Mbandaka — When a young man in his town died of a haemorrhagic fever, Fabien Impanda Boliko had to act fast. The 56-year-old laboratory technician in Mbandaka tested and identified the first case of the Democratic Republic of the Congo's (DRC) 11th Ebola outbreak in the western Equateur province.
The sudden death caused concern among local health officials who raised an alert: perhaps the haemorrhagic fever was Ebola or, maybe it was caused by another disease. Boliko accompanied a rapid response team to obtain a sample and find out.
"I could feel the pressure. As soon as I got back to the laboratory in Mbandaka, I started to do some tests," said Boliko. "The results came back positive [for Ebola]." On 1 June, just one day later, the DRC government officially declared a new outbreak and response efforts began.
Boliko credits his swift actions to a training he and 25 other laboratory technicians received in 2018 following an outbreak of Ebola there, DRC's 9th. They were trained by World Health Organization (WHO) on sample collection and testing possible Ebola cases. They learned how to use a GeneXpert machine, which can provide test results in just under two hours.
"The training strengthened our ability to use the GeneXpert machine and test. Otherwise, if we didn't know how to test here in Mbandaka or didn't have the technology, the city could have experienced several weeks of uncertainty," Boliko explained.
The DRC's National Institute for Biomedical Research (INRB), based in the capital of Kinshasa, is responsible for verifying the results of such tests. But, as Boliko pointed out, it can take time for a sample to reach the INRB's more-equipped laboratories.
"Equateur Province is able to use local resources to collect, handle, and test samples in strict compliance with biosafety rules. This is ideal," said INRB medical biologist and laboratory expert, Dr Meris Matondo. Being able to provide accurate preliminary results at the provincial level means that local health authorities can take immediate preventive precautions even before there is a national, official declaration of a new public health emergency.
Boliko's quick identification of the disease translated into a swift response. Just four days after the outbreak was declared, the Ministry of Health and WHO began vaccination to stem the spread of Ebola. As of 22 June 2020, more than 4 700 people had been vaccinated. Screening for travellers at designated points of control had also been ramped up.
"DRC has often been confronted with Ebola outbreaks. I know that this one in June 2020 won't be our last," Boliko said. An outbreak of Ebola between May and July 2018 in the same province was the third in the Grand Equateur region (Yambuku in 1976, Tandala in 1977 and Djera in 2014]. The 2018 outbreak claimed 33 lives, but 21 patients survived.
In the current outbreak, five health zones in Equateur province have so far been affected (Bolomba, Bikoro, Iboko, Mbandaka and Wangata). To Boliko, beating Ebola is a matter of preparedness. He feels that he and his colleagues are already more prepared than they were during the last outbreak. This time around, all the laboratory technicians trained in 2018 are working to test samples of possible case-patients. There are also three GeneXpert machines--two in Mbandaka and one in Bikoro health zone -- available locally to provide rapid test results.
Improving the capacity of health workers in Mbandaka during the 2018 outbreak is paying off, says Dr Amédée Prosper Djiguimdé, WHO Officer in Charge in the DRC. "This response is being handled differently and much more at the local level because the expertise already exists. WHO is here only to advise and fill critical gaps where needed."
WHO has deployed experts to Mbandaka, Bolomba, Bikoro and Iboko. Additional teams have been sent to other rural communities that are reporting cases. Most of the experts are coming from North Kivu where an ongoing Ebola outbreak is winding down. The team includes experts in epidemiology, vaccination, community engagement, infection prevention and control, laboratory, case management, logistics and data management.
The Organization has also shipped supplies including vaccines, testing kits and personal protective equipment. Over 114 000 travellers have so far been screened at strategic points of control to help detect and stem further spread of the virus.