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Democratic Republic of the Congo (DRC): Ebola virus disease outbreak - Emergency Plan of Action Operations Update n°3 (MDRCD026)

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1. SITUATION ANALYSIS

1.1. Description of the disaster

The ninth outbreak of Ebola virus disease (EVD) was reported by the DRC Ministry of Health on 8 May 2018 in the Bikoro and Iboko health zones (Equateur province). This epidemic had caused the death of 33 people out of 38 confirmed cases out of 54 suspected cases reported.
Shortly after the declaration of the eradication of the ninth Ebola epidemic in Equateur province on 25 July 2018, another outbreak was discovered in the Mabalako health zone in Beni territory, in North Kivu province, leading to the tenth round of this epidemic in the DRC.
This tenth epidemic quickly spread to the village of Mandima in the neighbouring province of Ituri. Ituri province was subsequently declared affected by the virus after a case was confirmed on August 13, 2018.
Between the beginning of the outbreak on 1 August 2018 and 16 June 2019 there have been a total of 2,168 Ebola Virus Disease (EVD) cases (2,074 confirmed and 94 probable) with 1,449 deaths (1,355 confirmed) and 590 survivors for a total case fatality rate of 66%.
The tenth EVD outbreak in DRC has so far been characterised by three epidemiological waves; the first wave in Mabalako (North Kivu) and Mandima (Ituri) through to 19 August 2018, then expansion into Beni (North Kivu) through to November 2019 and is now into the third phase expansion to the other health zones with hotspots in Butembo and Katwa. So far 137 health areas within 22 health zones of North Kivu and Ituri have been affected2. The tenth outbreak is considered the second deadliest in history after West Africa epidemic in 2013 -163 and is considered the worst in DRC. It has been made more complex by being a public health emergency within a wider humanitarian emergency characterized by active armed conflicts, displaced populations, community resistance and other disease outbreaks (Cholera, Measles)4. Furthermore, it is the first outbreak in North Kivu and Ituri Provinces which have high population density (6,655,000 and 3,650 000, respectively), large population movements and cross-border activity, particularly with Uganda and Rwanda.
While the WHO Emergency Committee met on 14 June 2019 and recommended that the EVD outbreak is a health emergency in DRC and the region it does not meet the criteria for a Public Health Emergency of International Concern (PHEIC)5. However, despite the collective efforts of the Ebola response, in the event that the epidemic continues to expand, and more cases are reported in neighbouring countries this position may be reconsidered.

On 11 June 2019, the Ministry of Health of Uganda Republic reported a first confirmed case of Ebola virus disease in Bwera in the western part of the country (bordering the Democratic Republic of Congo).
It was a 5-year-old child whose family reportedly attended the funeral of a family member who died in DRC and who was confirmed to have EVD. The child and his family entered Uganda through Bwera Border post and sought medical care at Kagando hospital where health workers identified Ebola as a possible cause of illness6. The child was then transferred to Bwera Ebola Treatment Unit for management.
This was the first confirmed case on Ugandan soil; three cases have been confirmed in total with two deaths, on Ugandan soil, followed by one on the way back to Beni.
Following this confirmed case, the Ugandan authorities have activated measures to fight the epidemic. The remaining family members of the deceased boy were repatriated to the DRC on 13 June 2019. To date, Uganda has had no other confirmed cases of Ebola virus disease, but the country still remains in the "Ebola response" mode.
Other countries bordering the DRC, namely Rwanda, South Sudan, and Burundi also remain on high alert due to the high risk of cross-border cases. Red Cross teams continue undertaking preparedness activities such as point of entry screening, community risk communication and engagement, training of Safe and Dignified Burial teams as well as prepositioning SDB supplies (see 1.3).