1. Situation update
The outbreak of Ebola virus disease (EVD) in North Kivu and Ituri provinces, Democratic Republic of the Congo (DRC)continued this past week with an overall similar transmission intensity compared to recent weeks.
On 14 July 2019, a confirmed case of EVD was reported in Goma, a city of two million inhabitants close to the Rwandan border. The case was a man who had travelled to the city from Butembo by bus and visited a healthcare centre with fever. He was initially admitted at an Ebola Treatment Centre (ETC) in Goma and died while being transferred to the ETC in Butembo. The case’s full travel history is known, and all contacts are being identified and followed-up. Vaccination of high-risk contacts commenced on 15 July 2019. The confirmation of a case in the city of Goma has long been anticipated, and there has been intensive preparation work for the past six months. At the time of this report’s publication, approximately 3000 health workers had been vaccinated, and healthcare centres were provided with intensive training and personal protective equipment to improve infection prevention and control (IPC), while surveillance teams continue with enhanced alert investigations and contact tracing efforts.
On 9 July 2019, an EVD case was reported from Mambasa. The case was a known contact whose mother died in Beni in mid-June 2019. He started experiencing symptoms while traveling from Beni to Mandima with a family member on 4 July 2019. The case was admitted to a healthcare centre in Mandima before being transferred to the regional hospital in Mambasa where he subsequently died. In response to this case, vaccinations have been completed for at least 140 individuals at this time, including 60 contacts, and 15 frontline workers.
Overall, EVD case incidence rates remained largely unchanged in the past week (Figure 1). In the 21 days between 24 June to 14 July 2019, 73 health areas within 22 health zones reported new cases, representing 11% of the 664 health areas within North Kivu and Ituri provinces (Table 1 and Figure 2). During this period, a total of 254 confirmed cases were reported, the majority of which were from the health zones of Beni (48%, n=121) and Mabalako (16%, n=41), which are the main active areas in the outbreak.
As of 14 July 2019, a total of 2501 EVD cases, including 2407 confirmed and 94 probable cases, were reported. A total of 1668 death were reported (overall case fatality ratio 67%), including 1574 deaths among confirmed cases. Of the 2501 confirmed and probable cases with known age and sex, 57% (1419) were female, and 29% (718) were children aged less than 18 years. Cases continue to rise among health workers, with the cumulative number infected increasing to 135 (5% of total cases).
The spread of EVD into new geographical areas further contributes to the general increase in security incidents. Two DRC nationals involved in the outbreak response, a community leader and local volunteer, were killed in separate locations in Beni, reportedly by local armed militia. The underlying motive and possible relationship between these two killings in separate locations remain unknown at this time. Security forces are currently conducting an investigation into these two fatalities.
The Director-General will convene the Emergency Committee under the International Health Regulations (IHR) to review the situation on the Ebola outbreak in the Democratic Republic of the Congo. This is the fourth time the Director-General convenes the Committee for this event since the start of the outbreak in August 2018 (previous meetings were held in October 2018, April 2019, and June 2019). The committee will discuss whether the event constitutes a public health emergency of international concern (PHEIC), and if yes, propose Temporary Recommendations under the IHR.