On 31 May 2020, WHO received information that between 18 and 30 May, four deaths were reported from the same quarter (quartier Air Congo) in Wangata Health Zone, Mbandaka city, Equateur Province, the Democratic Republic of the Congo. All cases had experienced fever and bleeding prior to their deaths. Of the four patients who died, two of them visited the General Reference Hospital (HGR) in Wangata; a sample (swab) was taken from one of them who died on 30 May. Safe and dignified burials were not performed for these four patients.
On 31 May, the brother of the probable case who died on 22 May and his wife presented to HGR Wangata; both had fever, non-bloody diarrhoea and vomiting. They were placed in isolation after blood samples were collected.
The three samples including two blood samples and a swab, were analyzed at a laboratory in Mbandaka where all three samples tested positive for Ebola virus disease (EVD) by GeneXpert Ebola assay. One of the three samples (swab) was sent on 31 May 2020, to the Institut National de Recherche Biomédicale (INRB) in Kinshasa and tested positive for Zaire Ebolavirus using polymerase chain reaction (PCR).
As of 2 June 2020, eight epidemiologically-linked cases, including two confirmed alive cases, two suspected cases and four deaths (one confirmed and three probable deaths), have been reported. The Ministry of Health (MOH) officially declared the outbreak in Equateur Province on 1 June 2020.
Equateur Province experienced an EVD outbreak with 54 cases and 33 deaths, reported between 8 May 2018 through 24 July 2018. This is the eleventh outbreak of EVD reported in the Democratic Republic of the Congo since the virus was discovered in 1976.
In the context of the current COVID-19 outbreak, the health capacity and resources in the Democratic Republic of the Congo are already strained and causing additional burdens on the national health system. The risk of disruption to surveillance and routine public health activities due to COVID-19 might jeopardize the country’s ability to rapidly contain re-emergence of these EVD cases. As of 2 June 2020, the Democratic Republic of the Congo has reported 3 194 COVID-19 cases and 71 deaths.
Public health response
WHO, with the MOH, are implementing a coordinated rapid response to stop the spread of the outbreak, and to identify any other suspect cases and initiate contact tracing. In-depth epidemiological investigation and contact tracing were initiated on 31 May 2020.
The MOH, with support from WHO and partners have planned the following actions:
- Start risk communication and community engagement activities;
- Develop rapid response plan with clear needs;
- Conduct rapid risk assessment;
- Supply vaccine and cold-chain equipment;
- Mobilize financial support.
The laboratory capacity in Mbandaka is being assessed and support is on-going for appropriate set-up and additional supplies. Safe and dignified burial activities could resume shortly following proper community engagement. Support for case management is also important to ensure provision of care to affected individuals.
WHO did not receive adequate EVD funding since the start of 2020, and is currently using its emergency funds to support the epidemiological and public health interventions. Financial and human resources of the Democratic Republic of the Congo, WHO, and partners are challenged by the ongoing COVID-19 outbreak.
WHO risk assessment
WHO notes that the current resurgence is undesirable, but not unexpected given the identification of wildlife spillover potential in Africa, accompanied by the high population density in the region and considering the sociological, ecological, and environmental drivers that could influence the emergence of EVD.
There is a need for: epidemiologists to conduct disease surveillance; infection prevention and control (IPC) specialists; vaccinators; case management and laboratory staff; and, risk communication and community engagement experts. Materials for infection prevention and control (IPC) and personal protective equipment (PPE), cold-chain, reagents for laboratory diagnostics, and means of transportation are required for the teams.
The area where the cases and deaths were reported, is populated with poor and vulnerable populations, known to be reluctant to social mobilization. This might pose further challenges in terms of case investigation, contact tracing, safe and dignified burials, and vaccination in the coming days.
Additional challenges have been identified regarding:
- further investigations into this event to understand the extent of the outbreak;
- contact identification and tracing, and identification of suspected cases;
- vaccination to control the outbreak;
- risk communication;
- the COVID-19 context including lockdowns and non-availability of flights.
The investigations are ongoing to assess the full extent of the outbreak and therefore high vigilance should be maintained. This information will help define the risk in the coming days.
WHO advises the following risk reduction measures as an effective way to reduce Ebola virus disease transmission in humans:
- Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat. Animals should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.
- Reducing the risk of human-to-human transmission from direct or close contact with people with Ebola symptoms, particularly with their bodily fluids. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.
- Reducing the risk of possible sexual transmission, based on further analysis of ongoing research and consideration by the WHO Advisory Group on the Ebola Virus Disease Response, WHO recommends that male survivors of EVD practice safe sex and hygiene for 12 months from onset of symptoms or until their semen tests negative twice for Ebola virus. Contact with body fluids should be avoided and washing with soap and water is recommended. WHO does not recommend isolation of male or female convalescent patients whose blood has been tested negative for Ebola virus.
- Continue training and re-training of health work force for early detection, isolation and treatment of EVD cases.
WHO continues to advise against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information.
For further information, please see:
- Ebola virus disease fact sheet
- Ebola situation reports: Democratic Republic of the Congo
- History of Ebola virus disease in the Democratic Republic of the Congo:
- Statement on the 1st meeting of the IHR Emergency Committee regarding the Ebola outbreak in 2018
- Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 17 July 2019
- Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 18 October 2019
- Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 12 February 2020
- Statement on the 5th meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 14 April 2020
- COVID-19: Operational guidance for maintaining essential health services during an outbreak
- WHO press release, New Ebola outbreak detected in northwest Democratic Republic of the Congo; WHO surge team supporting the response