1. Situation update
This past week saw a notable increase in the number of Ebola virus disease (EVD) cases, with 72 newly confirmed cases and one new probable case reported in the last seven days; the largest proportion of which were from Katwa and Vuhovi health zones (Figure 1). During the last 21 days (11-31 March 2019), 57 health areas within 12 health zones reported new cases; 42% of the 135 health areas affected to date (Table 1 and Figure 2). During this period, a total of 164 confirmed cases were reported from Katwa (46), Vuhovi (34), Mandima (25), Masereka (19), Beni (12), Butembo (10), Oicha (8), Kayna (3), Lubero (3), Kalunguta (2), Bunia (1) and Musienene (1). WHO and partners remain concerned by these recent developments and are continuing to adapt strategies to strengthen the response to limit the further spread of EVD in these health areas.
As of 31 March 2019, a total of 1089 EVD cases, including 1023 confirmed and 66 probable cases, were reported; the new probable case is from Vuhovi. A total of 679 deaths were reported (overall case fatality ratio 62%), including 613 deaths among confirmed cases. Of 1089 confirmed and probable cases with reported age and sex, 58% (629) were female, and 29% (318) were children aged less than 18 years. The number of healthcare workers affected has risen to 81, including 28 deaths.
Despite these setbacks, it should be noted that the recent shift in strategy of increasing community outreach from earlier weeks, is gradually yielding tangible results on the ground. In Katwa, the Ebola Treatment Centre was reopened after frank and open dialogue with the community. Previously reluctant communities are now permitting access to healthcare providers once again, with residents actively participating in the renewed response efforts at times. Incidents in the community are now also rigorously followed up to minimize any potential misunderstanding, which may inadvertently contribute to community reluctance, refusal, or resistance to response efforts. In the outbreak hotspots of Katwa, Butembo and Vuhovi, persistent efforts aimed at encouraging community dialogues saw the establishment of Ebola community committees across 16 health areas. Although these community engagement interventions take time to win over the trust and cooperation of the local population, they are an integral tool in aiding the acceptance of WHO response efforts to curtail the spread of EVD in these challenging social/geographic settings. Successes observed this past week are positive indicators that these measures should be maintained whilst continually adapting to the evolving context.