1. Situation update
The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces of the Democratic Republic of the Congo continues to be closely monitored, with the Ministry of Health (MoH), WHO and partners making progress in response to the outbreak. Recent trends (Figure 1) suggest that control measures are working, although these trends must be interpreted with caution. The outbreak remains ongoing in Beni, Mabalako and Butembo health zones in North Kivu. Tchomia Health Zone in Ituri Province was newly affected in the past week. Additional risks remain high following the movement of several cases in recent weeks across health zones, including Kalunguta.
Since our last situation report on 18 September 2018 (External Situation Report 7), an additional eight (8) new confirmed EVD cases and three (3) deaths (1 each in Beni, Butembo and Tchomia) have been reported. The new confirmed cases were reported from four health zones: Beni (4), Mabalako (1), Tchomia (2) and Butembo (1). This is the first time confirmed cases have been reported from Tchomia Health Zone in Ituri which borders Uganda. Both confirmed cases reported from Tchomia were linked to the ongoing Beni transmission chain.
As of 23 September 2018, 9 suspected cases have been identified following the investigation of 17 alerts. Table 1 summarizes the geographical distribution of these suspected cases. No additional cases were reported among health workers in the last week. Cumulatively, 19 health workers have been affected (18 confirmed and one probable), three of whom have died. All health workers’ exposures occurred in health facilities outside dedicated Ebola treatment centres (ETCs).
As of 23 September 2018, a total of 150 confirmed and probable EVD cases, including 100 deaths, have been reported resulting in a case fatality ratio (CFR) of 67%. Of the 150 cases, 119 are confirmed and 31 are probable. Among confirmed cases only, the CFR was 58% (69/119). Of the 140 cases with known age and sex, 56% (n=78) are female. Among females, the most affected age group is 25-34 years, while among men, the most affected age group is 35-44 years (Figure 2).
As of 23 September 2018, 41 confirmed cases have recovered and been discharged from ETCs; eight (8) confirmed cases remain hospitalized in ETCs.
The epicentres of the outbreak remain in Mabalako and Beni health zones in North Kivu Province, reporting 60% (n=90) and 22% (n=33) of all confirmed and probable cases, respectively. However, since late August 2018, most new cases have occurred in Beni or are related to the ongoing Beni transmission chain. Of the total deaths reported to date, 65% (n=65) were from Mabalako, while 24% (n=24) were from Beni (Table 1 and Figure 3). Additionally, five other health zones in North Kivu Province and three in Ituri Province have reported confirmed and probable cases (Table 1 and Figure 3).
The MoH, WHO and partners are monitoring and investigating all alerts in affected areas, in other provinces in the Democratic Republic of the Congo (including Kisangani and Tshopo provinces) and in neighbouring countries. As of 23 September 2018, nine (9) suspected cases are awaiting laboratory testing within outbreak affected areas (Table 1). Since the last report was published, alerts were investigated in several provinces of the Democratic Republic of the Congo as well as in Uganda and South Sudan; and to date, EVD has been ruled out in all alerts from neighbouring provinces and countries.