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DRC: Plague outbreak in Ituri - Operation Update 1, DREF No. MDRCD035

DR Congo
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GLIDE n° EP-2022-000202-COD

Summary of major revisions made to emergency plan of action:

This operation update is to inform on the implementation progress in response to both the bubonic and pneumonic plague through a DREF launched on 22 April 2022 and extend the operation to respond to the two plague outbreaks for two additional months.

The main changes supported by this update are as follow:

• Notification of a case (01) of pneumonic plague declared by MoH on 27 May 2022 in Lokpa health area, tested positive by rapid diagnostic test (RDT). Pneumonic plague can be transmitted from person to person, while bubonic plague cannot.

• The epidemic has spread beyond the 3 initial Health areas including Gudjo, Rethy and Kpandroma from Health Zone of Rethy (HZ). 400 bubonic cases have been reported since April against 58 cases at the launch of this DREF response. Total at risk Health Zone are Rethy and neighboring HZ of Rethy: Angumu Kambala, Mangala, Fataki, Logo, Linga and Rimba.

• Continuous lack of diagnostic tests, with pneumonic plague requiring safe burials for all positive cases deaths given the transmission mechanism through human secretion.

In view of its role as an auxiliary to the public authorities, the DRC RC, is thus required, following the MoH and WHO indications, to update the operational plan for more impact with the following changes undertaken:

• Increase total target of the operation from 91,738 people to 241,162 people.

• Direct target changing from 35,995 people in 3 affected areas to 88,087 people for 6 affected areas (Lokpa, Rassia, Uketha, Rethy, Kpandroma, Gudjo in Rethy Health Zone). Extension of the initial response and inclusion of pulmonary response with adequate protection material, prevention, SDB and Vector control activities for direct target.

• Communities’ prevention activities and National Society preparedness actions in 8 Health Zone neighbour of the affected health areas. This indirect target changing from 55,743 people to 153,075 people. 5% of the population.

  • Eight (08) health areas adjacent to the 6 epicenters (Terali, Aboro, Zali, Budza, Kokpa,
    Ngirimandefu, Ngribalo in the Rethy HZ) and Gengere in the Angumu Health Zone,

  • Seven (07) neighbouring health zones of Rethy. Angumu, Kambala, Mangala, Fataki,
    Logo, Linga and Rimba)

This will involve strengthening of capacities in, CEA, Wash and PSS through the following main activities:

• Enhanced surveillance with 98 additional volunteers trained and deployed in the 6 affected health areas and 8 adjacent areas. Total activated volunteers will be 240 in 14 health areas.

• Increase capacity for contact follow-up in the 14 health areas and infection prevention.

• Capacity building of all the community health volunteers added, using the EPiC model, to increase the capacity to detect and refer cases in the community to health centres.

• Strengthening of the RCCE strategy through the increase of the capacities of the teams to focus on radio, the feedback system including the strengthening of skills in interpersonal communication, necessary for the effective continuation of health education actions on the fight against plague. Enhance the information mechanism to communities on the disease to increased community surveillance in the villages.

• Sensitise of the overall target populations in good to build granaries to separate community members (households) from agricultural and pastoral products that attract rodents (sources of contamination).

• Provision of adequate Protective material for the plague burials and sanitation with PPE needed for plague burials which should include a gown, goggles, N95 masks and gloves.

• Strengthen the capacity of the Wash/ interventions to control fleas and rodents with

  • The provision of additional material for sanitation in the villages: shovels, caoutchouc gloves, mask and wheelbarrows for clearing brush, digging rubbish pits to keep rats out of households e.t.c. The formation of hygiene committees in each village which will support the promotion of individual hygiene messages and the setting of all the sanitation activities.

  • Support health areas for desensitisation.

• Deployment of an DRC RC information management (IM) focal point in Bunia (Ituri)

• The deployment of the planned surge is cancelled following the security rules in place in Bunia, which not allowed to carry out activities in the health zones of Bunia and international staff presence. However, the IFRC team based in Kinshasa and Bunia continues to provide the necessary remote support to the DRC RC on this operation.

• Request an additional allocation of CHF 125,337 for a total of CHF 312,460 to cover the costs of the changes in the operational plan.


The 9th outbreak of plague was announced by the Provincial Health Division (DPS) of Ituri province on 4 April 2022 in the health zone of Rethy, Djugu territory in the Democratic Republic of Congo. Plague is endemic in this part of the country and cases of infection with enzootic variants of Yersinia pestis are frequently found in a large part of the wild rodent population.

According to the information available from the INRB, it is likely that all three clinical forms of plague (bubonic, septicaemic, and pulmonary) are present.

The current epi-data shows alongside are positive diagnostic cases based on clinical signs, as currently the DPS still facing issue to get the laboratory tests for diagnostic purposes. Only the pneumonic case declared by MoH has been identified through the rare available rapid diagnostic test at the health zone. As such, there is a high risk of unknown spreading of pulmonary cases and an urge need to reinforce the prevention for both bubonic and pneumonic plague.
Although the absence of diagnostic tests is still a handicap to the confirmation of cases, there has been a clear communication from health areas on the case hold evolution trend as follows:

• Between weeks 1-22, 261 cases of suspected bubonic plague have been reported, with 6 deaths (Case Fatality Rate, CFR 2.3%). All cases have been reported from Rethy health zone (Ituri). Cases are primarily concentrated in three sanitation areas: Lokpa, Rassia and Uketha (as per the graph). Cases are up by more than 100% compared to the same period in 20211 when there was a total of 115 suspect cases and 13 deaths.

• As of 30 June 2022, the information communicated by MoH on the epidemiological situation show a suspected cumulative number of 400 cases with one (01) pneumonic case in Lokpa, compared to 58 when the Emergency Action Plan (EPoA) was issued on 22 April 2022.

• Pneumonic case was officially confirmed by MoH on 27 May 2022, thanks to rare diagnostic test available at the health Zone.

On the security front, there are reports of atrocities and violence attributed to militias/armed groups against the population of this territory (Djugu and its surroundings). This sometimes makes it impossible for other partners to intervene apart from the local Red Cross branch in Djugu. Similarly, the current lack of equipment greatly limits the response and the establishment of an effective system for fighting and limiting the disease. From DPS information, there is lack of laboratory tests for the diagnostic of plague as mentioned above but also medicines for the treatment of patients and a logistical problem for the transport of tests and materials. With the spread of the disease detailed above, the vulnerability of the population will remain high and there is an urging need to scale-up the response to include the current geographical expansion, changes in priority actions and set an appropriate response.