Ebola virus disease – Democratic Republic of the Congo

From 22 to 28 April 2020, one new confirmed case of Ebola virus disease (EVD) was reported from Beni Health Zone in North Kivu Province, Democratic Republic of the Congo (Figure 1). This person was listed as a contact of a confirmed case, a family member who was reported on 17 April. The person was vaccinated on 20 April and was followed by the contact tracing team, though not on a regular basis due to insecurity.

Since the resurgence of the outbreak on 10 April 2020, seven confirmed cases have been reported, all from Beni Health Zone. Of these, one is receiving care at the Beni Ebola treatment centre (ETC), one who was receiving care at the ETC recovered and was discharged, and one remains in the community. Response teams are engaging with the community in order to try to bring that person to the ETC for access to treatment and supportive care, and to prevent further transmission in the community. Four of the people confirmed to have Ebola died, including two community deaths and two deaths in the ETC in Beni.

Specimens from all confirmed cases were sent to the Institut Research Biomédicale (INRB) for genetic sequencing to support surveillance teams in investigating the source of infection. Laboratory sequencing of the virus showed that six out of seven cases were linked to the same chain confirmed in July 2019, suggesting exposure to a persistent source of infection. Individuals in the current cluster may have been infected by direct contact with body fluids of a survivor (asymptomatic or relapse case). Investigations into the transmission chains from July 2019 in Beni and Katwa Health Zones and the confirmed cases reported in April 2020 are ongoing in order to identify the origin of the current cluster of EVD cases.

Surveillance performances have improved compared to last week, although alert rates remain suboptimal. A total of 970 contacts of the seven recent confirmed cases have been registered; among these contacts, 897 (92%) were followed and 726 (75%) were vaccinated. Of the 970 contacts, 382 (40%) were high risk contacts (direct contact with body fluids of confirmed cases). As of 28 April 2020, 57 (15%) of the 382 high risk contacts of confirmed cases have been offered accommodation in a dedicated facility where they are provided with food and other essential goods, to allow for closer monitoring and prompt isolation and provision of care to those who might become symptomatic.

From 22 to 28 April 2020, an average of 2152 alerts were reported and investigated per day. Of these, an average of 230 alerts were validated as suspected cases each day, requiring specialized care and laboratory testing to rule-out EVD. Timely testing of suspected cases continues to be provided from eight laboratories. From 20 to 26 April 2020, 1544 samples were tested including 961 blood samples from alive, suspected cases; 285 swabs from community deaths; and 298 samples from re-tested patients. Overall, laboratory activities increased by 50% compared to the previous week.

As of 28 April 2020, a total of 3462 EVD cases, including 3316 confirmed and 145 probable cases have been reported, of which 2279 cases died (overall case fatality ratio 66%). Of the total confirmed and probable cases, 57% (n=1961) were female, 29% (n=996) were children aged less than 18 years, and 5% (n=171) were health care workers. As of 28 April, a total of 1170 cases have recovered from EVD.

Response teams face a number of challenges, including limited response resources because of other local and global emergencies, and the presence of armed groups which limits access to some communities. It is essential to detect, isolate, test and treat new suspected cases as early as possible in order to improve outcome of cases and break the chain of transmission. A major funding gap is also constraining the response; WHO currently requires US$21.5 million to ensure continuity of essential response activities in the Democratic Republic of the Congo.

Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset by health zone. Data as of 28 April 2020*

*Excludes n=88/3461 cases for whom onset dates not reported. Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning. ‘Non-active zones’ indicate health zones that have not reported new cases in the last 42 days.

Table 1: Confirmed and probable Ebola virus disease cases, and number of health areas affected, by health zone, North Kivu Province, Democratic Republic of the Congo, data as of 28 April 2020**

**Total cases and areas affected during the last 21 days are based on the initial date of case alert and may differ from date of confirmation and daily reporting by the Ministry of Health.

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

On 14 April 2020, WHO revised the risk assessment for this event from High to Moderate at the national and regional levels, while the risk level remained Low at the global level. The risk assessment will be continuously reassessed in the coming days based on available and shared information.

For further information, please see the Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 14 April 2020

WHO advice

WHO advises against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on the currently available information regarding this EVD outbreak. 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 in relation to this EVD outbreak. Travellers should seek medical advice before travel and should practise 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:

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