spread of the disease and to provide patients with adequate care, Lusamba-Dikassa said. The WHO official also reported an improvement in cooperation between the local community and the WHO-led outbreak control teams made up of national and international experts and volunteers brought together within the framework of WHO's Global Outbreak Alert and Response Network. The network is a technical collaboration of existing institutions and networks that pool human and technical resources for the rapid identification, confirmation and response to outbreaks of international importance. It provides an operational framework to link this expertise and skill to keep the international community constantly alert to the threat of outbreaks, and ready to respond. Among the international experts working to contain the latest Ebola outbreak in the ROC are four clinicians, three epidemiologists, three medical anthropologists and two logisticians. Their activities range from case management and case search to surveillance of contacts and provision of public information, including advice and assistance with safe burial practices. Lusamba-Dikassa added that as the situation was "very dynamic", the size and composition of the field team would be adjusted accordingly. "The efforts of the outbreak control team in the field are being hampered by enormous logistical problems in terms of road access to affected localities, transport and telecommunications, but we are encouraged by the cooperation of all our partners in support of the Congolese government," he said. The 10 worst affected villages in Kelle District are Abolo, Akamou, Ambomi, Andjokou, Entsiami, Kelle, Lossi, Ndjoukou, Ongonda and Yembelangoye. The first human victim, or "index case", was reported in Yembelangoye on 4 January 2002. In Mbomo District, the three worst affected villages are Ilombo la Pendo, Mbomo, and Lengui-Lengui Mbomo. Ebola is characterised by fever, diarrhoea, severe blood loss, and intense fatigue, and transmitted through direct contact with body fluids of infected persons or of other primates. There is no cure, and between 50 percent and 90 percent of victims die. The best way of halting its spread is through prevention and prompt detection and isolation of suspected cases. Authorities were first alerted to a possible Ebola outbreak among gorillas in late 2002 when a band of them in the region began dying. Tests carried out on the bodies confirmed that they had died of Ebola. The current outbreak is believed to have been caused by villagers eating infected primates.