Ebola virus disease – Democratic Republic of the Congo

From April 15 to 21, 2020, three new confirmed cases of Ebola virus (EVD) were reported in the Democratic Republic of the Congo, all from the Beni Health Zone in North Kivu (Figure 1). Two of the three cases were registered as contacts, although none regularly followed up with the response team due to insecurity and ongoing challenges with the backlog of the community.

As of April 10, a total of six cases were reported, four of which were deceased; two in the community and two at the Ebola Treatment Center (ETC). There is currently one confirmed case for ETC care and one that remains in the community; response teams are engaged with the community to try to bring a person to the ETC to access treatment and support and to prevent further transmission in the community.

Prior to the appearance of this cluster in Beni, the last person confirmed that EVD had been tested negative twice and was discharged from the treatment center on March 3, 2020. As of April 21, a total of 762 contacts of these cases had been registered. of which 603 (79%).

Samples from all six confirmed cases were sent to Genetic Sequencing Research Institute Biomédicale (INRB) to support the monitoring teams in investigating the source of the infection and to determine if the cases were related to a known transmission chain. Laboratory virus sequencing showed a link to cases confirmed in July 2019, suggesting exposure to a persistent source of infection. Therefore, individuals in the current cluster may become infected by direct contact with the body fluids of the survivor (case of asymptomatic disease or relapse). An investigation into transmission chains since July 2019 in Beni and Katwa health zones as well as confirmed cases reported in April 2020 is ongoing.

Between April 15 and 21, 2020, an average of 2037 warnings per day were reported and investigated. Of these, an average of 196 warnings were confirmed as suspicious cases every day, specialized care and laboratory testing were required to exclude EVD. Although the alert rate increased slightly in the past week, it remains at a subtle level as teams withdraw in 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 from nine laboratories continues. From April 13 to 19, 2020, 1030 samples were tested, including 583 blood samples from live, suspected cases; 267 community death swabs; and 180 samples of retested patients. Overall, laboratory activity increased 6% compared to the previous week.

As of April 21, 2020, a total of 3461 EVD cases were reported, including 3316 confirmed and 145 probable cases, of which 2279 cases (66% overall case fatality rate). Of the total confirmed and probable cases, 56% (n= 1943) were women, 28% (n= 983) were children under the age of 18 and 5% (n= 171) were healthcare professionals. As of April 21, a total of 1169 cases had recovered from EVD.

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

Figure 1: Confirmed and probable cases of Ebola disease by weeks of onset of disease by health field. Data as of April 21, 2020 *

* Excludes n= 130/3461 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 probable cases of Ebola disease and number of affected health areas by health zone, North Kivu, 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 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 on this outbreak of EVD. All applications for Ebola vaccination certificates are not a reasonable basis for restricting movement across borders or issuing visas to travelers to / from the affected countries. WHO continues to closely monitor and, if necessary, review travel and trade measures regarding this event. Currently, no country has implemented travel measures that significantly impede international traffic to and from the Democratic Republic of the Congo in relation to this EVD epidemic. 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: