1. Situation update
The 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. On the evening of 16 November 2018, an armed group attacked the MONUSCO base in Boikene District in the city of Beni, close to the residences of UN Ebola responders. Response operations in Beni were briefly paused and resumed (not to full functionally) on 18 November 2018.
No new confirmed EVD cases were reported on 19 November 2018, while one death occurred in Beni. On 18 November 2018, there were seven new confirmed EVD cases in Beni (3), Katwa (3, including 1 community death) and Butembo (1). Since our last situation report on 13 November 2018 (External Situation Report 15), 40 additional confirmed EVD cases and eight deaths were reported. Overall trends in the outbreak (Figure 1) reflect continued 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 19 November 2018, a total of 373 EVD cases, including 326 confirmed and 47 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 cases, 217 died, including 170 deaths among confirmed cases. Deaths among confirmed cases account for 78% of all deaths (170/217) with a case fatality rate of 52% among all confirmed cases (170/326).
Females account for 61% of all confirmed and probable cases. A total of 37 health workers have been infected to date, including 10 deaths. A total of 71 new suspected cases were reported on 19 November 2018 from the affected health zones. Kalunguta, Beni, and Butembo/Katwa remain the principle hotspots of the outbreak. As of 19 November 2018, 130 patients were hospitalized in Ebola treatment centres (ETCs), 40 of whom were confirmed positive for EVD. There were 43 new admissions recorded during the reporting day. The bed occupancy in Beni ETC is at 70%. A total of 110 patients were cured and reintegrated into their communities.
The 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 South Sudan, Uganda and Zambia. To date, EVD has been ruled out in all alerts from neighbouring provinces and countries. WHO, in collaboration with regional and global partners, has deployed over 119 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. A joint mission to support preparedness measures in South Sudan was conducted, with participation from the MoH, UN agencies, including UNOCHA, UNICEF, UNFPA, IOM, and WFP as well as EU/ECHO, NGOs and donors. The findings of the mission will be used to prioritize and coordinate the implementation of EVD readiness actions.