The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo continues to be closely monitored by the Ministry of Health (MoH), WHO and partners. Of concern is the increased incidence of confirmed cases reported in the past four weeks, most notably in Beni. Security remains the biggest challenge faced by the response teams in Beni and Butembo, undermining the response activities.
Continued security incidents severely impact both civilians and frontline workers, forcing suspension of EVD response activities and increasing the risk that the virus will continue to spread. Moreover, with heightened transmission of the virus in outbreak affected areas, the risk of exportation of case to neighbouring provinces and countries is increased. Neighbouring countries need to be ready in case the outbreak spreads beyond the Democratic Republic of the Congo.
Since WHO’s last situation report issued on 17 October 2018 (External Situation Report 11), an additional 22 new confirmed EVD cases, from Beni (19) and Butembo (3), and 16 new deaths have been reported. As of 21 October 2018, a total of 238 confirmed and probable EVD cases, including 155 deaths, have been reported, resulting in a case fatality ratio (CFR) of 65%. Among the 238 cases, 203 are confirmed and 35 are probable cases. Of the 155 deaths reported since the beginning of the outbreak, 120 were among confirmed cases and 35 among probable cases. The proportion of deaths among confirmed cases was 59% (120/203). On 21 October, 14 new suspected cases were under investigation in Beni (8), Mabalako (1), Butembo (2) and Mandima (3).
As of 21 October 2018, 63 cases have recovered, been discharged from ETCs, and re-integrated into their communities. On 21 October, a total of 60 cases remained hospitalized in four ETCs in Beni (38), Butembo (19), Mangina (two) and Makeke (one). On that day, the treatment centres in Beni and Butembo recorded an occupancy rate of 93% (38/41) and 79% (19/24) respectively.
Among the 235 cases with known age and sex, 55% (n=129) are female, and adults aged 15-44 account for 56% (n=134) (Figure 2). Recent cases in Beni include a disproportionate number of cases in children aged ≤16 years; 43% (n=30) of 70 cases reported since 1 October 2018, including 13 cases in infants and young children aged <5 years. Investigations are ongoing to elucidate the source(s) of infection in children to interrupt transmission. A health worker from Beni was confirmed positive to Ebola virus disease on 20 October, raising the total number of health workers affected in this outbreak to 21, including 20 confirmed. Three health workers have died from the disease.
The confirmed cases were reported from six health zones in North Kivu Province: Beni (96), Mabalako (71), Butembo (16), Masereka (4), Kalunguta (2), and Oicha (2); and three health zones in Ituri Province: Mandima (9), Tchomia (2) and Komanda (1). Beni has surpassed Mabalako in terms of cumulative number of confirmed cases.
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 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 the Gambia, South Sudan, Tanzania, and Uganda. To date, EVD has been ruled out in all alerts from neighbouring provinces and countries.