1. Situation update
The Ministry of Health and WHO continue to closely monitor the outbreak of Ebola virus disease (EVD) in Équateur Province, the Democratic Republic of the Congo. Until the outbreak is declared over, intensive surveillance, survivor monitoring and other response activities are ongoing to prevent, promptly detect and respond to potential resurgences of the virus.
No new laboratory-confirmed EVD cases have been detected since the last case developed symptoms on 2 June 2018 (Figure 1). Since the beginning of the outbreak (on 4 April 2018), a total of 38 laboratory confirmed and 15 probable cases (deaths for which it was not possible to collect laboratory specimens for testing) have been reported. Of these 53 cases, 29 died, giving a case fatality ratio of 54.7%. Twenty-eight (53%) cases were from Iboko, 21 (40%) from Bikoro and four (8%) from Wangata health zones (Table 1 and Figure 2). Five healthcare workers were affected, of which two died.
An additional five suspected EVD cases have been reported since our last report on 12 July 2018, (External Situation Report 15), three of which are currently awaiting laboratory results. All other previously reported suspected cases have tested negative.
On 12 June 2018, the last surviving confirmed EVD case was discharged from an Ebola treatment centre (ETC) following two negative tests on serial laboratory specimens. Before the outbreak can be declared over, a period of 42 days (two maximum incubation periods) following the last possible exposure to a confirmed case must elapse without any new confirmed cases being detected.
On 8 May 2018, the Ministry of Health of the Democratic Republic of the Congo notified WHO of an EVD outbreak in Bikoro Health Zone, Équateur Province. The event was initially reported on 3 May 2018 by the Provincial Health Division of Équateur when a cluster of 21 cases of an undiagnosed illness, involving 17 community deaths, occurred in Ikoko-Impenge health area. A team from the Ministry of Health, supported by WHO and Médecins Sans Frontières (MSF), visited Ikoko-Impenge health area on 5 May 2018 and found five case-patients, two of whom were admitted in Bikoro General Hospital and three were in the health centre in Ikoko-Impenge. Samples were taken from each of the five cases and sent for analysis at the Institute National de Recherche Biomédicale (INRB), Kinshasa on 6 May 2018. Of these, two tested positive for Ebola virus, Zaire ebolavirus species, by reverse transcription polymerase chain reaction (RT-PCR) on 7 May 2018, and the outbreak was officially declared on 8 May 2018. This is the ninth EVD outbreak in the Democratic Republic of the Congo over the last four decades, with the most recent one occurring in May 2017. Further information on past outbreaks is available at: http://www.who.int/ebola/historical-outbreaks-drc/en/.