No new cases of Ebola virus disease (EVD) have been reported since 17 February 2020. The last person confirmed to have Ebola was discharged from an Ebola Treatment Centre on 3 March 2020 after recovering and testing negative for the virus twice. The last 46 contacts finished their follow-up period on 9 March 2020. These developments are significant milestones in this outbreak. There is, however, still a high risk of re-emergence of EVD, and it is critical to maintain response activities to rapidly detect and respond to any new cases, and to continue ongoing support and health monitoring operations for EVD survivors – as outlined in the WHO recommended criteria for declaring the end of the EVD outbreak.
Extensive surveillance, pathogen detection, and clinical management activities in previously affected areas continue, including alert validation, rapid diagnosis of suspected cases, and building of partnerships with community members to strengthen investigation of potential community EVD deaths. Last week, nine historical probable cases were validated, whose dates of symptom onset were between October 2018 to July 2019, bringing the cumulative number of probable cases to 143. Further historical probable cases are expected to be validated as investigations into past cases continue.
Insecurity remains a challenge, hindering ongoing surveillance activities in some areas, which could delay the detection of potential reintroduction events.
From 16 to 22 March 2020, 31 984 alerts were reported and investigated. Of these, 2 555 alerts were validated as suspected cases, requiring specialized care and laboratory testing to rule-out EVD. On average, people stay in these facilities for three days while waiting for EVD to be definitively ruled out (i.e. after two negative polymerase chain reaction tests 48 hours apart), while care is provided for their illness under isolation precautions. Timely testing of suspected cases continues to be provided across 11 laboratories. From 16 to 22 March 2020, 2 747 samples were tested including: 1 479 blood samples from alive, suspected cases; 374 swabs from community deaths; and 894 samples from re-tested patients. Overall, laboratory activity was conducted as similar levels as compared to the prior week.
Since the beginning of the outbreak, alert rates steadily climbed as active and passive case finding systems were strengthened and adapted to suit the local context, reaching additional health zones involved in the evolution of the outbreak. As expected, alert rates have begun to decline in some areas as the incidence of confirmed cases decreased and disease surveillance activities gradually transitioned toward routine operations. However, it remains important to maintain appropriate levels of surveillance through the end of outbreak declaration to rapidly detect relapse, reintroduction or new emergence events, thereby providing an opportunity to implement effective control measures and avoid a potential resurgence of the outbreak.
As of 21 March 2020, a total of 3 453 EVD cases were reported from 29 health zones (Table 1), including 3 310 confirmed and 143 probable cases, of which 2 273 cases died (overall case fatality ratio=66%). Of the total confirmed and probable cases, 56% (1931) were female, 28% (975) were children aged less than 18 years, and 5% (171) were healthcare workers.
WHO has not received funding for the Ebola response in the Democratic Republic of the Congo since December 2019. An urgent injection of US$ 20 million is required to ensure that response teams have the capacity to maintain the appropriate level of operations through to the beginning of May 2020, and are able to rapidly respond to any flare-ups. If no new resources are received, WHO risks running out of funds for the Ebola response before the end of the outbreak. For more information see this recent statement: https://www.who.int/news-room/detail/06-03-2020-end-in-sight-but-flare-u...