Ebola virus disease – Democratic Republic of the Congo

From 10 to 14 April 2020, three new confirmed cases of Ebola virus (EVD) were reported during an outbreak in the Democratic Republic of the Congo (Figure 1). All cases were reported from the Beni Health Zone in North Kivu Province. Two people have died in the community after visiting several health care facilities. Third-person infection is epidemiologically linked to one of these cases. The individual is currently being cared for at the Ebola Treatment Center. Prior to this development, the last person confirmed that EVD was tested negative twice and was discharged from the medical center on March 3, 2020.

Samples of all confirmed cases were sent to the Institut de Recherche Biomedicale (INRB) in Katwa and Kinshasa for genetic sequencing to support surveillance teams in investigating the source of the infection and to determine whether these cases were related to a known transmission chain. A total of 332 contacts were registered in these cases, of which 248 were monitored on 14 April 2020, and 200 were vaccinated by three activated vaccination teams. Although approximately 6,000 doses are available in the Beni Health Zone, WHO expects potential challenges with the vaccine pipeline due to its limited flight ability due to the 2019 coronavirus pandemic (COVID-19).

From April 8 to 14, 2020, reports and investigations averaged over the 2015 alert. Of these, an average of 177 warnings were confirmed as suspicious cases each day, and specialized care and laboratory testing were required to exclude EVD. Alert rates have dropped in the last three weeks as teams withdraw in 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 of central coordination of epidemic responses. Timely testing of suspected cases from 11 laboratories continues. From April 6 to April 12, 968 samples were tested, including 466 blood samples from live, suspected cases; 274 community swabs; and 228 samples of retested patients. Overall, laboratory activity 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 confirmed. As of April 14, 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 (66% overall mortality rate). Of the total confirmed and probable cases, 56% (n= 1943) were women, 28% (n= 982) were children under the age of 18 and 5% (n= 171) were healthcare professionals.

An emergency injection of US $ 20 million is required to ensure that response teams are able to maintain an appropriate level of operations by early May 2020. More information is available at End in sight, but flashes of possible Ebola outbreaks in the Democratic Republic of Congo.

New confirmed cases 40 days after the last person was tested negative and discharged from care are not unexpected. The WHO recommended criteria for declaring the end of the EVD epidemic includes a 42-day waiting period as undetected transmission chains or new flames may form. Sequence analysis will be crucial to inform the source of the infection and to help detect any missed cases in the transmission chain that led to this cluster. It is important to remain vigilant and maintain enhanced surveillance, rapid detection and response capabilities, as well as continue to engage community leaders in addressing or alleviating distrust in the affected areas.

Figure 1: Confirmed and probable cases of Ebola disease by weeks of onset of disease by health field. Data as of April 14, 2020 *

* Excludes n= 130/3458 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 zones” means health zones that have not reported new cases in the last 42 days.

Table 1: Confirmed and likely cases of Ebola virus and number of health areas affected by the health zone, North Kivu Province, Democratic Republic of the Congo, data as of April 14, 2020 **

** Total cases and areas affected during the last 21 days are based on the initial date of the case and may differ from the date of confirmation and daily reporting by 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 April 14, 2020, WHO revised the risk assessment for this event from high to moderate at national and regional levels, while the risk level remained low globally. The risk assessment will be continually re-evaluated in the coming days based on the information available and common.

For further information, please see the section Meeting Statement of the International Health Regulations Meeting (2005) Ebola Emergency Committee in the Democratic Republic of the Congo 14 April 2020

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: