1. Situation update
As the Ebola virus disease (EVD) outbreak surpasses the 2000 case mark, indicators over the past two weeks provide early signs of an easing of the transmission intensity. This follows a period of improved security and therefore access to communities, allowing response teams to operate more freely. A total of 88 confirmed cases were reported each week for the past two weeks, down from a peak of 126 cases per week observed in April 2019. Declines in the incidence of new cases have been most apparent in hotspots such as Katwa, Mandima and Beni health zones. Concurrently, improvements in the proportion of cases among contacts registered prior to onset (up from 30% three weeks ago to 55% last week), and a lower proportion of cases resulting from transmission within community health facilities (from 31% during the first week of April 2019 to 9% during the last week of May 2019), are encouraging, although both indicators are below where we would aim to be. The outbreak continues to be contained to 13 active health zones in North Kivu and Ituri provinces. However, substantive rates of transmission continue within affected communities, and further waves of the outbreak would be expected. An increase in the incidence of new cases has been reported from Mabalako Health Zone this past week, and high infection rates continue within Butembo metropolitan. Times between detecting, reporting and admission of cases at Ebola treatment/transit centres (ETCs) remain too long (median 6 days, interquartile range 49 days in the past 3 weeks), with about a third (34% in the past 3 weeks) of cases dying outside ETCs. Collectively these indicators highlight that the risks associated with this outbreak remain very high.
In the 21 days between 13 May to 2 June 2019, 82 health areas within 13 health zones reported new cases, representing 46% of the 179 health areas affected to date (Table 1 and Figure 2). During this period, a total of 297 confirmed cases were reported, the majority of which were from the health zones of Mabalako (27%, n=79), Butembo (22%, n=64), Katwa (15%, n=46) and Beni (12%, n=35).
As of 2 June 2019, a total of 2008 EVD cases, including 1914 confirmed and 94 probable cases, were reported. A total of 1346 deaths were reported (overall case fatality ratio 67%), including 1252 deaths among confirmed cases. Of the 2008 confirmed and probable cases with known age and sex, 58% (1159) were female, and 29% (585) were children aged less than 18 years. Cases continue to rise among health workers, with the cumulative number infected rising to 110 (6% of total cases).