From 10 to 14 April 2020, three new confirmed cases of Ebola virus disease (EVD) were reported in the ongoing outbreak in the Democratic Republic of the Congo (Figure 1). All of the cases were reported from Beni Health Zone in North Kivu Province. Two individuals passed away in the community after visiting several healthcare facilities. The infection of the third individual has been epidemiologically linked to one of these cases. The individual is currently receiving care at an Ebola treatment centre. Prior to this development, the last person confirmed to have EVD tested negative twice and was discharged from a treatment centre on 3 March 2020.
Specimens from all confirmed cases were sent to the Institut de Recherche Biomedicale (INRB) in Katwa and in Kinshasa for genetic sequencing in order to support surveillance teams in the investigation of the source of infection and to determine whether these cases were linked to a known chain of transmission. A total of 332 contacts of these cases have been registered, 248 of whom were followed on 14 April 2020, and 200 of whom were vaccinated by three vaccination teams that have been activated. While approximately 6,000 doses are available in Beni Health Zone, WHO anticipates potential challenges with the vaccine pipeline due to limited flight ability as a result of the coronavirus disease 2019 (COVID-19) pandemic.
From 8 to 14 April 2020, an average of 2015 alerts were reported and investigated per day. Of these, an average of 177 alerts were validated as suspected cases each day, requiring specialized care and laboratory testing to rule-out EVD. The alert rate has decreased for the past three weeks as teams are pulled into other emergencies, including COVID-19. Other challenges include the presence of armed groups and limited access to some affected health areas, movement of contacts, and possible under-reporting to the central coordination of the outbreak response. Timely testing of suspected cases continues to be provided from 11 laboratories. From 6 to 12 April 2020, 968 samples were tested including 466 blood samples from alive, suspected cases; 274 swabs from community deaths; and 228 samples from re-tested patients. Overall, laboratory activities decreased by 28% compared to the previous week.
On 9 April 2020, two new probable cases, with onset of symptoms in November 2019 and December 2019, were retrospectively validated. As of 14 April 2020, a total of 3458 EVD cases were reported from 29 health zones (Table 1), including 3313 confirmed and 145 probable cases, of which 2277 cases died (overall case fatality ratio 66%). Of the total confirmed and probable cases, 56% (n=1943) were female, 28% (n=982) were children aged less than 18 years, and 5% (n=171) were health care workers.
An urgent injection of US $20 million is required to ensure that response teams have the capacity to maintain the appropriate level of operations through to the beginning of May 2020. More information is available from End in sight, but flare-ups likely in the Ebola outbreak in the Democratic Republic of the Congo.
The new confirmed cases 40 days after the last person tested negative and was discharged from care are not unexpected. The WHO recommended criteria for declaring the end of the EVD outbreak includes a 42-day waiting period because undetected chains of transmission or new flare-ups may arise. The sequencing analysis will be critical to inform the investigation of the source of infection and to help detect any missed cases in the chain of transmission that led to this cluster. It is essential to remain vigilant and maintain enhanced surveillance, rapid detection and response capacities, as well as continue to engage community leaders to address or mitigate community mistrust in affected areas.
Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset by health zone. Data as of 14 April 2020*
*Excludes n=130/3458 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 14 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 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 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: