Ebola virus disease – Democratic Republic of the Congo

This week, the incidence rate remains low in the Ebola Outbreak (EVD) in the Democratic Republic of the Congo (Figure 1). From February 5 to 11, three new confirmed cases were reported in the Beni Health Zone, North Kivu Province. All three cases have epidemiological links to the transmission chain originating from Aloya Health Area, Mabalako Health Zone, with possible nosocomial exposure in Bena. The latest case reported from the Beni Health Zone on February 11 was isolated the day after the onset of symptoms. Early detection of cases reduces the likelihood of transmission of EVD in the community and significantly improves the clinical outcome for patients.

In the past 21 days (22 January to 11 February 2020), 12 confirmed cases were reported, including three community deaths from four health areas within two active health zones in North Kivu province (Figure 2, Table 1): Beni (n= 11) and Mabalako (n= 1). It’s been 42 days since Katwa Health Zone reported new cases. Encourages the continued decline in the geographical spread of EVD cases and the declining trend in cases recorded over the past 21 days; however, these improvements remain fragile and should not be interpreted as indicating that response efforts can be reduced. Continued vigilance is key to improving infection prevention and control in healthcare settings, as well as to early detection and monitoring of cases and contacts.

As of February 11, a total of 3432 EVD cases were reported, including 3309 confirmed and 123 probable cases, of which 2253 cases died (66% overall mortality rate) (Table 1). Of the total confirmed and probable cases, 56% (n= 1923) were women, 28% (n= 968) were children under the age of 18 and 5% (n= 172) of all reported cases were healthcare professionals.

On February 12, the Director-General of WHO relaunched the Emergency Committee in accordance with International Health Regulations (IHR). The Committee reviewed progress on the implementation of the provisional recommendations issued on 18 October 2019. Updates on the epidemic were submitted by representatives of the Ministry of Health of the Democratic Republic of the Congo, the UN Ebola Emergency Coordinator and the WHO Secretariat. The situation in neighboring countries was revised, as was preparedness in the intact areas of the Democratic Republic of Congo. The Committee considered that this event continues to be a public health emergency (PHEIC). Further details can be found in the Emergency Committee statement.

On February 10, WHO announced a new one guidelines for healthcare providers regarding the management of pregnant and breastfeeding women in the context of Ebola virus disease. The document reviews the existing evidence and provides a unique set of recommendations for the continued care of women who are exposed, diagnosed or recovering from Ebola, and will enable health care providers, emergency teams and policy makers to improve their Ebola prevention and treatment measures. You can find news about these guidelines here.

Figure 1: Confirmed and probable cases of Ebola disease by weeks of onset of disease by health field. Data as of February 11, 2020 *

*3432 confirmed and probable cases, reported February 11, 2020. Excludes n = 163 cases for which start dates have not been reported. Data in recent weeks is subject to delays in confirmation and reporting, as well as ongoing data cleanup. Inactive health zones indicate an area of ​​health that has not recorded cases in the last 42 days.

Figure 2: Confirmed and probable cases of Ebola virus disease by weeks of disease onset by health field. Data as of February 11, 2020 *

Table 1: Confirmed and probable cases of Ebola virus and number of affected health areas by health zone, North Kivu, Democratic Republic of the Congo, data as of 11 February 2020 **

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

Public health response

For further information on the public health response activities of the Ministry of Health, WHO and partners, see the latest status reports published by the WHO Regional Office for Africa:

WHO risk assessment

On 12 February 2020, the WHO revised the risk assessment for this event from very high to high at national and regional levels, while maintaining the risk level as low globally. WHO continually monitors changes in the epidemiological situation and outbreak context to ensure that response support is adapted to evolving circumstances. This assessment acknowledged improvements in the occurrence of cases and other epidemiological indicators, as well as strengthened local and regional capacity. However, the dynamics of the epidemic depend on access to response teams in the affected areas. Continued insecurity remains an obstacle to efforts to respond to the epidemic. The limited number of community fatalities still occasionally reported among new EVD cases may strengthen transmission, with the possibility that new cases may occur outside the surveillance groups. Ebola virus may exist in the body fluids of some survivors. In a limited number of cases, secondary transmissions of exposure to body fluids of survivors have been documented. In the next few months, we should expect further accumulations of cases after exposure to body fluids that survivors have. This risk can be mitigated by a specific survivor care and monitoring program. At national and regional level, the potential constraints imposed by response and preparedness activities (e.g., lack of funding, loss of access to communities due to deteriorating security, etc.) could reverse the gains made in epidemic control.

Tip of WHO

WHO advises against any restrictions on travel to and trade with the Democratic Republic of the Congo, based on currently available information. All applications for Ebola vaccination certificates are not a reasonable basis for restricting movement across borders or issuing visas to travelers to / from affected countries. WHO continues to closely monitor and, if necessary, review travel and trade measures regarding this event. At present, no country has implemented travel measures that significantly impede international traffic to and from the Democratic Republic of the Congo. Travelers should seek medical attention before traveling and should be based on good hygiene. More information is available at WHO recommendations for international traffic related to the Ebola epidemic in the Democratic Republic of the Congo.

For more information, see: