Reports indicating that up to 80 per cent of contacts linked to the thousands of confirmed Ebola cases in the Democratic Republic of Congo (DRC) have been traced are inaccurate, the Africa Centres for Disease Control and Prevention (Africa CDC) has revealed.
Speaking to journalists during the latest media briefing, Africa CDC Director General Dr Jean Kaseya said the number of contacts actually being followed up is far lower than the figures being reported. He warned that the outbreak, first declared in May, is rapidly becoming the largest Ebola outbreak on record, surpassing the 2014 West African outbreak, which infected more than 28,000 people over two years.
Contact tracing, a public health measure recommended by the World Health Organisation (WHO), involves epidemiologists and surveillance teams identifying, testing and monitoring people who have been in contact with an infected person to prevent further transmission.
Kaseya said that while health workers in Uganda were able to trace an average of 40 contacts for every confirmed case, the approach is proving increasingly difficult in the DRC. He said responders there are listing an average of 57 contacts for follow-up for every confirmed case, but are only managing to reach between nine and 10 of them.
The DRC has so far confirmed 4,449 cases and 2,061 deaths, representing a case fatality rate of 46 per cent, higher than the 40 per cent recorded during the 2014 West African outbreak, which remains the largest Ebola outbreak recorded to date. Kaseya said children below one year of age account for 66 per cent of the deaths recorded in the DRC.
Figures released by the DRC Ministry of Health show that, by Monday, only 886 people had been confirmed to have recovered from the disease. Against this backdrop, Kaseya said responders need to change their approach to contact tracing and adopt a village-centred strategy in which community health workers lead surveillance teams to people who may be sick.
He said that despite ongoing awareness campaigns and contact tracing efforts, more than 60 per cent of the confirmed deaths have occurred at community level rather than in health facilities. This makes it difficult for responders to guarantee that bodies are handled safely and that the necessary infection prevention and control measures are followed.
Studies indicate that Ebola had been spreading silently in the DRC since February, with unexplained deaths occurring in communities without being detected by the formal health system. Kaseya warned that continued failure to identify and respond to community deaths could worsen the outbreak in the DRC and increase the risk of the virus spreading to neighbouring countries, as happened with Uganda.
In Uganda, however, State Minister for Primary Health Care Dr Charles Ayume said the country remains on high alert despite declaring itself Ebola-free after discharging all confirmed cases and their contacts. He said the government is continuing to invest heavily in border surveillance and preparedness to prevent the importation of another Ebola case.
Ayume said deploying Ugandan health workers to assist the response in the DRC is among the measures being taken to keep the disease from spreading into Uganda. He also said the government has planned multi-stakeholder engagements in all border districts to reinforce Ebola prevention messages, with the campaign expected to begin in the West Nile region next week.
