1. Situation update
Ministry of Health (MoH), WHO and partners continue to respond to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo, and remain confident that the outbreak can be contained, despite ongoing challenges. Over the past week (reporting data from 5 to 11 November), we observed the continuation of the outbreak in several areas of North Kivu Province, as well as geographical expansion to new areas, including Kyondo (30 km south-east of Butembo) and Mutwanga (50 km south-east of Beni). The initial cases in these areas were exposed through contact with cases in Butembo and Beni, respectively. During this period, 31 new confirmed cases were reported, among which there were seven newborn babies and infants aged <2 years, three children aged 2-17 years, three women who were pregnant or breastfeeding, and three health workers.
Furthermore, this week, a review and reconciliation of case records resulted in the addition of 14 probable cases, invalidation of 11 historic deaths previously reported as probable cases, and exclusion of duplicate case counts. Moreover, some confirmed and probable cases were recategorized to health zones where their infection most likely occurred (as opposed to location of Ebola treatment centres (ETCs) where they were admitted) (Table 1).
Overall trends in the outbreak (Figure 1) reflect the continuation of transmission in several cities and villages in North Kivu. Given the persisting delays in case detection and the ongoing data reconciliation activities, trends in weekly incidence (especially in the most recent weeks) must be interpreted cautiously.
As of 11 November 2018, a total of 333 EVD cases, including 295 confirmed and 38 probable cases (Table 1), have been reported from 14 health zones in the two neighbouring provinces of North Kivu and Ituri (Figure 2).
Of the total 333 cases, 209 died, including 171 among confirmed cases, and 101 recovered. As of 11 November 2018, 77 patients (confirmed and suspected cases) were hospitalized in ETCs. Females account for 62% of confirmed and probable cases. A total of 30 health workers have been infected to date, including three deaths.
The Ministry of Health (MoH), WHO and partners continue to monitor and investigate 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 Uganda and South Soudan. To date, EVD has been ruled out in all alerts from neighbouring provinces and countries. WHO in collaboration with regional and global partners have deployed over 110 experts in the nine neighbouring countries (Angola, Burundi, Central Africa Republic, Republic of Congo, Rwanda, South Sudan, Tanzania, Uganda and Zambia) and in non-affected provinces in the Democratic Republic of the Congo to support EVD preparedness activities. Four of the nine neighbouring countries have been sensitized on EVD vaccination. Uganda received the approval for EVD vaccination of health and frontline workers and initiated vaccination on 7 November 2018. Preparation for vaccination of frontline health workers is ongoing in Rwanda and South Sudan.