1. Situation update
In the week of 25 November to 1 December 2019, 10 new confirmed EVD cases were reported from two health zones in two affected provinces in the Democratic Republic of the Congo. The confirmed cases in this week came from Mabalako (50%, n=5) and Mandima (50%, n=5) Health Zones.
In the past week, violence, widespread civil unrest, and targeted attacks have severely disrupted the Ebola response and restricted access to affected communities in multiple locations.
On the night of 27 November 2019, an attack on the Ebola response camp in Biakato Mines resulted in the death of three responders and the injury of seven others. Response personnel in Biakato were relocated to Goma, and the majority of response activities in the area have been suspended. On the same night, a separate attack on the Ebola coordination office in Mangina resulted in one death. Most response personnel in Mangina have also been relocated. As of 2 December 2019, North Kivu Province has declared ‘ville morte’ and many response activities have been suspended across the province.
As seen previously during this outbreak, such disruptions limit contact tracing, surveillance, and vaccination efforts, and they may result in increased transmission. Following insecurity, the volume of reported daily alerts from healthcare facilities and the community dropped in Beni in the six-day period from 23 to 28 November 2019 from approximately 400 per day to approximately 170. The number of alerts since 29 November 2019 is fluctuating but remains below regular levels.
Proportionally, similar reductions in the number of alerts were observed in Butembo following two days of protests, but numbers still remain low. Contact tracing has improved in Oicha from only 15% of contacts under surveillance to 42%, although this is still below desirable levels. The overall average percentage of contacts under surveillance in the last 7 days is 86%, but it dropped as low as 59% on 25 November 2019. These are essential functions of the response that are well known to reduce the risk of spread of the virus, and the fluctuations in performance following insecurity may enable new chains of transmission. The emphasis now is on prioritizing response activities to maximize the impact on reducing EVD transmission, even in areas with limited access due to security.
In the past 21 days from (11 November to 1 December 2019), 11 health areas and four health zones have reported cases (Table 1, Figure 2). During this period, a total of 26 confirmed cases were reported, with the majority reported from Mabalako (54%; n=14), Mandima (23%; n=6), and Beni (15%; n=4).
As of 1 December 2019, a total of 3313 EVD cases, including 3195 confirmed and 118 probable cases have been reported, of which 2204 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 56% (1866) were female, 28% (936) were children aged less than 18 years, and 5% (163) were healthcare workers.