WHO issues warning as measles infects 34,000 in Europe this year

FILE PHOTO: A vial of the measles, mumps, and rubella (MMR) vaccine is pictured at the International Community Health Services clinic in Seattle, Washington, U.S., March 20, 2019. REUTERS/Lindsey Wasson/File Photo

By Kate Kelland

LONDON (Reuters) – More than 34,000 people across Europe caught measles in the first two months of 2019, with the vast majority of cases in Ukraine, the World Health Organization said on Tuesday as it urged authorities to ensure vulnerable people get vaccinated.

The death toll among 34,300 cases reported across 42 countries in the WHO’s European region reached 13, with the virus killing people in Ukraine – which is suffering a measles epidemic – as well as in Romania and Albania. The risk is that outbreaks may continue to spread, the WHO warned.

“If outbreak response is not timely and comprehensive, the virus will find its way into more pockets of vulnerable individuals and potentially spread to additional countries within and beyond the region,” it said in a statement.

“Every opportunity should be used to vaccinate susceptible children, adolescents and adults.”

Measles is a highly contagious disease that can kill and cause blindness, deafness or brain damage. It can be prevented with two doses of an effective vaccine, but – in part due to pockets of unvaccinated people – it is currently spreading in outbreaks in many parts of the world including in the United States, the Philippines and Thailand.

In Europe, the majority of measles cases so far in 2019 are in Ukraine, which saw more than 25,000 people infected in the first two months of the year.

There is no specific antiviral treatment for measles, and vaccination is the only way to prevent it, the WHO said. Most cases are in unvaccinated or under-vaccinated people.

It added that even though the region had its highest ever estimated coverage for the second dose of measles vaccination in 2017 – at around 90 percent – some countries have had problems, including declining or stagnating immunization coverage in some cases, low coverage in some marginalized groups, and immunity gaps in older populations.

The WHO called on national health authorities across the region to focus efforts on ensuring all population groups have access to vaccines.

“The impact on public health will persist until the ongoing outbreaks are controlled,” it said, adding that health authorities should “identify who has been missed in the past and reach them with the vaccines they need.”

A report by the United Nations children’s fund UNICEF last month found that more than 20 million children a year missed out on measles vaccines across the world in the past eight years, laying the ground for dangerous outbreaks.

(Reporting by Kate Kelland; Editing by Mark Heinrich)

Congo Ebola death toll nears 1,000, new vaccine planned -WHO

Mike Ryan, Executive Director of the World Health Organisation (WHO) attends a news conference on the Ebola outbreak in the Democratic Republic of Congo at the United Nations in Geneva, Switzerland May 3, 2019. REUTERS/Denis Balibouse

By Stephanie Nebehay

GENEVA (Reuters) – The World Health Organization said on Friday it feared continued “intense transmission” of Ebola virus in the Democratic Republic of Congo, where deaths from a nine-month-old epidemic stood at 994 and were expected to exceed 1,000 within hours.

The WHO plans to expand vaccination with an unlicensed new Ebola vaccine made by Johnson & Johnson, in addition to a Merck vaccine already being used, said Dr. Michael Ryan, executive director of WHO’s Health Emergencies Programme.

“We are anticipating a scenario of continued intense transmission,” Ryan told a news briefing.

“We haven’t exceeded the 1,000 (deaths) as of this morning but we will likely exceed that today when we see the numbers later this evening. We want to use every tool in the tool box.”

Security incidents continue to plague the response to the outbreak, with 119 since January alone, Ryan said. This curtails access and thereby slows efforts to vaccinate more than 900 people a day as well as daily checks on some 12,000 people potentially exposed to the virus, he said.

“We still face major issues of community acceptance and trust,” Ryan added.

There was a would-be assault on an Ebola treatment facility in Butembe on Thursday, he said, adding that nobody was injured and the assailants were captured.

(Reporting by Stephanie Nebehay; Editing by Mark Heinrich)

East Libyan warplanes hit Tripoli government positions

Troops from eastern Libyan forces are seen in Ain Zara, south of Tripoli, Libya April 11, 2019. Picture taken April 11, 2019. REUTERS/Stringer

By Ulf Laessing and Ahmed Elumami

TRIPOLI (Reuters) – Eastern Libyan forces bogged down in street battles in a push to seize the capital Tripoli deployed warplanes on Friday to hit several government positions, as more civilians fled the fighting.

More than 1,000 people gathered in central Tripoli to demand that Khalifa Haftar stop the advance of his Libyan National Army (LNA) on the coastal city of about 1.2 million people.

Haftar launched the campaign a week ago, in the latest conflict in a cycle of anarchy since the 2011 overthrow of dictator Muammar Gaddafi.

But forces loyal to Prime Minister Fayez al-Serraj’s internationally recognized government have so far kept them at bay, with fierce fighting around a disused former airport about 11 km (7 miles) from the center.

On Friday, an LNA warplane bombed the camp of a force allied to Serraj in Zuwara, west of Tripoli toward the Tunisian border, an LNA military source and residents said.

Zuwara is near the Mellitah oil and gas plant, jointly operated by Italy’s ENI and state oil firm NOC, which supplies Italy with gas through the Greenstream pipeline.

An LNA warplane also attacked the only partly-functioning airport in Tripoli, Mitiga, where anti-aircraft opened fire in response, witnesses said. The extent of damage and possible casualties in both places was not clear.

A week of battles has killed 75 people – mainly fighters but also 17 civilians – and wounded another 323, according to latest U.N. tallies. Some 9,500 people have also been forced out of their homes.

As the sound of fighting echoed around their city, residents sought to maintain some normality on Friday.

Some families were eating in cafes next to the fish market where people were stocking up for the weekend.

“We have got used to wars. I fear only in God,” said Yamim Ahmed, 20, who works in a fast food restaurant.

More than 1,000 people staged a protest in Martyrs Square in central Tripoli to demand an end to the offensive, witnesses said. The turnout was bigger than last Friday.

As well as the humanitarian cost, the conflict threatens to disrupt oil supplies, increase migration across the Mediterranean to Europe, scupper a U.N. peace plan, and allow Islamist militants to exploit the chaos.

CITY STALEMATE

Haftar, 75, a former general in Gaddafi’s army who later joined the revolt against him, moved his troops out of their eastern stronghold to take the oil-rich, desert south earlier this year, before sweeping up to Tripoli at the start of April.

But Serraj’s government has managed to halt for now the advance, helped by forces with machine-guns on pickups and steel containers across the road into Tripoli. The Tripoli government says it has taken nearly 200 prisoners from Haftar’s forces.

The United Nations, which had hoped to organize a national conference this month bringing the rival eastern and western administrations together to organize an election, has called for a ceasefire. The United States, G7 bloc of wealthy nations and European Union have also urged the LNA to halt its offensive.

Tripoli-based Foreign Minister Mohamed Siyala urged the U.N. Security Council to call on Haftar to halt the advance.

The U.N. health agency said it fears outbreaks of tuberculosis, measles and diarrhea due to poor sanitation, especially among those displaced.

Five ambulances have been hit trying to extract wounded people from the conflict zone, World Health Organisation (WHO) representative Dr Syed Jaffar Hussain also told a Geneva news briefing from Tripoli.

The WHO said it had only two weeks of medical supplies available for Tripoli’s hospitals.

Haftar casts himself as a bulwark against Islamist militancy who wants to restore order to Libya. But opponents see him as a potential would-be new dictator like Gaddafi.

He has so far resisted U.N. pressure to accept a power-sharing settlement, using his leverage as an ally of the West in attempts to stem jihadists in North Africa.

About 1,500 refugees and migrants are trapped in detention centers, the head of the U.N. refugee agency said. “They must be urgently brought to safety. Simply put, this is a matter of life or death,” Filippo Grandi said in a statement.

Libya is a major transit point for migrants pouring into Europe in recent years, mostly trafficked by smuggling gangs.

(Additional reporting by Ayman al-Warfalli in Benghazi, Ahmed Salem in Tripoli, Tom Miles, Stephanie Nebehay in Geneva; Writing by Ulf Laessing; Editing by Kevin Liffey and Andrew Cawthorne)

Ebola spread concentrated in Congo, not a wider emergency: WHO

FILE PHOTO: Health workers carry a newly admitted confirmed Ebola patient into a treatment centre in Butembo in the eastern Democratic Republic of Congo, March 28, 2019. REUTERS/Baz Ratner

By Stephanie Nebehay and Kate Kelland

GENEVA/LONDON (Reuters) – An outbreak of Ebola in the Democratic Republic of Congo (DRC) that has killed more than 700 people and is continuing to spread does not constitute an international emergency, the World Health Organization said on Friday.

Declaring the epidemic a “public health emergency of international concern” would have signaled that greater resources and international coordination are needed.

The WHO’s independent Emergency Committee, which analyzed the latest data, said the disease was entrenched in several epicenters in the northeast and was being transmitted in health care settings.

It had not spread across borders to Uganda, Rwanda or South Sudan, but neighboring countries should shore up their preparedness, the experts said.

“It was an almost unanimous vote that this would not constitute a PHEIC (public health emergency of international concern) because we are moderately optimistic that this outbreak can be brought into control – not immediately, but still within a foreseeable time,” panel chairman Professor Robert Steffen told a news conference.

Dozens of new cases reported this week have been mainly in the epicenters of Butembe, Katwe and Vuhovi, said Mike Ryan, head of the WHO’s health emergencies program.

“It’s quite a focused amplification of disease in a very specific geographic area,” Ryan said.

“But the disease there has risen because of lack of access to that community, we’ve fallen behind in starting vaccination rings,” he said, referring to attacks on health centers by armed groups in February that cut-off hotspot areas.

“Vaccine is proving to be a highly effective way of stopping this virus but if we can’t vaccinate people we cannot protect them,” he added, noting that nearly 100,000 people have been vaccinated.

Experts have declared four emergencies in the past decade: the H1N1 virus that caused an influenza pandemic (2009), a major Ebola outbreak in West Africa (2014), polio (2014) and Zika virus (2016).

Some experts expressed concern that the Emergency Committee was too narrowly interpreting WHO guidelines.

“This is a deeply concerning event, due to the pathogen itself, the total number of cases, the increase in cases just this week, and the difficulty of coordinating the response due to conflict – that needs to receive the appropriate level of attention,” health experts Rebecca Katz and Alexandra Phelan of Georgetown University in Washington D.C. said in a statement.

The Ebola outbreak – by far the biggest Congo has seen, and the world’s second largest in history – was declared by national authorities in August. It is concentrated in Congo’s North Kivu and Ituri provinces.

It has already infected at least 1,206 people, of whom 764 have died – giving a death rate of 63 percent.

They include 20 new cases reported by the health ministry on Thursday, another one-day record after 18 on Wednesday. Two workers at the Butembo airport tested positive, it said.

(Reporting by Stephanie Nebehay and Kate Kelland Additional reporting by Aaron Ross in Dakar; Editing by Hugh Lawson and Frances Kerry)

Deadly plague breaks out on Uganda-Congo border, WHO says

FILE PHOTO: A logo is pictured on the World Health Organization (WHO) headquarters in Geneva, Switzerland, November 22, 2017. REUTERS/Denis Balibouse

GENEVA (Reuters) – A deadly form of plague has broken out on Uganda’s border with Democratic Republic of Congo and several people are thought to have died of the disease, the World Health Organization said on Monday.

The agency praised Ugandan health workers for vigilance and prompt action in spotting a suspected outbreak of pneumonic plague, which the WHO says is usually fatal unless detected early and treated with antibiotics.

Uganda’s Health Ministry reported two probable cases of the illness in Zombo district on March 5 after a 35-year-old woman died and her 23-year-old cousin reported similar symptoms, the WHO said in a report.

Further investigation revealed the dead woman had lived in Atungulei village in Congo’s Ituri province, and her 4-year-old child had died days beforehand. Finding her sick at her child’s burial, her relatives took her to Uganda for treatment.

The cousin’s symptoms raised suspicions of plague and a preliminary rapid diagnostic test was positive for the disease. Results on additional specimens sent to Uganda’s Plague Laboratory in Arua were pending. The patient was steadily improving, the WHO report said.

Some 55 people, including 11 healthworkers and people who took part in the dead woman’s funeral, had been identified as high risk contacts and were being followed up.

Three other people reportedly died of similar symptoms in Congo, the WHO said, and Congolese authorities were investigating.

Plague is endemic in Democratic Republic of Congo, Madagascar and Peru, according to the WHO.

Congolese health authorities are already fighting a major outbreak of Ebola further south in Ituri and North Kivu provinces.

Pneumonic plague is caused by the Yersinia pestis bacteria, usually found in small mammals and their fleas. Humans can be infected through flea bites, unprotected contact with bodily fluids or contaminated materials and the inhalation of droplets or small particles from a patient with pneumonic plague.

(Reporting by Tom Miles; Editing by Frances Kerry)

World must prepare for inevitable next flu pandemic, WHO says

FILE PHOTO: A logo is pictured on the World Health Organization (WHO) headquarters in Geneva, Switzerland, November 22, 2017. REUTERS/Denis Balibouse

By Kate Kelland

LONDON (Reuters) – The world will inevitably face another pandemic of flu and needs to prepare for the potential devastation that could cause, and not underestimate the risks, the World Health Organization (WHO) said on Monday.

Outlining a global plan to fight the viral disease and get ahead of a potential global outbreak, the WHO said the next influenza pandemic “is a matter of when not if”.

“The threat of pandemic influenza is ever-present,” Tedros Adhanom Ghebreyesus, the WHO’s director-general, said in a statement. “We must be vigilant and prepared; the cost of a major influenza outbreak will far outweigh the price of prevention.”

The world’s last flu pandemic was caused by the H1N1 virus, which spread around the world in 2009 and 2010. Studies of that pandemic found that at least one in five people worldwide were infected in the first year, and the death rate was 0.02 percent.

Global health experts and the WHO warn there is a risk that a more deadly flu virus will one day jump from animals to people, mutate and infect many hundreds of thousands of people.

Flu viruses are multiple and ever-changing, and they infect around a billion people every year around the world in seasonal outbreaks. Of those infections, around 3 to 5 million are severe cases, leading to between 290,000 and 650,000 seasonal flu-related respiratory deaths.

Vaccines can help prevent some cases, and the WHO recommends annual vaccination – especially for people working in health care and for vulnerable people such as the old, the very young and people with underlying illness.

The WHO plan – which it described as its most comprehensive to date – includes measures to try to protect populations as much as possible from annual outbreaks of seasonal flu, as well as prepare for a pandemic.

Its two main goals, the WHO said, are to improve worldwide capacities for surveillance and response – by urging all governments to develop a national flu plan, and to develop better tools to prevent, detect, control and treat flu, such as more effective vaccines and antiviral drugs.

(Reporting by Kate Kelland, editing by Gareth Jones)

Public mistrust after Congo election raises Ebola epidemic anxiety

FILE PHOTO: A healthcare worker sprays a room during a funeral of a person who is suspected of dying of Ebola in Beni, North Kivu Province of Democratic Republic of Congo, December 9, 2018. REUTERS/Goran Tomasevic/File Photo

By By, Kate, Kelland,, Health and and

LONDON, Jan 14 (Reuters) – Global health teams battling the world’s second largest Ebola epidemic in Democratic Republic of Congo fear an election dispute may deepen public mistrust and allow the epidemic to run out of control.

Fostering confidence in health authorities is essential when fighting a disease that can spread furiously through communities where local services are scant and patients are often scared to come forward to government or international response teams.

“When you have political instability, public health always suffers,” said Jeremy Farrar, an infectious disease expert who recently visited east Congo with a World Health Organization leadership team.

Without public trust, he said, the Congo epidemic could kill many hundreds more people.

The Dec. 30 election was supposed to mark Congo’s first uncontested democratic transfer of power after 18 years of chaotic rule by President Joseph Kabila.

But accusations of fraud and calls for a recount are threatening more volatility and violence after opposition leader Felix Tshisekedi was declared the winner.

“The worst case scenario is that political instability remains, mistrust grows … and then there’s nothing to stop the epidemic getting embedded into a big urban center and taking off as it did in West Africa,” said Farrar.

“GAINS COULD BE LOST”

Already, 385 people have been killed in the outbreak of Ebola in east Congo that began six months ago and has infected at least 630 people, according to WHO data. The death rate in this epidemic – by far the biggest Congo has seen, and the world’s second largest in history – is more than 60 percent.

Ebola spreads through contact with bodily fluids. It causes hemorrhagic fever with severe vomiting, diarrhea and bleeding. The outbreak is concentrated in North Kivu and Ituri provinces.

There are some signs case numbers in the North Kivu city of Beni may be leveling off, but WHO experts are cautious.

They say the apparent lull might be due to people getting ill but failing to seek proper diagnosis and treatment.

The West Africa Ebola outbreak Farrar referred to lasted for two years from 2014. It infected 28,000 and killed more than 11,300 people in an epidemic that devastated Sierra Leone, Liberia and Guinea and spread in sporadic cases to several other African countries as well as the United States and Europe.

The WHO says the risk of the disease spreading remains “very high” at national and regional levels and is working urgently with Congo and its neighbors – Uganda, Rwanda and South Sudan – to do everything to avoid that happening again.

WHO spokesman Tarik Jasarevic said 25 million people have already been screened for Ebola at border checks with Congo’s neighbors. Vaccination campaigns have also begun for health workers in Uganda and South Sudan.

Jasarevic also said multiple threats to response teams’ ability to find, treat and prevent cases of Ebola infection make the Congo situation particularly worrisome: “Gains could be lost if we suffer a period of prolonged insecurity,” he said.

(Reporting by Kate Kelland; Editing by Andrew Cawthorne)

As Ebola threatens mega-cities, vaccine stockpile needs grow

FILE PHOTO: Healthcare workers carry the coffin of a baby believed to have died of Ebola, in Beni, North Kivu Province of Democratic Republic of Congo, December 15, 2018. REUTERS/Goran Tomasevic/File Photo

By Kate Kelland

LONDON, Dec 20 (Reuters) – Doubts are growing about whether the world’s emergency stockpile of 300,000 Ebola vaccine doses is enough to control future epidemics as the deadly disease moves out of rural forest areas and into urban mega-cities.

Outbreak response experts at the World Health Organization (WHO) and at the vaccines alliance GAVI are already talking to the leading Ebola vaccine manufacturer, Merck, to reassess just how much larger global stocks need to be.

“We’re actively engaged with the World Health Organization and with groups like GAVI, the U.S. government and others to try to understand what will be an appropriate sized stockpile in the future,” Merck’s head of vaccines clinical research, Beth-Ann Coller, said in a telephone interview.

Supply of the Merck shot, which is currently being used to fight a large and spreading outbreak of Ebola in the eastern Democratic Republic of Congo, is not a problem right now, according to the WHO’s deputy director-general of emergency preparedness and response, Peter Salama.

But the nature of Ebola outbreaks is changing, he told Reuters. As the virus finds its way out of rural villages into populous urban settings, plans for how to contain it in future must change too.

“What I’m concerned about is the medium- to long-term stockpile. The figure of 300,000 was very much based on previous Ebola outbreaks where you never really had huge numbers of cases because they were in isolated, rural, populations. But now, we increasingly see Ebola in mega-cities and towns.”

“We need to view it now as an urban disease as well as a rural one – and therefore one requiring a different order of magnitude of preparations, including vaccines,” he said.

Merck’s experimental Ebola vaccine, known as rVSV-ZEBOV, is the furthest ahead in development. Another potential vaccine being developed by Johnson & Johnson could also eventually become part of the stockpile, global health officials say.

Congo’s two Ebola outbreaks this year illustrate the shifting nature of the threat.

The first was relatively contained, infecting up to 54 people and killing 33 of them in an area of DRC’s Equateur Province that is remote and sparsely populated.

Several of the eight outbreaks before this one in Congo – including one in 2014 and another in 2017 both also in Equateur – were also quickly contained and limited in size.

But this year’s second outbreak in Congo – and the country’s tenth since the virus was first identified there in 1976 – is concentrated not in rural villages but in urban areas of the North Kivu and Ituri provinces.

It has already infected more than 450 people, killed more than 270, and last month spread to Butembo, a densely populated city of about one million.

This kind of prospect means global health emergency responders must “review our assumptions around Ebola”, Salama said. “If it were to take off in Butembo, or Goma, or, even worse, Kinshasa, we’d be talking about a totally different issue in terms of … vaccine supplies required.”

Seth Berkley, chief executive of the GAVI vaccines alliance which has an agreement with Merck to ensure a current stockpile of 300,000 rVSV-ZEBOV doses, told Reuters that around 40,000 doses had been used so far in the Congo outbreak.

The emergency response is based on “ring vaccination” which aims to control an outbreak by identifying and offering the vaccine to contacts of anyone likely to be infected. This method uses relatively small numbers of vaccine doses and forms a human buffer of immunity to try to prevent spread of the disease.

For now, in Congo, Berkley said, there is no immediate need to boost the stockpile. But looking towards future inevitable outbreaks, the numbers would likely need to change.

“The challenge we would have – and this has been under discussion – is if we started to do community-based vaccination in urban and semi-urban areas. That’s when the numbers would start to get quite big quite quickly,” he told Reuters.

Merck’s shot has proven safe and effective in trials in West Africa but has yet to be approved for a license by U.S. and European regulators, so is being used in the Congo outbreak under special emergency rules for experimental products.

When it gets approval, which Coller hopes would be in 2019, it will be made at a newly built manufacturing plant in Germany.

Coller said Merck is not yet clear how many doses a year, or a month, the German facility could churn out once it is in production, but she stressed the company would “work collaboratively with the public health agencies to do our best to support their needs”.

(Reporting by Kate Kelland; Editing by Giles Elgood)

Ten die of MERS in Saudi Arabia among 32 cases in last three months: WHO

The headquarters of the World Health Organization are pictured in Geneva

By Kate Kelland

LONDON (Reuters) – Ten people have died among 32 infected with Middle East Respiratory Syndrome (MERS) in Saudi Arabia since June in a series of clusters of the viral disease, the World Health Organization (WHO) said on Wednesday.

The latest cases, recorded between June 1 and September 16, bring the global total of laboratory-confirmed MERS cases to 2,254, with 800 deaths, the United Nations agency said in a “disease outbreak” statement on its website.

MERS first emerged in humans in Saudi Arabia in 2012 and has since spread to cause outbreaks in dozens of countries around the world. The vast majority of the cases – around 1,800 of them – have been in Saudi Arabia.

The virus MERS can cause severe respiratory disease in people and kills one in three of those it infects. It is thought to be carried by camels and comes from the same family as the coronavirus that caused China’s deadly Severe Acute Respiratory Syndrome (SARS) outbreak in 2003.

Most of the known human-to-human transmission of the disease has occurred in healthcare settings, and the WHO has warned hospitals and medical workers to take stringent precautions to stop the disease from spreading.

The WHO said these latest cases did not change its overall assessment that the virus poses a risk of spreading both within and beyond the Middle East.

“WHO expects that additional cases … will be reported from the Middle East, and that cases will continue to be exported to other countries,” its statement said.

The disease spread into South Korea in 2015 and killed 38 people in a major outbreak. And in its first case in three years, South Korea said last month that a 61-year-old man had been diagnosed with MERS.

Among the 32 latest Saudi cases, 12 were part of “five distinct clusters”, the WHO said. Four of these were within households or families, and the fifth was in a hospital in Buraidah, a city in Qassim Province north of the capital Riyadh.

(Reporting by Kate Kelland, Editing by William Maclean)

WHO extremely concerned about Ebola ‘perfect storm’ in Congo

FILE PHOTO: A medical worker wears a protective suit as he prepares to administer Ebola patient care at The Alliance for International Medical Action (ALIMA) treatment center in Beni, North Kivu province of the Democratic Republic of Congo September 6, 2018. REUTERS/Fiston Mahamba/File Photo

By Tom Miles

GENEVA (Reuters) – The World Health Organization (WHO) said on Tuesday an Ebola outbreak in northeastern Democratic Republic of Congo could worsen rapidly because of attacks by armed groups, community resistance and the geographic spread of the disease.

At least 100 people have died in the outbreak, out of 150 cases in North Kivu and Ituri provinces.

“We are now extremely concerned that several factors may be coming together over the next weeks and months to create a potential perfect storm,” the WHO’s head of emergency response, Peter Salama, told a news conference in Geneva.

The response is at a critical juncture and, although the weekly number of new cases has fallen from about 40 to about 10 in the past few weeks and more than 11,700 people have been vaccinated, major obstacles remain ahead, Salama said.

Attacks by armed opposition groups have increased in severity and frequency, especially those attributed to the Alliance of Democratic Forces, most dramatically an attack that killed 21 in the city of Beni, where WHO’s operation is based.

The city has declared a “ville morte”, a period of mourning until at least Friday, obliging WHO to suspend its operations.

Overnight on Monday, unidentified assailants entered the town of Oïcha, about 20 km (12 miles) north of Beni, burned houses, killed one man and kidnapped 14 children and one woman, according to two local officials. Oicha has two confirmed cases of the virus and one probable case.

On Monday 80 percent of Ebola contacts — people at risk of developing the disease and so requiring monitoring — and three suspected cases in and around Beni could not be reached for disease monitoring.

EXPLOITATION

Pockets of “reluctance, refusal, and resistance” to accept Ebola vaccination were generating many of the new cases, Salama said.

“We also see a very concerning trend. That resistance, driven by quite natural fear of this terrifying disease, is starting to be exploited by local politicians, and we’re very concerned in the run-up to elections, projected for December, that exploitation… will gather momentum and make it very difficult to root out the last cases of Ebola.”

Some people were fleeing into the forest to escape Ebola follow-up treatment and checks, sometimes moving hundreds of kilometers, he said.

There was one such case to the south of Beni, and another to the north, close to the riverbanks of Lake Albert. Both were inaccessible for security reasons.

Neighboring Uganda was now facing an “imminent threat”, and social media posts were conflating Ebola with criticism of the DRC government and the United Nations and “a range of conspiracy theories”, which could put health workers at risk.

“We will not yet consider the need to evacuate but we are developing a range of contingency plans to see where our staff are best located,” he said.

“If WHO and its partners had to leave North Kivu … we would have grave concerns that this outbreak would not be able to be well controlled in the coming weeks or months.”

(Reporting by Tom Miles; Additional reporting by Fiston Mahamba in Goma,; Editing by Andrew Heavens, William Maclean)