Six new confirmed cases were reported in the past week (6 to 12 November) in the ongoing Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces. All six cases resulted from local transmission in Beni and in Mabalako Health Zones, and all were known contacts of a confirmed case. While all cases can be linked to earlier transmission chains in Biakato Mines Health Area, Mandima Health Zone, that health area has not reported a case since 4 November.
In the past week, Kalunguta Health Zone reported 21 days with no new confirmed EVD cases and Katwa Health Zone cleared 42 days with no new confirmed cases. As the number of cases decreases steadily, other case indicators appear to be encouraging. The proportion of registered contacts among cases prior to symptom onset is increasing over time, reaching 100% (6/6) in the past 7 days. Trends in proportion of community deaths among confirmed cases have also improved. In past 3 weeks, 12% (3/34) of cases were community deaths, compared to 28% (17/61) in the previous 3-week period (9-29 October) and 33% over the course of the entire outbreak. AA shorter delay from symptom onset to admission to isolation of alive EVD patients has also been reported. Between 24 August and 1 October 2019 the delay averaged 4.1 days, compared to 3.2 days between 2 October and 12 November 2019.
However, concerns remain around the recent shift of cases to Mabalako Health Zone. In the past 21 days (23 October – 12 November), 40 confirmed cases were reported from five active health zones in North Kivu and Ituri provinces (Figure 2, Table 1) with the majority reported in three health zones: Mabalako (40%, n= 16), Mandima (33%, n= 13), and Beni (20%, n= 8). Ongoing local transmission in Bingo and Ngoyo Health Areas in Mabalako Health Zone is challenging because security issues have caused access and response difficulties in these areas.
As of 12 November, a total of 3291 EVD cases were reported, including 3173 confirmed and 118 probable cases, of which 2193 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 56% (n=1856) were female, 28% (n=930) were children aged less than 18 years, and 5% (n=163) were health workers.
This week the World Health Organization prequalified an Ebola vaccine for the first time. The injectable Ebola vaccine, Ervebo, manufactured by Merck (known as MSD outside the US and Canada) has met WHO standards for quality, safety and efficacy and can now be procured for at-risk countries by United Nations agencies and Gavi, the Vaccine Alliance. This decision will not have an immediate impact on the availability of the vaccine or how current doses are used in the Democratic Republic of the Congo, but is a step towards greater availability in the future.
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 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 Democratic Republic of the Congo and neighboring 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. 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.
For more information, please see:
- WHO resources and updates on Ebola virus disease
- News release: As Ebola cases reach 3000 in DRC, WHO calls on all partners to fulfil promises to communities
- Ebola virus disease in the Democratic Republic of the Congo – Operational readiness and preparedness in neighbouring countries
- Second Ebola vaccine to complement “ring vaccination” given green light in DRC
- Update on Ebola drug trial: two strong performers identified
- Ebola response funding
- The Strategic Advisory Group of Experts (SAGE) on Immunization
- Highlights from the Meeting of the Strategic Advisory Group of Experts (SAGE) on Immunization
- 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