Ebola death toll in east Congo outbreak climbs above 2,000

FILE PHOTO: A health worker fills a syringe with Ebola vaccine before injecting it to a patient, in Goma, Democratic Republic of Congo, August 5, 2019. REUTERS/Baz Ratner/File Photo

By Djaffar Al Katanty and Aaron Ross

GOMA, Democratic Republic of Congo (Reuters) – The death toll from Democratic Republic of Congo’s year-long Ebola outbreak has climbed above 2,000, government data showed on Friday, as responders battle to overcome community mistrust and widespread security problems.

The death in neighboring Uganda of a 9-year-old girl who had tested positive for the virus after entering the country from Congo underscored the challenge medical teams face containing the disease in border territory with a highly mobile population.

The government team overseeing the response said the number of confirmed and probable cases had also hit a milestone of more than 3,000 in what has become the second-worst epidemic of the virus on record.

Despite the development of an effective vaccine and treatments, health workers have struggled to stop the virus spreading in remote and conflict-hit areas of eastern Congo, where many locals are wary of the response effort.

Nevertheless, the World Health Organization said the latest Uganda case highlighted the border authorities’ skill at detecting and isolating potential sources of transmission.

“This case was picked up at the border,” WHO spokeswoman Fadela Chaib said at a briefing in Geneva. “The people who are at the borders have the expertise.”

This is Congo’s 10th Ebola outbreak, but it is the first in the densely forested hillside provinces of North Kivu and Ituri, where militia-led violence and ethnic killing have undermined security in certain areas for decades.

The WHO declared the epidemic an international health emergency in July – only the fifth outbreak to warrant this status since the system was introduced in 2005.

The authorities have since come up against new fronts in their fight to contain the virus, testing the reach and flexibility of responders.

Health workers confirmed the first cases in South Kivu province on Aug. 16. Soon after, a woman contracted the virus in a remote, militia-controlled territory in North Kivu, hundreds of kilometers away from other known cases.

“The response is being spread too thin chasing new cases at the expense of the longer-term community engagement that is crucial if we’re ever to hope of being Ebola free,” Oxfam’s Congo Director Corinne N’Daw said in a statement.

Despite the virus spreading to new areas, the past week’s transmission rate was little changed from that of the past month and a half, which has seen an average of 77 new cases per week, according to the WHO.

Last week the WHO voiced concern about the widening geographic reach of the disease, but confirmed the virus had not gained a foothold in the major city of Goma, even after four cases were recorded there in July and early August.

Goma, a lakeside city of nearly 2 million people on the Rwandan border, had been on high alert for weeks after a gold miner with a large family infected several people with Ebola before dying himself.

The latest government data showed Ebola deaths reaching 2,006 and cases at 3,004.

“Two thousand deaths means that there is a problem,” said Timothée Buliga, a priest, returning home from his church in Goma. “We need to reach the point where we reject Ebola, say no and eradicate it definitively.”

Only the 2013-2016 Ebola outbreak in West Africa has been deadlier than the current outbreak. More than 11,300 people died then out of the 28,000 who were infected.

(Additional reporting by Tom Miles and Stephanie Nebehey in Geneva; Elias Biryabarema in Kampala; Writing by Alessandra Prentice; Editing by Kirsten Donovan and Hugh Lawson)

Fourth Ebola case found in Congo city, raising fears of faster spread

FILE PHOTO: Congolese health workers prepare to administer ebola vaccination to residents at a centre in Goma, Democratic Republic of Congo, August 1, 2019. REUTERS/Djaffer Sabiti

GOMA, Democratic Republic of Congo (Reuters) – A fourth case of Ebola has been confirmed in the eastern Congo city of Goma, the government said late on Thursday, raising fears of an acceleration in infections close to the border with Rwanda.

The new case is the wife of a miner who died of the virus earlier this week and who only sought treatment more than a week after starting to show symptoms, authorities said.

“This time … the individual concerned spent time with his family and spent time [being] very symptomatic within the community. So we did expect further cases and we are seeing further cases,” said Margaret Harris, a spokeswoman for the World Health Organization (WHO).

One of the couple’s daughters has also tested positive for Ebola though the government said on Friday two others were negative in preliminary checks. More than 200 people who came into contact with the man have been tracked and 160 of them vaccinated.

An outbreak on Ebola has killed more than 1,800 people in other parts of Democratic Republic of Congo since it was declared one year ago, making it the second-worst on record. Two people have died in Uganda, which also borders Congo, but no registered cases have occurred in Rwanda.

Fears the disease was gaining a foothold in Goma, a city of 1 million people, had subsided after its first case emerged in July but was not immediately followed by more. The new cases confirmed this week were not linked to that first case, authorities said.

BORDER TOWN

Nestled in hilly country at the foot of an active volcano, Goma lies just 7 km (4.5 miles) from Rwanda’s main border town of Gisenyi.

On Thursday, Rwanda briefly shut its border crossings with Congo around the city, after the new cases emerged.

Increased health screenings caused traffic slowdowns at the border, Rwandan Health Minister Diane Gashumba said, hours after Congolese traders had reported it shut. About 45,000 people a day go through the main border post, an immigration official said.

In July, the outbreak was declared an international health emergency by the WHO, but the body said there should be no trade or travel restrictions.

“When you close borders… two things happen: first you get panic, people see this as a signal to start panicking,” Harris told reporters in Geneva.

“Secondly, people who do have symptoms go underground. Because they don’t want to be seen and they do want to continue their daily lives, and so we are even less likely to detect where this virus is moving,” she added.

(Reporting by Fiston Mahamba in Goma, Anna Pujol-Mazzini in Dakar and Stephanie Nebehay in Geneva; editing by Alison Williams, Larry King and Andrew Heavens)

Congolese cross-border trader’s Ebola death fuels Uganda outbreak fears

FILE PHOTO: A Congolese health worker prepares to administer Ebola vaccine, outside the house of a victim who died from Ebola in the village of Mangina in North Kivu province of the Democratic Republic of Congo, August 18, 2018. REUTERS/Olivia Acland/File Photo

By Tom Miles

GENEVA (Reuters) – A Congolese woman who died of Ebola this month vomited four times in a Ugandan market after crossing the border days earlier to sell fish, the WHO said, fuelling fears that the virus may be spreading beyond the Democratic Republic of Congo.

The current outbreak of the highly infectious disease has been all but confined to Congo, killing 1,673 people there – more than two-thirds of those who contracted it – over the past year, and three in Uganda last month.

A World Health Organization panel is debating whether to declare the outbreak “of international concern”, a designation that the agency’s head suggested a case this month in the large Congolese city of Goma had made more likely.

The fisherwoman traveled across the border to Mpondwe market on July 11, according to a Ugandan Health Ministry report published on Wednesday by the WHO.

It said 19 fishmongers were listed as having had possible contact with her while another 590 could be targeted for vaccination.

The health response to the virus relies on tracking down and testing people who may have been exposed to it and vaccinating them and anybody they have had contact with.

Ugandan and Congolese officials were working to find people who might have been put at risk by the dead woman, who appeared to have used an illegal border crossing, health ministry spokesman Emmanuel Ainebyona said.

So far “no one has been found to be positive of the Ebola virus. The team is still monitoring the tested traders,” he said.

The report said health workers had not established where the fishmonger spent nights, who transported her merchandise and who cleaned up her vomit.

The Ministry and the WHO said there were currently no confirmed Ebola cases in Uganda.

The WHO’s emergency committee of international experts were meeting on Wednesday for a fourth time to consider if the 11-month outbreak constituted a “public health emergency of international concern” (PHEIC), and will announce their decision at 1700 GMT.

A PHEIC declaration would be just the fifth in WHO history and include recommendations for international action. It could also help unlock sorely needed funds.

Last month the committee decided the potential disruption of declaring one risked causing economic harm while achieving nothing.

But WHO chief Tedros Adhanom Ghebreyesus said this week that the case in Goma was a potential game-changer since it meant Ebola might now spread among the urban population and into neighboring Rwanda.

A separate WHO report cited a very high risk for Uganda’s Arua district, which borders a Congolese area where an Ebola patient died after having had contact with over 200 people. Two deaths in Arua were under investigation.

(Reporting by Tom Miles and Nairobi newsroom; Editing by Gareth Jones and John Stonestreet)

First Ebola patient in eastern Congo’s main city dies, fears of epidemic spreading

A health worker checks the temperature of a woman as she crosses the Mpondwe border point separating Uganda and the Democratic Republic of Congo as part of the ebola screening at the computerised Mpondwe Health Screening Facility in Mpondwe, Uganda June 13, 2019. REUTERS/Newton Nabwaya

GOMA, Democratic Republic of Congo (Reuters) – The first Ebola patient in eastern Democratic Republic of Congo’s largest city, Goma, has died, the government said on Tuesday.

The spread of the virus to Goma, a city of roughly 1 million people on the border with Rwanda, has raised fears the outbreak, which is already the second deadliest Ebola epidemic ever, could spread more widely.

The patient was a priest who became infected during a visit to the town of Butembo, one of the epicenters of the outbreak, before taking a bus to Goma, according to Congo’s health ministry.

He was being driven from Goma to a clinic in Butembo on Monday to receive treatment when he died, North Kivu province’s Governor Carly Nzanzu told an Ebola response meeting.

The World Health Organization (WHO) said on Monday that health officials had identified 60 people who had come into contact with the pastor since he was taken ill and that half of them had been vaccinated.

Goma, a lakeside city more than 350 kilometers (220 miles) south of where Ebola was first detected a year ago, is the largest city to be affected by the outbreak, which has infected more than 2,500 people and killed nearly 1,700.

Three Ebola cases which originated in Congo were confirmed in neighboring Uganda a month ago, but no new cases have since been registered in that country.

(Reporting by Stanis Bujakera and Djaffar Al Katanty, Writing by Anna Pujol-Mazzini, Editing by Ed Osmond)

Eroding trust in vaccines leaves populations vulnerable, global study finds

FILE PHOTO: A vial of measles, mumps and rubella vaccine and an information sheet is seen at Boston Children's Hospital in Boston, Massachusetts February 26, 2015. REUTERS/Brian Snyder/File Photo

By Kate Kelland

LONDON, June 19 (Reuters) – Trust in vaccines – one of the world’s most effective and widely-used medical products – is highest in poorer countries but weaker in wealthier ones where skepticism has allowed outbreaks of diseases such as measles to persist, a global study found on Wednesday.

France has the least confidence of any country in the world in the safety and effectiveness of vaccines, with a third believing that vaccines are unsafe, according to the study.

While most parents do choose to vaccinate their children, varying levels of confidence expose vulnerabilities in some countries to potential disease outbreaks, the study’s authors said, recommending that scientists need to ensure people have access to robust information from those they trust.

Public health experts and the World Health Organization (WHO) say vaccines save up to 3 million lives every year worldwide, and decades of research evidence consistently shows they are safe and effective.

But to achieve “herd immunity” to protect whole populations, immunization coverage rates must generally be above 90% or 95%, and vaccine mistrust can quickly reduce that protection.

“Over the last century, vaccines have made many devastating infectious diseases a distant memory,” said Charlie Weller, head of vaccines at the Wellcome Trust health charity, which co-led the Wellcome Global Monitor study.

“It is reassuring that almost all parents worldwide are vaccinating their children. However, there are pockets of lower confidence in vaccines across the world.”

The spread of measles, including in major outbreaks in the United States, the Philippines and Ukraine, is just one of the health risks linked to lower confidence in vaccines.

In Afghanistan and Pakistan, false rumors about polio vaccines being part of a Western plot have in recent years hampered global efforts to wipe out the crippling disease.

The study, led by Wellcome and polling company Gallup, covered 140,000 people from more than 140 countries.

It found 6% of parents worldwide – equivalent to 188 million – say their children are unvaccinated. “The highest totals were in China at 9%, Austria at 8% and Japan at 7%.”

Seth Berkley, chief executive of the not-for-profit GAVI vaccine alliance, said the report showed a “worrying number of people” questioning vaccine safety. But by focusing on the “vocal minority” who refused to vaccinate, it was easy to forget that the vast majority trusted vaccines and the science that underpinned them.

The study also found that three-quarters of the world’s people trust doctors and nurses more than anyone else for health advice and that in most parts of the world, more education and greater trust in health systems, governments and scientists is a also sign of higher vaccine confidence.

In some high-income regions, however, confidence is weaker. Only 72% of people in North America and 73% in Northern Europe agree that vaccines are safe. In Eastern Europe, it is just 50%.

Heidi Larson, director of the vaccine confidence project at the London School of Hygiene and Tropical Medicine, worked with researchers on this study. She said it “exposes the paradox of Europe” which, despite being a region with among the highest income and education levels, also has the world’s highest levels of vaccine skepticism.

In poorer regions, trust levels tend to be much higher, with 95% in South Asia and 92% in Eastern Africa feeling confident that vaccines are safe and effective.

(Reporting by Kate Kelland; editing by John Stonestreet)

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)