Democratic Republic of Congo: Ebola Virus Disease - External Situation Report 9
The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo continues to be closely monitored, with the Ministry of Health, WHO and partners making progress in response to the outbreak. Recent trends (Figure 1) suggest that control measures are largely working, although these trends must be interpreted with caution. The outbreak remains active in Beni Health Zone, and additional risks remain following the confirmation of two EVD cases in Tchomia and one case in Komanda, both health zones in Ituri province. This is the first time that confirmed cases have been reported in Tchomia Health Zone, which borders Uganda, and in Komanda Health Zone. All of these cases have been linked to the ongoing transmission chain in Ndindi health area, Beni Health Zone.
Since WHO’s last situation report on 25 September 2018 (External Situation Report 8), an additional 12 new confirmed EVD cases and six new deaths have been reported. A total of 17 new suspected cases are under investigation in Mabalako (8), Beni (7), Mandima (1) and Tchomia (1).
As of 2 October 2018, a total of 162 confirmed and probable EVD cases, including 106 deaths, have been reported - resulting in a global case fatality ratio (CFR) of 65.4%. Among the 162 cases, 130 are confirmed and 32 are probable. The CFR among confirmed cases only was 56.9% (74/130). The confirmed cases were reported from nine health zones: Mabalako (69), Beni (38), Oicha (2), Masereka (1), Butembo (7), Kalunguta (1), Mandima (9) Tchomia (2) and Komanda (1). Cumulatively, 19 health workers have been affected, of whom 18 are confirmed cases; three health workers have died. All health workers’ exposures occurred in health facilities outside the dedicated Ebola treatment centres (ETCs).
Among the 155 cases with known age and sex, 55% (n=86) are female. Among females, the most affected age group is 15-24 years, while among men the most affected age group is 35-44 years (Figure 2).
As of 2 October 2018, 46 cases have recovered, been discharged from ETCs, and re-integrated into their communities. A total of 27 cases (10 confirmed and 17 suspected) remain hospitalized in the ETCs.
The epicentres of the outbreak remain Mabalako and Beni Health Zones in North Kivu Province, reporting 56% (n=90) and 27% (n=43) of all confirmed and probable cases respectively. Beni is reporting an increasing number of all new cases, indicating the persistence of Ebola virus transmission in this area. The Beni Health Zone has reported 60% of all cases reported since early September 2018. Of the total deaths reported to date, 61.3% (n=65) were from Mabalako, while 27.4% (n=29) were from Beni. 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 Ministry of Health (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. 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.
On 25 September 2018, three refugees from the Democratic Republic of the Congo reported to be contacts of an EVD-confirmed case that died on 20 September 2018 in Tchomia Health Zone, Ituri Province arrived at the Sebagoro point of entry in Hoima District in Uganda, and are currently being monitored.
Field activities were severely limited in Beni during the week of 24 September 2018 following a community-led declaration of “ville morte”, a community-enforced general strike on all local activity. The declaration followed clashes between rebels and the Congolese armed forces, which took place on 22 September 2018. In solidarity with Beni, community leaders in Butembo and Mabalako Health Zones also declared a ville morte that severely limited Ebola response activities in those health zones. Consequently, the proportion of contacts followed-up in Beni fell to a low of 20% on the 23 September 2018. Activities resumed on 26 September 2018, but movement remained restricted in the city. As of 30 September 2018, a total of 1463 contacts remain under surveillance and 1355 (93%) have been followed.