Nine new confirmed cases were reported from January 15 to 21 in the ongoing Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo. All cases were reported from the Beni health area in North Kivu province. Eight of the cases (8/9) were contacts registered before the onset of symptoms; all nine had epidemiological links to a confirmed case.
In the last 21 days (from January 1 to 21, 2020), 35 confirmed cases were reported from 11 health areas within five active health zones in North Kivu and Ituri provinces (Figure 1, Figure 2, Table 1): Beni (north= 14), Mabalako (north= 11), Butembo (north= 5), Mambasa (north= 4), and Musienene (north= 1). The Beni and Mabalako health zones remain the current hot spots of the outbreak, having reported 71% of confirmed cases in the last 21 days. Of the 35 people confirmed with EVD in the last 21 days, 24 were isolated and received care within the first two days after the onset of symptoms, which means they have a better chance of survival and are less likely to infect contacts in the community. In the last 21 days, only one confirmed EVD death occurred in the community, outside of an Ebola treatment center.
In the past few weeks, contacts of confirmed cases have been offered the option of staying in assigned supportive accommodations for identified EVD contacts where food and other essential goods are provided. This enables systematic daily monitoring of contacts and allows immediate isolation and provision of care for contacts who become symptomatic. As a result, the average isolation time in the last 21 days has decreased from three days to one day (interquartile range 0-3).
The number of new confirmed cases reported each week has been stable for the past six weeks, with approximately 14 new EVD cases reported weekly. Furthermore, improved surveillance indicators, such as the proportion of cases listed as contacts and followed up before detection, and decreased isolation time of cases are encouraging signs.
As of January 21, a total of 3,416 EVD cases were reported, including 3,297 confirmed cases and 119 probable cases, of which 2,238 died (66% overall case fatality rate) (Table 1). Of the total confirmed and probable cases, 56% (north= 1912) were women, 28% (north= 963) were children under 18 and 5% (north= 172) of all reported cases) were health workers.
Analysis of the ongoing transmission chain.
As of January 21, the current transmission chain is made up of 82 confirmed and probable cases reported in 13 health areas in six health areas; Mabalako, Beni, Biena, Butembo, Katwa and Musienene health zones. The chain of transmission originated from an individual who was classified as a relapse of EVD in the Aloya Health Area, Mabalako Health Zone (first reported in the Disease Outbreak News published on December 19, 2019) . The individual, who is the first and only documented case of relapse in this outbreak, was infected in June 2019, relapsed in November, and died in December.
Other analyzes indicate that the individual directly infected 29 people while symptomatic in the community for nine days before being isolated. Of the cases that were directly infected from this case, 11/29 were through a possible nosocomial transmission. The remaining 52 cases resulted from subsequent broadcasts.
According to the information available on the place of exposure for cases in this chain of transmission, the main drivers are people exposed in the community due to delays in the isolation of cases (50%, 41/82), possible nosocomial transmission ( 37%, 30/82), and community deaths where cases were exposed during funerals (2%, 2/82). The estimated reproduction number (R), which is the expected number of secondary cases produced by a single infection in a susceptible population, for this transmission chain was not statistically significantly different from the general mean R for this outbreak, probably due to the shows a limited size of the cases in the transmission chain that originated in the Aloya Health Area. These findings reinforce the importance of early identification of safe and dignified cases and burials.
Figure 1: Confirmed and probable cases of Ebola virus disease by week of onset of disease by health area. Data as of January 21, 2020 *
* *3416 confirmed and probable cases, reported as of January 21, 2020. Excludes n = 169 cases for which start dates were not reported. Data for the past few weeks is subject to confirmation delays and case reports, as well as continuous data cleansing. Other health areas include: Alimbongo, Ariwara, Bunia, Goma, Kayna, Komanda, Kyondo, Lolwa, Lubero, Mandima, Manguredjipa, Masereka, Mutwanga, Mwenga, Nyakunde, Nyiragongo, Oicha, Pinga, Rwampara, Tchomia and Vuhovi.
Figure 2: Confirmed and probable cases of Ebola virus disease by week of onset of disease by health area. Data as of January 21, 2020 *
Table 1: Confirmed and probable cases of Ebola virus disease by week of onset of disease by health area. Data as of January 21, 2020 **
** **Total cases and affected areas during the last 21 days are based on the initial alert date of the case and may differ from the confirmation date and the daily report of the Ministry of Health.
Public health response
For more information on the public health response actions of the Ministry of Health, WHO and their partners, see the latest status reports published by the WHO Regional Office for Africa:
WHO risk assessment
WHO continually monitors changes in the epidemiological situation and outbreak context to ensure that response support is tailored to changing circumstances. The latest evaluation concluded that national and regional risk levels remain very high, while global risk levels remain low.
WHO advises against any travel and trade restrictions with the Democratic Republic of the Congo based on currently available information. Any requirement for Ebola vaccination certificates is not a reasonable basis to restrict movement across borders or issuance of travel visas to / from 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. Travelers should seek medical advice before traveling and should practice good hygiene. More information is available in the WHO recommendations for international trafficking related to the Ebola virus disease outbreak in the Democratic Republic of the Congo.
For more information, see: