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New measures to overcome obstacles in responding to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo are having a positive impact. The Ministry of Health (MoH), WHO and partners continue to be confident that, despite challenges, the outbreak can be contained.
Over the past week (7 – 13 November), transmission continued in several areas of North Kivu Province, while a geographical expansion of the outbreak to two new health zones (Kyondo and Mutwanga) was observed (Figure 1). The first cases reported from these health zones were exposed through contact with cases in Butembo and Beni, respectively.
During the reporting period, 31 new confirmed EVD cases were reported from Beni, Mutwanga, Kalunguta, Butembo, Vuhovi, Kyondo and Musienene. Four of the new cases were newborn babies and infants aged less than two years, three were children aged between 2 – 17 years and three were women who were pregnant or breastfeeding. Three health workers from Beni and Butembo were among the newly infected; 31 health workers have been infected to date. Twelve additional survivors were discharged from Beni (nine), Butembo (two) and Mabalako (one) Ebola treatment centres (ETCs) and reintegrated into their communities; 103 patients have recovered to date.
During the past week, a review and reconciliation of case records was conducted. This review resulted in the addition of 14 probable cases, invalidation of 11 past deaths previously reported as probable cases and exclusion of duplicate cases. In addition, some confirmed and probable cases were recategorized to health zones where their infection most likely occurred, as opposed to the location of the ETC where they were admitted.
As of 13 November, 341 EVD cases (303 confirmed and 38 probable), including 215 deaths (177 confirmed and 38 probable)1, have been reported in 11 health zones in North Kivu Province and three health zones in Ituri Province (Figure 1). The overall trends in weekly case incidence reflect the continuation of community transmission in several cities and villages in North Kivu (Figure 2). Given the expected delays in case detection and ongoing data reconciliation activities, trends, especially in the most recent weeks, must be interpreted cautiously.
The risk of the outbreak spreading to other provinces in the Democratic Republic of the Congo, as well as to neighbouring countries, remains very high. Over the course of the past week, alerts have been reported from South Sudan and Uganda; EVD has been ruled out for all alerts to date. The vaccination of health and frontline workers at priority sites in Uganda began on 7 November, and preparations are ongoing for the vaccination of health and frontline workers in Rwanda and South Sudan.
Public health response
The MoH continues to strengthen response measures, with support from WHO and partners. Priorities include coordinating the response, surveillance, contact tracing, laboratory capacity, infection prevention and control (IPC), clinical management of patients, vaccination, risk communication and community engagement, psychosocial support, safe and dignified burials (SDB), cross-border surveillance and preparedness activities in neighbouring provinces and countries. To support the MoH, WHO is working intensively with a wide range of multisectoral and multidisciplinary regional and global partners and stakeholders for EVD response, research and urgent preparedness, including in neighbouring countries.
For detailed information about the public health response actions by WHO and partners, see the latest situation reports published by the WHO Regional Office for Africa:
WHO risk assessment
This outbreak of EVD is affecting north-eastern provinces of the country, which border Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include: transportation links between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations; and the displacement of Congolese refugees to neighbouring countries. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri at times limits the implementation of response activities. WHO’s risk assessment for the outbreak is currently very high at the national and regional levels; the global risk level remains low. WHO continues to advise against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on currently available information.
As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. The IHR Emergency Committee has advised that failing to intensify these preparedness and surveillance activities would lead to worsening conditions and further spread. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.
WHO advice
International traffic: WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information. There is currently no licensed vaccine to protect people from the Ebola virus. Therefore, any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for passengers leaving the Democratic Republic of the Congo. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.
For more information, see:
- Summary report for the SAGE meeting of October 2018
- Statement on the October 2018 meeting of the IHR Emergency Committee on the Ebola virus disease outbreak in the Democratic Republic of the Congo
- WHO Interim recommendation Ebola vaccines
- WHO recommendations for international travellers related to the Ebola Virus Disease outbreak in the Democratic Republic of the Congo
- Ebola virus disease in the Democratic Republic of the Congo – Operational readiness and preparedness in neighbouring countries
- Ebola virus disease fact sheet