The number of confirmed cases of Ebola virus disease (EVD) remains relatively low this week, with 21 new confirmed cases reported in North Kivu and Ituri provinces during the epidemiological week of 14 – 20 October. The observed fluctuation in case incidence (Figure 1) may be expected given the challenges faced by response teams in the prior weeks.
Biakato Health Area in Mandima Health Zone reported almost half the number of new confirmed cases in the past week (52%, n=11) and had links to the majority of cases (76%, n=16). The movement of 5 cases exposed in Biakato Mines Health Area, but detected outside of the area, brings forth operational challenges for teams on the ground. Movement of cases while symptomatic not only increases the risk of spread of EVD to unaffected and previously cleared geographic areas, it also hinders timely case investigations, contact tracing, and response measures implemented to limit the risk of transmission.
The deployment of additional support to the Biakato Mines Health Area has led to improvements in response efforts in the past week. The proportion of confirmed cases listed as contacts has increased from 13% to 57%. Similarly, in the past week there has been an increase from 47% to 90% in confirmed cases with a known epidemiological link to a case. Nevertheless, both indicators are below the level we would aim to be at this stage. As case incidence declines, continued strengthening of community-based surveillance and alerts from health facilities to rapidly detect flare-ups is a high priority for all areas.
During the past 21 days (from 2 – 22 October), 50 confirmed cases were reported from eight active health zones in North Kivu and Ituri provinces (Figure 2, Table 1) with the majority reported in three health zones: Mandima (52%, n=26), Mambasa (12%, n=6), and Mabalako (10%, n=5). The major metropolitan area of Butembo city, comprising Katwa and Butembo health zones, which reported almost 1000 cases to date, recently cleared 21 days without newly detected cases. While this milestone highlights advances in the response, movement of cases to previously cleared health zones can quickly result in resurgence. An example of this was the detection of cases in Mabalako, all linked to Biakato Mines, after not reporting a confirmed case for 33 days. To mitigate the risk of onward transmission, ensuring community access and full operational readiness in cleared health zones and strategic at-risk communities is essential.
As of 22 October, a total of 3250 EVD cases were reported, including 3133 confirmed and 117 probable cases, of which 2174 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 56% (n=1827) were female, 28% (n=921) were children aged less than 18 years, and 5% (n=163) were health workers.
On 18 October, the Director-General reconvened the Emergency Committee under the International Health Regulations. The Committee reviewed progress in the implementation of the Temporary Recommendations issued by the Director-General on 17 July 2019. Updates on the outbreak were provided by representatives of the Democratic Republic of the Congo, as well as the UN Ebola Emergency Response Coordinator and the WHO Secretariat. Updates on preparedness in the neighbouring countries were provided by the United Republic of Tanzania, Republic of Uganda and the WHO Regional Office for Africa. It was the view of the Committee that this event still constitutes a public health emergency of international concern (PHEIC) under the IHR. The Committee provided this advice to the Director-General, who issued revised Temporary Recommendations under the IHR.
Under Pillar 1 of the current Strategic Response Plan, the estimated funding requirement for all partners for the period July to December 2019 is US$ 287 million, including US$ 140 million for WHO. As of 21 October 2019, US$ 69.5 million has been received by WHO, with additional funds committed or pledged. Further resources are needed to fully fund the response through to December 2019 and into Q1 2020.
Under Pillar 5, Regional Preparedness, pillar, the funding requirement for all partners is US$ 66 million, of which WHO requires US$ 21 million. As of 21 October 2019, WHO has received US$ 4.3 million. While some additional pledges are in the pipeline, increased funding for preparedness in neighbouring countries is urgently needed. WHO is appealing to donors to provide generous support. A summary of funding received by WHO since the start of this outbreak can be found here.
Public health response
For further information about public health response actions by the Ministry of Health, WHO, and partners, please refer to the latest situation reports published by the WHO Regional Office for Africa:
WHO risk assessment
WHO continuously monitors changes to the epidemiological situation and context of the outbreak to ensure that support to the response is adapted to the evolving circumstances. The last assessment, carried out on 8 October 2019, concluded that the national and regional risk levels remain very high, while global risk levels remain low.
While the relatively lower case incidence observed is encouraging, it must be interpreted with caution as the situation remains highly contingent upon the level of access and security within affected communities. Concurrent with the decline in case incidence, there was a further shift in hotspots from urban settings to more rural, hard-to-reach communities, within a more concentrated geographical area. These areas bring additional challenges to the response, including: an extremely volatile security situation; difficulty accessing some remote areas; delays to engaging with the community which in turn lead to mistrust and misunderstandings; and, potential under-reporting of cases. In such environments, risks of resurgence remain very high, as do the risks of re-dispersion of the outbreak with cases travelling outside of hotspots to seek healthcare or for other reasons. These risks continue to be mitigated by the substantial response and preparedness activities in the DRC and neighbouring countries, with support from a consortium of international partners.
WHO advises against any restriction of travel to, and trade with, 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 travellers to/from the affected countries. 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. Further information is available in the WHO recommendations for international traffic related to the Ebola Virus Disease outbreak in the Democratic Republic of the Congo.