DR Congo

Ebola virus disease – Democratic Republic of the Congo: Disease outbreak news, 26 June 2020

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On 25 June 2020, the Minister of Health of the Democratic Republic of the Congo declared the end of the Ebola Virus Disease (EVD) outbreak in North Kivu, Ituri and South Kivu Provinces . In accordance with WHO recommendations, the declaration was made more than 42 days after the last person who contracted EVD in this outbreak tested negative twice and was discharged from care.

The outbreak was declared on 1 August 2018 following investigations and laboratory confirmation of a cluster of EVD cases in North Kivu Province. Further investigations identified cases in Ituri and North Kivu Provinces with dates of symptom onset from May to August 2018. In 2019, the outbreak subsequently spread to South Kivu Province, and on 17 July 2019, the WHO Director-General declared the outbreak a Public Health Emergency of International Concern. In the Democratic Republic of the Congo, 11 outbreaks have been recorded since the first recognized outbreak in 1976. The 10th EVD outbreak in North Kivu, Ituri and South Kivu Provinces was the country's longest EVD outbreak and the second largest in the world after the 2014–2016 EVD outbreak in West Africa.

The response to the outbreak was led by the Ministry of Health with support from WHO and partners in the areas of surveillance, contact tracing, laboratory services, infection prevention and control (IPC), clinical management, community engagement, safe and dignified burials, response coordination and preparedness activities in neighbouring provinces. The engagement of local leaders, communities and survivors in EVD survivor care programmes and community messaging played a central role in curtailing the outbreak. Challenges in establishing trust with affected communities, reticence for admission to Ebola treatment facilities, a high level of insecurity due to the presence of armed groups in the affected areas, as well as a series of attacks against health workers contributed to the difficulty of containing this outbreak.

Despite these challenges, no new confirmed cases have been reported since April 2020, and North Kivu, Ituri and South Kivu Provinces were declared Ebola-free 23 months after the first cases were reported. June 2020 marks the beginning of the handover of outbreak response and surveillance activities from the central government and international partners to the Provincial Health Divisions.

From 17 to 23 June 2020, an average of 2790 alerts were reported per day and investigated. Of these, over 99% were investigated within 24 hours, and an average of 428 alerts were validated as suspected cases each day, requiring specialized care and laboratory testing to rule out EVD. Sustained numbers of alerts have been reported daily since April 2020 due to strengthened capacity to detect emergent cases and continuous support of provincial health divisions and the Ministry of Health. The timely testing of suspected cases was achieved by a network of eight laboratories. From 15 to 21 June 2020, a total of 3219 samples were tested including 2665 blood samples from alive, suspected cases; 323 swabs from community deaths; and 344 samples from re-tested patients. Overall, the number of samples tested by the laboratories increased by 4% compared to the previous week.

From 1 August 2018 to 25 June 2020, a total of 3470 EVD cases were reported from 29 health zones including 3317 confirmed cases and 153 probable cases. Of the total confirmed and probable cases, 57% (n=1974) were female, 29% (n=1006) were children aged less than 18 years and 5% (n=171) were health care workers. There were 2287 deaths recorded (overall case fatality ratio 66%), 33% (1152/3470) of cases died outside of Ebola treatment centres, and 1171 cases recovered from EVD. Over the course of the outbreak, more than 250 000 contacts of cases were registered in North Kivu, Ituri and South Kivu Provinces.

On 25 June 2020, the Democratic Republic of the Congo entered a 90-day period of heightened surveillance. Although human-to-human transmission of Ebola virus has ended in North Kivu, Ituri and South Kivu Provinces and the outbreak has officially been declared over, the risk of re-emergence still exists. Therefore, there is a critical need to maintain response operations to rapidly detect and respond to any new cases and to prioritize ongoing support and care for people who recovered from EVD.

Ebola virus can persist in some body fluids of survivors for several months, and in rare cases may result in secondary transmission or in relapse, as seen in this outbreak. In addition, Ebola virus is present in animal reservoirs in the region, so there is continued risk of zoonotic spillover. Given that cases may continue to occur from time to time in the Democratic Republic of the Congo, maintaining a robust surveillance system and response operations to rapidly detect, isolate, test and treat new suspected cases are essential.