A. Situation analysis
Description of the disaster
On 04 April 2022, the Provincial Health Division (DPS) of the province of Ituri declared a resurgence of the Bubonic Plague epidemic in the health zone of Rethy, in the territory of Djugu. According to the authorities, the history of this disease in the Rethy health zone goes back to more than 9 outbreaks, including this one. The eighth one dates back to January 2022 in the UKETHA health area. On 07/04/2022, the epidemiological situation covering 26 March to 4 April was as follows from DPS data: 31 notified cases of which only 15 have been tested, 2 deaths and nearly 2,000 contacts listed in the absence of local reactivity. The epicenter of the plague disease is in the Health Areas of Lokpa, Rassia, and Uketha, where the 3 confirmed cases are located. These three health areas are in the Rethy health zone, Djugu territory, in ITURI Province.
Between 4 and 16 April 2022, 27 suspected cases in addition to the above were notified by the Lokpa Health Centre but in the absence of testing, the confirmation of cases remains very low and the level of vulnerability is underestimated. The absence of partners in the Rethy Health Zone apart from the local branch of the DRC Red Cross, MEDAIR, and MALTESER, as well as the lack of materials, greatly limits the response and the establishment of effective disease control and containment system.
This health zone of Rethy is in a permanent state of insecurity, which is at the root of the lack of partners and is subject to the internal displacement of the population. Populations fled Rethy to Fataki in 2021 following clashes from November to December and then from Fataki to Rethy following attacks in Rethy between armed groups in February 2022. There is a likelihood that population flows are linked to cases and/or influence the spread of the disease. In the Ngri Mandefu Health areas, for example, 8,306 were displaced to the Mbr'bu, Bale, and Gudjo Health Areas, following clashes between the military and armed men in Dhera locality on 30 March. In total, the Rethy Health Zone has 60,875 IDPs from other health areas according to an OCHA report of 7 March 2022, and 59,921 people who had left Rethy and have now returned.
It should be noted that plague is endemic in Ituri province. Most patients recorded as suspected cases present symptomatology of fever, lymph nodes, and headache, and these lymph nodes are mostly inguinal, submaxillary, axillary, jugular, and cervical. These plague-like symptoms were recorded in the Rethy health zone. The initial symptoms of all forms of plague are similar to those of influenza in the early stages of the disease. However, based on these symptoms, and considering that the recorded cases of death have been declared as Bubonic plague by the health zone, it is projected that the most widespread probable cases would be Bubonic plague.
It should be noted that plague is an infectious disease caused by the bacterium Yersinia pestis, which is found in rodents and their fleas. There are three types of plague: Bubonic, pneumonic and septicaemic.
Bubonic, which is the most common with inflammation of the lymph nodes in addition to the above symptoms and is caused by the bite of an infected flea feeding on an infected rodent, commonly rats.
In 2020 Ituri recorded 461 cases of bubonic plague with 31 deaths, compared to 138 cases with 14 deaths in 2021. The Rethy Health Zone is among the highest case-producing areas in the province, with a total of 13 deaths between January 2020 and 3 April 2022 (including the 9th outbreak - 2022 declaration described above).
During the 7th resurgence of the plague epidemic in the DRC in Ituri, the National Society was overwhelmed by the need to respond to the EBOLA epidemic, and its capacity was absorbed by the scale of the response. All teams were focused on Ebola, which the government had also prioritized. During this epidemic, there was a very significant spread of the disease (461 cases, 31 deaths). With this 9th resurgence of the disease, with 31 suspected cases from January to 6 April and almost 27 additional cases between 6 and 16 April, the risk remains very high. The absence of RDTs could lead to an unknown spread and the limit of the current response capacity of the health zone coupled with risk factors such as population movement, household living conditions, etc, increases the need for support expressed by the DPS.
Ituri is the only province in DRC to record plague cases and the border countries familiar with the disease in the context of population movement inside the country with other health areas and across the border still make this area very vulnerable to a resurgence of the epidemic