From 15 to 21 April 2020, three new confirmed cases of Ebola virus disease (EVD) were reported in the Democratic Republic of the Congo, all from Beni Health Zone in North Kivu Province (Figure 1). Two out of three cases were registered as contacts, though none were regularly followed by the response team because of insecurity and ongoing challenges with community reticence.
In total, six cases have been reported since 10 April, four of whom have passed away; two in the community and two in an Ebola treatment centre (ETC). Currently, there is one confirmed case receiving care at an ETC and one who remains in the community; response teams are engaging with the community in order to try to bring the person to the ETC for access to treatment and supportive care, and to prevent further transmission in the community.
Prior to the emergence of this cluster in Beni, the last person confirmed to have EVD tested negative twice and was discharged from a treatment centre on 3 March 2020. As of 21 April, a total of 762 contacts of these cases have been registered, of which 603 (79%) were followed.
Specimens from all six confirmed cases were sent to the Institut Research Biomédicale (INRB) for genetic sequencing to support surveillance teams in investigating the source of infection and to determine if cases were linked to a known chain of transmission. Laboratory sequencing of the virus showed a link to cases that were confirmed in July 2019, suggesting exposure to a persistent source of infection. Therefore, 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, as well as confirmed cases reported in April 2020 are ongoing.
From 15 to 21 April 2020, an average of 2037 alerts were reported and investigated per day. Of these, an average of 196 alerts were validated as suspected cases each day, requiring specialized care and laboratory testing to rule-out EVD. Though the alert rate increased slightly in the past week, it remains at a suboptimal level as teams are pulled into other emergencies, including COVID-19. Response teams also face other challenges, such as the presence of armed groups and limited access to some communities.
Timely testing of suspected cases continues to be provided from nine laboratories. From 13 to 19 April 2020, 1030 samples were tested including 583 blood samples from alive, suspected cases; 267 swabs from community deaths; and 180 samples from re-tested patients. Overall, laboratory activities increased by 6% compared to the previous week.
As of 21 April 2020, a total of 3461 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, 56% (n=1943) were female, 28% (n=983) were children aged less than 18 years, and 5% (n=171) were health care workers. As of 21 April, a total of 1169 cases have recovered from EVD.
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: End in sight, but flare-ups likely in the Ebola outbreak 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 21 April 2020*
*Excludes n=130/3461 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 21 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 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: