Friday, 18 May 2018

DR. CONGO: Ebola Spreads To Mbandaka, 25 Dead, Congo On High Alert

Ebola outbreak in DR Congo has spread from the countryside into Mbandaka, causing fears that the disease will be spread further and become increasingly difficult to control.

Health Minister Oly Ilunga Kalenga confirmed a case in Mbandaka, a city of a million about 130km (80 miles) from where the first cases were confirmed.

The city is a major transportation hub with routes to the capital Kinshasa.

At least 44 people are thought to have been infected with ebola and 23 deaths are being investigated.

Ebola is a serious infectious illness that causes internal bleeding and often proves fatal.

It can spread rapidly through contact with small amounts of bodily fluid and its early flu-like symptoms are not always easy to suspect.

The World Health Organization (WHO) has called an emergency meeting of experts to talk about the risk that Ebola might spread beyond DR Congo.

World Health Organization (WHO) holds a meeting today to decide whether to declare an international public health emergency which would trigger a larger global response, like in the case of the 2014-16 Western African Ebola outbreak and the 2016 Zika virus in Latin America.

The 2014-16 West Africa outbreak, which killed 11,300 people, was particularly deadly because it spread to the capital cities of Guinea, Sierra Leone and Liberia.

Senior WHO official Peter Salama said the spread to Mbandaka meant there was the potential for an explosive increase in cases.

This is a major development in the outbreak, Salama said.

We have urban Ebola, which is a very different animal from rural Ebola. The potential for an explosive increase in cases is now there.

Mr Salama, who is the WHO's deputy director-general for emergency preparedness and response, said Mbandaka's location on the Congo river, widely used for transportation, raised the chaances of Ebola spreading to surrounding countries.

Surrounding countries such as Congo-Brazzaville and the Central African Republic as well as downstream to Kinshasa, a city of 10 million people.

This puts a whole different lens on this outbreak and gives us increased urgency to move very quickly into Mbandaka to stop this new first sign of transmission, he said.

So far only three of the 44 cases have been confirmed as Ebola and involve people who are still alive, the WHO says.

There are a further 20 probable cases and 21 suspected cases.

The cases were recorded in three health zones of Congo's Equateur province.

Isolation and rudimentary Ebola case management facilities had been set up in Mbandaka to cope with cases, Mr Salama said.

The disease may have been brought there, he said, by two or three people who had attended the funeral of an Ebola victim in Bikoro to the south of Mbandaka before travelling to the city.

On Wednesday more than 4,000 doses of an experimental vaccine sent by the WHO arrived in Kinshasa with another batch expected soon.

These would be given as a priority to people in Mbandaka who had been in contact with those suspected of carrying the Ebola virus before people in any other affected area, in order to stop Ebola spreading in the urban region and beyond, Mr Salama said.

The vaccine from pharmaceutical firm Merck is unlicensed but was effective in limited trials during the West Africa Ebola Outbreak.

It needs to be stored at a temperature of between -60 and -80 C. Electricity supplies in Congo are unreliable.

Health workers had identified 430 people who may have had contact with the disease and were working to trace more than 4,000 contacts of Ebola patients, who had spread across north-west DR Congo, the WHO said.

Many of these people were in areas only reachable by motorbike, Mr Salama said.

Mbandaka is a poor city on the banks of the River Congo.

Those of its residents who can afford to pay for electricity only get it for three to four hours a day, otherwise people use generators or solar panels.

The city has two hospitals, which have received money for renovations.

But even they do not have a regular electricity supply and have to rely on generators.

For water, Mbandaka's residents use wells or the river.

Many people also use the river as a toilet, meaning there is a high risk of diseases, not just Ebola, spreading.

Passenger boats used to operate along the river to Kinshasa but these are no longer working.

However, traders still use wooden canoes to reach the capital to buy and sell their goods, and this is how it is feared Ebola could spread.

The WHO said it was not recommending any trade or travel restrictions either within DR Congo, for example between Mbandaka and Kinshasa, or internationally.

But Mr Salama said that 13 countries in the region were boosting border screening measures and said DR Congo itself was increasing exit screening measures.

The good news is that the DR Congo population is very used to Ebola outbreaks, Salama said.

They know to protect themselves by avoiding mass gatherings and mass funerals.

They know as well that traditional healers can amplify the outbreak.

Observers described the international response so far as remarkable and very rapid.

The logistic issues will also be considerable on the ground to identify who should be vaccinated and to get out in this vast and very difficult area and provide vaccination in an appropriate way.

There have been three outbreaks in DR Congo since the 2014-16 epidemic.

Ebola is thought to be spread over long distances by fruit bats and is often transmitted to humans via contaminated bushmeat.

It can also be introduced into the human population through close contact with the blood, organs or other bodily fluids of infected animals.

These can include chimpanzees, gorillas, monkeys, antelope and porcupines.

The disease is endemic to the area and it is not possible to eradicate all the animals who might be a host for Ebola.

As long as humans come in contact with them, there is always a possibility that Ebola could breakup in any place.

Health officials have expressed concern about containment as the virus reaches a city of 1 million people. At the same time, WHO began shipping thousands of trial vaccines to Kinshasa.

The Democratic Republic of Congo warned late on Wednesday that the nation's Ebola outbreak had entered a new phase after a case was discovered in the northwestern city of Mbandaka.

It was the first registered urban case of the deadly virus, as the city has a population of some 1 million people.

We are entering a new phase of the Ebola outbreak that is now affecting three health zones, including an urban health zone, Health Minister Oly Ilunga Kalenga said.

Kalenga added that the authorities were tracing all air, river, and road routes in and out of the city in order to trace the source of the virus.

At least 23 people have died in Congo's latest outbreak, which had originally been detected in only rural areas where it would have given health officials a better chance of containing the spread of Ebola.

On Wednesday, the World Health Organization (WHO) announced that it was intensifying its vaccination campaign in Congo.

A first batch of 4,000 inoculations has arrived in the capital Kinshasa, with another 4,000 to follow soon after.

The experimental vaccines were developed two years ago following the deaths of 11,300 people in Guinea, Liberia, and Sierra Leone in a 2014-2016 outbreak that was the deadliest in the virus' history.

Ebola virus disease spreads between humans and other infected animals via bodily fluids and can cause severe fevers, vomiting, and internal bleeding.

It was named for the Ebola River in Congo, where it was first identified in 1976.

WHO officials have described the affected area as one of the most difficult terrains on earth, making it difficult to access.

World Health Organisation is hoping to avert an epidemic like the West Africa outbreak in 2014.

The World Health Organization (WHO) on Friday said 10 countries, including the Democratic Republic of Congo (DRC) and its neighbors, have been put on high alert after local authorities declared an Ebola outbreak earlier this week.

We are very concerned, and we are planning for all scenarios, including the worst-case scenario, said WHO emergency response chief Peter Salama in Geneva.

Salama said that WHO officials are most worried about the spread of Ebola in Congo-Brazzaville and the Central African Republic, since they are both connected to the outbreak area through river systems.

He noted that the latest outbreak has occurred in a remote area near Bikoro.

But if the virus spreads to Mbandaka, the capital of DRC's Equateur province home to more than one million inhabitants, it could have devastating consequences, he added.

This is a highly complex, sophisticated operation in one of the most difficult terrains on earth, Salama said. "

If we see a town of that size infected with Ebola, then we are going to have a major urban outbreak.

A Nurse was the first to die in Congo's latest Ebola outbreak. The first death of a new Ebola outbreak was confirmed in the Democratic Republic of Congo When the nurse died.

The World Health Organization said it was preparing for the worst case scenario.

Officials declared the outbreak in the country's northwest on Tuesday after lab tests confirmed the deadly virus in two cases from the town of Bikoro in the Equateur province.

The nurse died overnight at a hospital in nearby Ikoko Impenge, where four new suspected cases of Ebola have been reported, Health Minister Oly Ilunga said at a news conference.

Seven people with a hemorrhagic fever, including two confirmed cases of Ebola, lay in hospital late Thursday, he added.

The patients could have links to a police officer in Bikoro who died after exhibiting symptoms of hemorrhagic fever in December, National Institute of Biological and Bacterial Research director Jean Jacques Muyembe said.

The officer's mother and 10 others then showed similar symptoms. Muyembe said officials would likely contain the outbreak.

Seventeen people have died from hemorrhagic fever in recent weeks, Ilunga said, and doctors are treating three more nurses for the symptoms.

Officials must test nine patients for Ebola, just one virus responsible for such symptoms. Doctors have traveled to Bikoro to trace contacts, identify the epicenter and all affected villages, and provide resources.

The World Health Organization said on Friday it was preparing for the worst case scenario in the latest Ebola outbreak, including for the disease spreading to a major town.

WHO Deputy Director-General of Emergency Preparedness and Response Peter Salama told a regular UN briefing in Geneva that the health agency had alerted the nine neighboring countries but currently regarded the risk of regional spread as moderate.

Separately, WHO Director-General Tedros Ghebreyesus tweeted that he and Congo's health minister had agreed that Ebola vaccines will be shipped as quickly as possible.

Counting the current one, Congo has experienced nine outbreaks since researchers identified Ebola there in 1976. The country approved the use of an experimental vaccine during a flare-up almost exactly a year ago.

Without preventive measures, the virus can also spread quickly via bodily fluids from person to person and even to animals such as bats and monkeys.

Ebola, which has no specific treatment, can prove fatal in up to 90 percent of cases.

None of the Ebola outbreaks in Congo have connections to the epidemic that began in 2013 and had left more than 11,000 people dead.

Almost all of them in Guinea, Liberia and Sierra Leone before it was declared over in 2016.

However, an outbreak did leave 49 people dead in the Central African country that year.

On Thursday, Nigeria's immigration service announced that it had increased screening tests at airports and other entry points as a precautionary measure.

Officials in Guinea and Gambia also said they had heightened screening measures along their borders to prevent the spread. Such efforts had helped to contain the virus during the West Africa epidemic.

Bushmeat is believed to be the origin of the current Ebola outbreak.

The first victim's family hunted bats, which carry the virus.

Could the practice of eating bushmeat, which is popular across Africa, be responsible for the current crisis?

The origin has been traced to a two-year-old child from the village of Gueckedou in south-eastern Guinea, an area where batmeat is frequently hunted and eaten.

The infant, dubbed Child Zero, died on 6 December 2013. The child's family stated they had hunted two species of bat which carry the Ebola virus.

Bushmeat or wild animal meat covers any animal that is killed for consumption including antelopes, chimpanzees, fruit bats and rats. It can even include porcupines and snakes.

In some remote areas it is a necessary source of food,in others it has become a delicacy.

In Africa's Congo Basin, people eat an estimated five million tonnes of bushmeat per year, according to the Centre of International Forestry Research.

Some of these animals can harbour deadly diseases. Bats carry a whole range of viruses and studies have shown that some species of fruit bats can harbour Ebola.

Via their droppings or fruit they have touched, bats can then in turn infect other non-human primates such as gorillas and chimpanzees.

For them, like us, this can be deadly. Bats on the other hand can escape from it unscathed. This makes them an ideal host for the virus.

Exactly how the virus spills over into humans is still not clear.

There's often an intermediate species involved, like primates such as chimpanzees, but evidence shows people can get the virus directly from bats.

But it is difficult for the virus to jump the species barrier from animals into humans, he adds. The virus first has to somehow gain access to the cells in which it can replicate by contact with infected blood.

Most people buy bushmeat from markets once it has already been cooked, so it is those hunting or preparing the raw meat that are at highest risk.
The current outbreak shows that, however difficult or rare it is, infection is clearly possible though it must be remembered that each further infection, from Child Zero to today, has been caused by contact with an infected person.

There has been talk of banning bushmeat, but that may simply drive it underground, experts have previously warned.

Hunting bushmeat is also a longstanding tradition.

It's a meat eating society, there's a feeling that if you do not have meat every day, you haven't properly eaten.

Although you can get other forms of meat, there's traditionally very little livestock production.

In Ghana, for example, currently unaffected by the outbreak, fruit bats are widely hunted.

To understand how people interact with this particular type of bushmeat, researchers surveyed nearly 600 Ghanaians about their practices relating to bats.

The study found that hunters used several different techniques to kill their prey including shooting, netting, scavenging and catapulting.

All hunters reported handling live bats, which often meant they came into contact with blood and in some instances were bitten and scratched.

These hunters are therefore the most at risk of contracting viruses present in bats, explains one of the authors, Dr Olivier Restif from the University of Cambridge.

The work also uncovered that the scale of the bat bushmeat trade in Ghana was much higher than previously thought, with more than 100,000 bats killed and sold every year.

People who eat bat bushmeat are rarely aware of any potential risk associated with consumption.

They tend to see it as healthy food. This survey was carried out before the current outbreak but the team says that understanding the perceived risks could help control future epidemics.

Fruit bats are believed to be a major carrier of the Ebola virus but they do not show symptoms.

While there is a risk, this study exemplifies that it is low. The estimate of more than 100,000 bats consumed has not resulted in a single case of Ebola in Ghana.

Researchers have also monitored populations of bats to test for Ebola and found very few animals with detectable levels of the virus.

Since the first recorded outbreak in 1976 there have been only 30 single spillover events from animals into humans, according to new research which has mapped all previous outbreaks.

But given Ebola's animal origin, it is perhaps not surprising that bushmeat has been cited as a core danger associated with the outbreak.

The Ebola outbreak is an opportunity to clamp down on a practice which both causes disease outbreaks and empties forests of wildlife.

At a minimum, governments should zealously enforce bans on the hunting and consumption of bats and apes.

Why do Congolese keep hunting and eating bushmeat despite Ebola concerns?

It's not a disease spread by eating bushmeat. As far as we know it originated in one spillover event from one bat to a child in Guinea.

Subsequent to that it's been a human-to-human disease.

People are more vulnerable to Ebola by interacting with people than by eating bats.

Negative coverage of bushmeat has deterred people from understanding the real risk of infection.

However, despite the current outbreak, the very fact that bats are carriers means there is always a risk of further infection.

For any given contact the risk is quite low but given the scale of contact it is inevitable that there will be new emergences of Ebola or potentially other diseases that the bats harbour.

The risks may be low but the consequences are severe as we are seeing at the moment.

Because the world's population is expanding, close contract with wildlife will increase, which is often the cause of all the Ebola dilema.

Many West Africans eat bushmeat, which is always sold openly in markets across the region.

More than 100,000 bats are thought to be eaten in Ghana each year.

Cooked or smoked bushmeat is not said to be harmful.

Bushmeat, wildmeat, or game meat is meat from non-domesticated mammals, reptiles, amphibians and birds hunted for food in tropical forests. Commercial harvesting and the trade of wildlife is considered a threat to biodiversity.

Bushmeat also provides a route for a number of serious tropical diseases to spread to humans from their animal hosts.

These include Ebola. Bushmeat is used for sustenance in remote areas, while in major towns and cities in bushmeat eating societies it is treated as a delicacy.

Today the term bushmeat is commonly used for meat of terrestrial wild or feral mammals, killed for sustenance or commercial purposes throughout the humid tropics of the Americas, Asia, and Africa.

In West Africa, mostly Ghana, Ivory Coast, and Nigeria, Achatina achatina, a giant African snail, is also gathered, sold, eaten, and monitored as part of the bushmeat trade.

To reflect the global nature of hunting of wild animals, Resolution 2.64 of the IUCN General Assembly in Amman in October 2000 referred to wild meat rather than bushmeat.

A more worldwide term for terrestrial wild animals is game. The term bushmeat crisis is sometimes used to describe unsustainable hunting of often endangered wild mammals in West and Central Africa and the humid tropics, depending on interpretation.

African hunting predates recorded history; by the 21st century, it had become an international issue.

The volume of the bushmeat trade in West and Central Africa was estimated at 1-5 million tonnes per year at the turn of the century.

According to the Center for International Forestry Research (CIFOR) in 2014, approximately 5 million tonnes were still being consumed per year in the Congo Basin.

For the people of this region, bushmeat represents a primary source of animal protein in the diet, making it a significant commercial industry.

According to a 1994 study in Gabon, annual sales were estimated at US$50 million. The study found that bushmeat accounted for more than half of meat sold in local markets, with primates representing 20% of the total bushmeat.

Logging concessions operated by companies in African forests have been closely linked to the bushmeat trade.

Because they provide roads, trucks and other access to remote forests, they are the primary means for the transportation of hunters and meat between forests and urban centres.

Some, including the Congolaise Industrielle du Bois (CIB) in the Republic of Congo, have partnered with governments and international conservation organizations to regulate the bushmeat trade within the concessions where they operate.

Numerous solutions are needed; because each country has different circumstances, traditions and laws, no one solution will work in every location.

In the case of Liberia in West Africa, bushmeat is eaten widely and is considered a delicacy.

A 2004 public opinion survey found that bushmeat ranked second behind fish among residents of the capital Monrovia as a preferred source of protein.

Of households where bushmeat was served, 80% of residents said they cooked it once in a while, while 13% cooked it once a week and 7% cooked bushmeat daily.

The survey was conducted during the last civil war, and bushmeat consumption is now believed to be far higher.

The transmission of highly variable retrovirus chains causes zoonotic diseases. Outbreaks of the Ebola virus in the Congo Basin and in Gabon in the 1990s have been associated with the butchering of apes and consumption of their meat.

Bushmeat hunters in Central Africa infected with the human T-lymphotropic virus were closely exposed to wild primates.

Results of research on wild chimpanzees in Cameroon indicate that they are naturally infected with the simian foamy virus and constitute a reservoir of HIV-1, a precursor of the acquired immunodeficiency syndrome (AIDS) in humans.

There are several distinct strains of HIV, indicating that this cross species transfer has occurred several times.

Researchers have shown that HIV originated from a similar virus in primates called simian immunodeficiency virus (SIV); it is likely that HIV was initially transferred to humans after having come into contact with infected bushmeat.

The Ebola virus, for which the primary host is suspected to be fruit bats, has been linked to bushmeat.

Between the first recorded outbreak in 1976 and the largest in 2014, the virus has transferred from animals to humans only 30 times, despite large numbers of bats being killed and sold each year.

Bats drop partially eaten fruits and pulp, then land mammals such as gorillas and duikers feed on these fallen fruits.

This chain of events forms a possible indirect means of transmission from the natural host to animal populations.

Although primates and other species may be intermediates, evidence suggests people primarily contract the virus from bats.

Since most people buy smoked bushmeat, hunters and people preparing the food have the highest risk of infection.

Hunters usually shoot, net, scavenge or catapult their prey, and butcher the bats without gloves, getting bites or scratches and coming in contact with their blood.

In 2014, the suspected index case for the Ebola outbreak in West Africa is a two-year-old child in Gueckedou in south-eastern Guinea, who was the child of a family that hunted two species of fruit bat, Hypsignathus monstrosus and Epomops franqueti.

Some researchers suggested the case was caused by zoonotic transmission through the child playing with an insectivorous bat from a colony of Angolan free-tailed bats near the village.

Despite health organisations warning about risks of bushmeat, surveys pre-dating the 2014 outbreak indicate that people who eat bushmeat are usually unaware of the risks and view it as healthy food.

Because of bushmeat's role as a protein source in Western Africa, it is traditionally associated with good nutrition, and efforts to outlaw the sale and consumption of bushmeat have been impossible to enforce and have met with suspicion from rural communities.

In one study in Ghana, none of the bushmeat hunters knew about Ghana's hunting laws, suggesting that bans may not be enforceable.

The UN Food and Agriculture Organization estimates that between 30 and 80 percent of protein intake in rural households in Central Africa comes from wild meat.

However, as human populations grow, the interactions between humans and wildlife will increase, making possible zoonotic transmission of diseases from animal hosts more likely.

One major Nigerian newspaper published a report about the widespread view that eating dog meat was a healthy alternative to bush meat.

Dog meat was implicated in a June 2015 Liberian outbreak of Ebola, where three villagers who had tested positive for the disease had shared a meal of dog meat.

One study conducted in Liberia during the recent Ebola crisis showed that socio-economic conditions impacted bushmeat consumption.

During the crisis, there was a decrease in bushmeat consumption and daily meal frequency. In addition, preferences for bushmeat species stayed the same.

Animals used as bushmeat may also carry other diseases such as smallpox, chicken pox, tuberculosis, measles, rubella, rabies, yellow fever and yaws.

African squirrels (Heliosciurus, Funisciurus) have been implicated as reservoirs of the monkeypox virus in the Democratic Republic of the Congo.

The bubonic plague bacteria can transfer to humans when handling or eating North American prairie dogs.

In many instances, contracting the diseases mentioned above often occurs due to the cutting of the meat, when animal blood and other fluids may touch the people cutting it, thereby infecting them.

Another path of infection is that some of the meat may not be completely cooked. This often occurs due to the type of cooking method: hanging the meat over an open fire.

Improper preparation of any infected animal may be fatal.

The consumption of bushmeat threatens a wide range of species, including species that are endangered and threatened with extinction. For example, a range of endangered species are hunted for bushmeat in Liberia.

Species hunted for food in Liberia include elephants, pygmy hippopotamus, chimpanzees, duikers, and other monkeys. Forest rangers in Liberia say that bushmeat poachers will kill any forest animal they encounter.

The great apes of Central and West Africa gorillas and chimpanzees are nearly ubiquitously sold as bushmeat throughout the region, and a study from 1995 suggests that the off take is unsustainable.

With the exception of a 1995 report from Cameroon, where gorillas were considered a target species for hunters, Central and West African hunters do not appear to target them.

Historically, poachers have favored hunting chimpanzees because they flee when one is shot.

Gorillas, however, only became easy targets when buckshot ammunition became available, allowing the hunters to more easily kill the dominant male silverback whose role it is to defend his troop.

Generally, great apes constitute a minor portion of the bushmeat trade. Although a 1996 study indicated that approximately 1.94% of animal carcasses sold and consumed in Brazzaville in the Republic of the Congo belonged to great apes.

It accounted for 2.23% of the biomass of the meat sold, which is significant for ape populations relative to their ecosystem.

Furthermore, these numbers may not have accurately represented the extent of the problem for the following reasons:

- Vendors may not have admitted the sale of great ape meat because it is illegal therefore giving wrong information.

- The carcasses are large, and may therefore have been consumed locally rather than been transported to large markets.

- Great ape hunting usually peaks when new forest areas are made accessible as they are unwary when unfamiliar with humans, but later hunting declines.

- It is nearly impossible to visually distinguish the meat source when it has been smoked.

Secondary effects, such as unintended deaths from traps, are not represented in market data.

During the time interval between a study from 1981 to 1983 and another study between 1998–2002 in Gabon, ape population density fell 56%, despite the country retaining nearly 80% of its original forest cover.

This decline was primarily associated with the transformation of the bushmeat trade from subsistence level to unregulated, commercial hunting, facilitated by transportation infrastructure intended for logging purposes.

Unsustainable hunting practices along with habitat loss makes the extinction of these endangered primates more likely.

Just stop eating or buying game meat!!!!!!!!!!!!!!!!

Tourism Observer

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