Risk factors for Ebola exposure in healthcare workers in Boende, Tshuapa Province, Democratic Republic of the Congo

Healthcare workers (HCW) are more likely to be exposed to Ebola virus (EBOV) during an outbreak compared to people in the general population due to close physical contact with patients and potential exposure to infectious fluids. However, not all will fall ill. Despite evidence of subclinical and paucisymptomatic Ebola Virus Disease (EVD), the prevalence and associated risk factors remains unknown. We conducted a serosurvey among healthcare workers in the town of Boende in Tshuapa Province, Democratic Republic of Congo (DRC). Human anti-EBOV Glycoprotein (GP) IgG titers were measured using a commercially available ELISA kit. We assessed associations between anti-EBOV IgG seroreactivity, defined as ≥2.5 units/mL and risk factors using univariable and multivariable logistic regression. Sensitivity analyses explored a more conservative cutoff >5 units/mL. Overall, 22.5% of HCWs were seroreactive for EBOV. In multivariable analyses, using any form of personal protective equipment (PPE) when interacting with a confirmed, probable, or suspect EVD case was negatively associated with seroreactivity [0.23 (95% CI: 0.07, 0.73)]. Our results suggest high exposure to EBOV among HCWs and provide additional evidence for asymptomatic or minimally symptomatic EVD. Further studies should be conducted to determine the probability of onward transmission and if seroreactivity is associated with immunity.

Challenges of ongoing Covid and Ebola epidemics amidst violence and other epidemics in DR Congo

The world has seen outbreaks of emergency and re-emergency of infectious diseases very often in the past years, many of them with devastating consequences for low-income countries with fragile or nonexistent health system, covid-19 being by now the last of a long series of global challenges. Although it is a huge challenge for the whole world, one country is facing it together with a current Ebola outbreak plus violence and some other diseases. The Democratic Republic of Congo is facing the immediate effects of both epidemics as illness and death, however its consequences at the political and economic level are usually more complex and may be protracted. Following the debate on why poor countries remain poor, it is maybe useful to rethink poverty and inequality keeping in mind Amartya Sen's seminal concepts: development must comprise freedom and respect for human rights and institutions at the price of fostering a vicious circle of (re)emerging diseases and structural violence. Ebola epidemics, that usually face some challenges when they happen alone, now together with malaria, measles, plague and covid, on top of violence in some areas, the disease sees its protocols harmed: for covid the orientation is to stay isolated, for Ebola the response includes tracking contacts. What means coming with a team to field to do the mapping in the middle of a confinement. The surveillance for such many epidemics on top of violence and humanitarian crisis makes the Democratic Republic of Congo one of the most worrying countries in terms of consequences of the Covid outbreak.

Serologic Markers for Ebolavirus Among Healthcare Workers in the Democratic Republic of the Congo

Healthcare settings have played a major role in propagation of Ebola virus (EBOV) outbreaks. Healthcare workers (HCWs) have elevated risk of contact with EBOV-infected patients, particularly if safety precautions are not rigorously practiced. We conducted a serosurvey to determine seroprevalence against multiple EBOV antigens among HCWs of Boende Health Zone, Democratic Republic of the Congo, the site of a 2014 EBOV outbreak. Interviews and specimens were collected from 565 consenting HCWs. Overall, 234 (41.4%) of enrolled HCWs were reactive to at least 1 EBOV protein: 159 (28.1%) were seroreactive for anti-glycoprotein immunoglobulin G (IgG), 89 (15.8%) were seroreactive for anti-nucleoprotein IgG, and 54 (9.5%) were VP40 positive. Additionally, sera from 16 (2.8%) HCWs demonstrated neutralization capacity. These data demonstrate that a significant proportion of HCWs have the ability to neutralize virus, despite never having developed Ebola virus disease symptoms, highlighting an important and poorly documented aspect of EBOV infection and progression.

Sparks creating light? Strengthening peripheral disease surveillance in the Democratic Republic of Congo

SETTING

The Democratic Republic of Congo suffers from an amalgam of disease outbreaks and other medical emergencies. An efficient response to these relies strongly on the national surveillance system. The Pool d'Urgence Congo (PUC, Congo Emergency Team) of Médecins Sans Frontières is a project that responds to emergencies in highly remote areas through short-term vertical interventions, during which it uses the opportunity of its presence to reinforce the local surveillance system.

OBJECTIVE

To investigate whether the ancillary strengthening of the peripheral surveillance system during short-term interventions leads to improved disease notification.

DESIGN

A descriptive paired study measuring disease notification before and after 12 PUC interventions in 2013-2014.

RESULTS

A significant increase in disease notification was observed after seven mass-vaccination campaigns and was sustained over 6 months. For the remaining five smaller-scaled interventions, no significant effects were observed.

CONCLUSION

The observed improvements after even short-term interventions underline, on the one hand, how external emergency actors can positively affect the system through their punctuated actions, and, on the other hand, the dire need for investment in surveillance at peripheral level.