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DRC Tshopo / DREF Meningitis outbreak - Operation Update report 1 (n° MDRCD033)

DR Congo
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Summary of major revisions made to emergency plan of action:

The DREF MDRCD033 DRC meningitis was initially approved for four months with an end date of 31 January 2022.
This update aims to inform stakeholders on the progress made in implementing the DREF, key challenges and accomplishments, as well as request an extension of the operation by one month. This extension will take into account delays related to the organization of the lessons learned workshop and the strengthening of ongoing epidemiological surveillance (partially achieved).

Although the provincial minister declared the end of the meningococcal meningitis epidemic (24 December 2021) in the health zone of Banalia (Tshopo province), the following measures were taken and will be followed through with RCCE/CEA activities during the remaining weeks. This DREF will continue to engage communities to ensure government measures such as:

  • Remain vigilant as the risk of resurgence of epidemics remains permanent.

  • Strengthening the epidemiological surveillance system.

  • Continuation of team activities and support in the transfer of skills to local providers for the sustainability of achievements of this response.

  • Maintain the alert and Community Based Surveillance mechanisms to remain vigilant throughout the postMeningitis epidemic period.

During the one month left, DRC Red Cross would like to continue to strengthen epidemiological surveillance and subsequently conduct a lesson learned workshop.

The deployment of a surge that was planned for the operation could not take place. However, the IFRC technical team present in the country was able to provide support to the DRC RC for the operation.


Description of the disaster

On 7 September 2021, the National Minister of Public Health declared a meningitis epidemic in the DRC. This declaration follows confirmation by the National Institute for Biomedical Research (INRB) and the Institut Pasteur in Paris of the presence of meningococcal meningitis type W in the samples of some patients taken in the province of Tshopo. The epidemiological events that raised suspicions date back to the beginning of July 2021 following an increase in deaths in a clinical picture of fever, headache, stiff neck, suggestive of meningitis. However, preliminary investigations have helped to establish that the health events observed date back to the beginning of June 2021 (S23) in two mining outbreaks in the health area (HA) of Panga, health zone (HZ) of Banalia, located north of Kisangani, capital of Tshopo province. According to the WHO epidemiological bulletin dated 13 September 2021, 301 suspected cases of meningitis, including 131 deaths (case-fatality rate of 48.8%) have been recorded since the beginning of the epidemic. The WHO noted the notification of 39 new suspected cases between 10 and 11 September 2021.

A few observations can be made at this level:

  • The epidemic remained confined to the Banalia health zone as 13 of 20 health areas (65%) have notified suspected cases.

  • The health area of Panga remained the epicentre of the disease as it has notified 72% of suspected cases (216/301).

  • The epidemic has progressed as a new health area (Ste Elisabeth) has been affected during the past week according to the WHO epidemiological bulletin of 13 September 2021.

  • The slightly high Case fatality (48.8%) indicated the need for rapid action at the community level.

As of 11 September 2021, 13 of the 20 health areas in this health zone were affected, 18 patients were in hospital and under treatment for meningitis, including 7 in Panga, 6 in Bethsaida, 3 in General referral hospital Banalia and 2 in Lukelo. According to an expert opinion from the Ministry of Health, all age groups were vulnerable to meningitis. However, the National Committee for the Fight against the disease in the DRC states in its latest report dated 8 September 2021 that the age group most affected by the current meningitis epidemic is 15 years and older. The population exposed to this meningitis epidemic resides in the Banalia health zone in Tshopo province. The total population of the Banalia health zone is 162,723 people, spread over 20 health areas.

It follows from the above that the DRC was once again faced with the emergence of a new meningitis epidemic, the last emergence of which dates to November 2009 with 214 cases and 18 deaths (a case-fatality rate of 8%) in the town of Kisangani, still in the Province of Tshopo. The epidemic was confined to the Banalia health zone but had shown an evolving trend. This situation, which put additional pressure on the DRC's health system already weakened by multiple health risks, the most current of which are Ebola virus disease (EVD), cholera, measles and COVID-19, requires the rapid involvement of the DRC RC volunteers in Tshopo to slow down the progression of meningitis within communities and mitigate its impact.

As of 16 November 2021, the most affected age group was 30-49 years, representing 37.5% of all cases. Out of a total of 2,661 notified suspected cases, 313 (11.76%) reported having been vaccinated during the meningitis A preventive campaign with MenAfriVac in May 2016.

The overall case fatality has improved (7.7% as of 20 December 2021) compared to the beginning of the epidemic (100%). This decrease in case fatality is due to early consultation of patients because of increased communication, surveillance and improved case management. The most affected health areas were Panga (epicentre) followed by Mangi, Lukelo, Mosanda, Bongonza, Dr Sharpe and Kole.

The epidemic remained limited in the Banalia health zone where 100% (20/20) of the health areas reported at least 1 suspected case. Nevertheless, suspected cases were under investigation in the health zones at risk, notably in the health zones of the city of Kisangani (Tshopo, Makiso, Mangobo), Bengamisa, Bafwagbobo and Yakusu.

In week 47 (28 November), out of a total of 20 health areas, 18, or 90%, had returned to the normal situation, i.e. neither in epidemic nor on alert, and two health areas (LUKELO and MOSANDA) had returned to alert. After the gradual improvement of the situation, surveillance, social mobilisation, community engagement and accountability (CEA) activities have continued in the affected communities. The DRC RC and other partners, such as Mini-santé, WHO and UNICEF, MSF/Switzerland continued their interventions.

On 24 December 2021, the provincial minister declared the end of the meningococcal meningitis epidemic in the health zone of Banalia (Tshopo province), the following measures were taken and will be followed through RCCE/CEA activities during the remaining weeks. The DREF will continue to engage communities to ensure government measures to strengthen the epidemiological surveillance system. Note that after the declaration of the end of the epidemic by the provincial Ministry of Health, a total of 2,662 cases and 205 deaths were already recorded.