This weeks feature : Médecins Sans Frontières Australia

11 September 2007

Democratic Republic Congo: Ebola virus confirmed in Kasai, MSF reinforces its team already on the ground

An MSF staff member enters the isolation structure set up by MSF. Inside, two other medical staff take care of a patient, Kampungu, West Kasai

An outbreak of Ebola haemorrhagic fever has been confirmed in West Kasai province, in the Democratic Republic Congo (DRC). MSF is reinforcing its emergency team already working on the ground with specialists and is sending additional material.

Kinshasa – On the evening of September 10, the Congolese Ministry of Health officially confirmed an outbreak of Ebola hemorrhagic fever in the province of West Kasai, central DRC. Laboratories in Atlanta, USA, and in Franceville, Gabon, have confirmed the presence of Ebola virus in samples. Not all these deaths are necessarily due to Ebola however. The presence of other diseases is also suspected, such as Shigella dysentery.

Since the end of April, cases of an unknown illness started to be reported in the region of Mweka, a town of 9,000 inhabitants in West Kasai, about two days drive from Kananga, the provincial capital. Over the last two weeks, more and more suspected cases were reported in the health zones of Mweka, Kampungu, Luebo, and even one in Kananga. MSF is working in the health centre of Kampungu, the most affected health zone. There are 12 patients currently hospitalized, of whom three are in severe conditions.

LEARN MORE ABOUT EBOLA - no antidote, no cure, all emphasis on isolating the infected
Dr Armand Sprecher, specialist of Hemorragic fevers like Ebola and Marburg, describes the disease and the measures that are taken to control the outbreak.

Listen to his interview

Read his interview

Dr Armand Sprecher

According to the World Health Organization (WHO), a total of 362 suspected cases have been reported and 166 people have died – a mortality rate of approximately 40%. Vulnerable people, such as children and elderly, seem to be most affected by the disease. Patients present high fever, headaches, vomiting, diarrhoea, and in a few cases external bleedings. Within two or three days, patients die from dehydration. No vaccine nor treatment exist for this type of fever, so MSF isolates patients to prevent contamination, treats the symptoms and reduces the suffering of patients. While waiting for the results of the samples, patients have been isolated, treated with antibiotics and put under perfusion to combat dehydration.

Since September 2, a team from MSF’s Congo Emergency Pool (PUC) has been working in Kampungu. The team consists of a medical doctor, a nurse and a logistician, and has already been reinforced by a Coordinator from the Emergency Unit from Brussels, Belgium, two water-and-sanitation specialists and a social worker. Additional doctors, nurses, logisticians, water-and-sanitation specialists, an epidemiologist and an expert in Ebola fever, will arrive in West Kasai in the coming days, bringing the MSF team to a total of 15 people.

"Ebola kits" will be sent by plane from Lubumbashi on Wednesday and from Kinshasa on Thursday. These kits are made up of several modules: protection kits for the team – surgeon and plastic gloves, boots, glasses, masks, protection uniforms, apron and hoods – for single use. The disease is highly contagious and protection clothing can only be used once and then must be carefully destroyed.

Additional material designed to take samples from sick patients and to transport them will reach Kananga on Thursday. Medical supplies, such as perfusions, antibiotics, anti-malaria drugs, as well as food rations, are being prepared in the DRC capital, Kinshasa, and are scheduled to arrive in West Kasai province on Wednesday. Water and sanitation material, such as water tanks and chlorine for disinfection will also be sent.

The MSF team will continue to isolate infected persons in the health centre of Kampungu; trace actively the people who have been in contact with sick patients; and raise awareness among the population about the basic rules to prevent the transmission of the disease.

MSF has built considerable experience in previous outbreaks of Hemorrhagic fever, of Ebola or Marburg types: in Angola (2005), Gabon (1997 and 2002), Uganda (2001), Congo-Brazzaville (2003/2004), South Sudan (2004). In DRC, MSF responded to a big Ebola outbreak in Kikwit, capital of the neighbouring province of Bandundu, in 1995. This epidemic killed 244 people between May and August 1995.

MSF Interview: Ebola - no antidote, no cure, all emphasis on isolating the infected

Armand Sprecher is an MSF doctor specialised in hemorrhagic fevers like Ebola and Marburg. He is currently advising MSF in the fight against the Ebola epidemic in the province of West Kasai, Democratic Republic of Congo. In this interview, he describes Ebola hemorrhagic fever and the measures that are taken to control the outbreak.

Dr Armand Sprecher, what is Ebola?
Ebola was discovered in 1976, in Zaire and Sudan. It is a viral disease. There have been periodic epidemics of Ebola and its cousin Marburg in Central Africa over the past thirty years. MSF has a history in responding to these outbreaks in Gabon, Uganda, Democratic Republic of the Congo, Congo-Brazzaville, Sudan, and Angola.

What are the origins of the disease?
It probably lives in bats, which are the reservoir. Then it moves to great apes and then into humans. It is then transmitted between people through contact with body fluids (blood, vomit, diarrhea...), which importantly occurs in the care of the sick. This means that in an Ebola outbreak the virus tens to spread also to health staff and family members of the patients.

What are the symptoms?
The disease is flu-like. It starts with fever, headache, muscle pains, and then people develop vomiting and diarrhea. And later, in the course of the disease, they can start bleeding (in vomit, diarrhea, from the nose, and at the gums). Up to 90% of the people who have the disease will die, depending on the strain of the virus.

How important are these hemorrhagic fevers in terms of public health?
In the history of Ebola and Marburg there have been about 2,000 known deaths, which by comparison with malaria is less than the number of people that will die in one day. So this disease is maybe limited in terms of a country’s public health but is extremely significant because of the extreme risk it can represent in an affected population.

Is there any treatment for Ebola?
There is no antidote and no treatment for this disease, so the care that we provide is supportive and palliative. Most of our efforts are aimed at controlling the outbreak, which is accomplished by detection of the sick and isolating them from the rest of the population. This is what we are doing now in West Kasai province.

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