Cholera epidemic spreading in DR Congo

MSF opening emergency treatment centres along Congo river

On June 24 2011 the Congolese authorities officially declared three new provinces affected by the cholera epidemic. So far the disease has affected 2,787 people and caused 153 deaths in a series of locations up and down the Congo river. The epidemic started in Kisangani in March and from there has spread to two other provinces and has reached the outskirts of the City-Province of Kinshasa, where the first cases were identified on June 20. In response to the spread of the disease, Médecins Sans Frontières’ Congo Emergency Team - the Pool d’Urgence Congo (PUC) – has opened several Cholera Treatment Centres (CTCs).

In Kisangani (Orientale province), the starting point of the epidemic, MSF treated more than 1,000 patients in April and May. The town of Bolobo (Bandundu province) is the current epidemic hotspot, where MSF has set up a 70-bed CTC and has treated 639 people between June 13 and June 26, recording 16 deaths. In Mbandaka (Equateur province), 84 cases and 9 deaths have been identified over the past two weeks. MSF has been treating patients in the general reference hospital in Mbandaka since June 27 while finishing the construction of a 50-bed CTC on site. In the outskirts of Kinshasa, where 13 cases have already been notified, MSF is about to open a CTC in order both to treat patients and to provide a training centre for all medical and non-medical personnel involved in the capital’s outbreak response. MSF is working in coordination with the Ministry of Health to identify the places with the most acute needs.

“The port of Kinshasa is the point of embarkation for thousands of people each day heading up and downstream on the Congo river. If the epidemic takes root in Kinshasa the consequences for people living in the capital could be disastrous,” warns Luis ENCINAS, Operations Coordinator for MSF. “This is why it is absolutely essential to immediately take major preventative measures: reinforce the epidemiological surveillance; limit the spread of the disease; and treat each end every patient who falls sick from cholera.”

The three major factors that promote the spread of cholera are all currently present in DRC: dense urban population; a lack of hygiene and little access to clean water; and the confirmed presence of the disease in several locations. “All the conditions are ripe for an explosion of the epidemic,” says Laurence SAILLY, MSF’s Medical Coordinator in DRC. “To avoid the spread of the disease, people must follow good hygiene practices without fail; thoroughly washing food and frequently washing hands, particularly before eating or preparing food. Anyone showing the symptoms of cholera (profuse diarrhoea and / or vomiting) should go directly to their nearest health centre.”

Cholera is an acute intestinal infection caused by a bacteria – Vibrio cholerae – found in unsanitary environments. The diarrhoea and vomiting brought on by the disease quickly lead to severe dehydration and can result in death. Cholera can be simply and effectively treated provided the treatment is started early enough.  Treatment involves replacing the lost water and electrolytes such as potassium and sodium by rehydrating the patient with oral rehydration solution or, for the more serious cases, intravenously.

In a country where the health system is faltering, this outbreak comes at a time when several other medical emergencies are already causing havoc, in particular a measles epidemic that is raging in several provinces.