Abstract
While the clinical, laboratory and epidemiological investigation results of the Ebola outbreak in Likati Health Zone, Democratic Republic of the Congo (DRC) in May 2017 have been previously reported, we provide novel commentary on the contextual, social, and epidemiological characteristics of the epidemic. As first responders with the outbreak Surveillance Team, we explain the procedures that led to a successful epidemiological investigation and ultimately a rapid end to the epidemic. We discuss the role that several factors played in the trajectory of the epidemic, including traditional healers, insufficient knowledge of epidemiological case definitions, a lack of community-based surveillance systems and tools, and remote geography. We also demonstrate how a collaborative Rapid Response Team and implementation of community-based surveillance methods helped counter contextual challenges during the Likati epidemic and aid in identifying and reporting suspected cases and contacts in remote and rural settings. Understanding these factors can hinder or help in the rapid detection, notification, and response to future epidemics in the DRC.
Highlights
In April 2017 [1, 2] the Likati Health Zone office in the northern province of Bas Uélé in the Democratic Republic of the Congo (DRC) identified a cluster of illnesses and deaths with Ebola-like symptoms
While the DRC is experienced in outbreak response, having responded to more Ebola Virus Disease (EVD) outbreaks than any other country, the current (2018– 2019) EVD outbreak in Ituri and North Kivu provinces—the longest-lasting in DRC’s history—has demonstrated that when certain factors converge, outbreaks can still be a challenge to contain [11]
As members of the Rapid Response Team, we describe the methods of our epidemiological investigation and expand upon previously published results [6] by describing the contextual, social and epidemiological factors that contributed to the Likati outbreak, and the potential implications these findings have on future EVD outbreaks in the DRC
Summary
In April 2017 [1, 2] the Likati Health Zone office in the northern province of Bas Uélé in the Democratic Republic of the Congo (DRC) identified a cluster of illnesses and deaths with Ebola-like symptoms. The MOH officially declared the EVD outbreak in the Likati Health Zone on May 11, 2017 [1] after a blood sample collected from one of five suspected cases tested positive by reverse transcription-polymerase chain reaction (RT-PCR) [5] for Ebola virus subtype Zaire at the national reference laboratory in Kinshasa [6]. Tropical forests rich in animal diversity and growing in population density, like those in the DRC, have been shown to increase the risk of emerging infectious diseases [9]. These ecological factors, regional sociopolitical insecurity and instability, shared borders with nine other countries, and a mobile population, make DRC highly vulnerable to disease outbreaks [9, 10]. While the DRC is experienced in outbreak response, having responded to more EVD outbreaks than any other country, the current (2018– 2019) EVD outbreak in Ituri and North Kivu provinces—the longest-lasting in DRC’s history—has demonstrated that when certain factors converge, outbreaks can still be a challenge to contain [11]
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