The Democratic Republic of Congo (DRC) confirmed its tenth outbreak of Ebola in 40 years on 1 August 2018. The outbreak is concentrated in the northeast of the country, in the North Kivu and Ituri provinces; cases were also reported in South Kivu. With the number of cases in excess of 3,000, it is the largest Ebola outbreak ever in the country. It is also the second largest Ebola epidemic ever recorded, behind the West African outbreak in 2014-2016.
During the first eight months of the epidemic, until March 2019, more than 1,000 cases of Ebola were reported in the region concerned. However, between April and June 2019 this number doubled, with a further 1,000 new cases reported only in those three months. Between early June and early August, the number of new cases notified per week was high, and on average between 75 and 100 per week; since August, this rate has been slowly decreasing. Only 70 cases were identified in October. Although still relatively low, this figure has changed during late 2019 in early 2020; in December, there was a large increase in cases from 11 cases reported per week to 24 cases the following week, before the year end to 14 cases by the end of the year.
Latest figures – information as at 11 January 2020; figures provided by the DRC Ministry of Health through WHO.
3,395 TOTAL CASES
3,277 CASES DETERMINED
2,235 TOTAL FEES
While there are positive signs that the number of cases is slowly declining, the outbreak is still a serious concern for public health, and it is not clear when it will end.
While there has been an increase in the number of new Ebola cases previously identified and monitored as contacts in recent months, the rate is still hovering at around a third. However, 40 per cent of new Ebola cases were never registered, indicating that it is difficult to contact and follow up with people diagnosed with Ebola. Reasons include the movement of people (for example in the case of motorcycle taxi drivers), in full fear in some communities that hinder participation.
A delay of at least five days is confirmed and disseminated to new Ebola patients after showing the symptoms, and during that time they are infectious to others and lose the benefit of early treatments and have a better chance of survival.
On 11 June 2019, Uganda announced that three people had been positively diagnosed with Ebola, the first cross-border cases since the outbreak began. After several weeks with no recorded cases, the Uganda government announced a new case on 29 August; Sadly, the patient, a young girl, died.
On 14 July 2019, the first case of Ebola in Gaoma, the capital of North Kivu, and a city of one million people, was ratified. The patient, who traveled from Butembo to Goma, was admitted to the Eoma Ebola Treatment Center with support from MSF. After confirming the laboratory results, the Ministry of Health decided to transfer the patient to Butembo on 15 July, where the patient died the following day. On 30 July, the second person in Gaoma was diagnosed with Ebola; they died the next day and two other cases were announced.
No new cases have been recorded in Uganda or Goma since then.
In response to the first case found in Goma, 17 July 2019, the World Health Organization (WHO) announced that the current Ebola outbreak in DR Congo represents a public health emergency that is of international concern (PICIC).
In mid-August, the epidemic spread to the neighboring province Kivu – and the third province in DRC was recorded cases in this outbreak – when some sick people arrived in Mwenga, 100 kilometers from Bukavu, the capital of the province.
Since November, violence has occurred in the North Kivu provinces and Ituri after disrupting the provision of care, surveillance, vaccination, contact tracking and other activities of Ebola's response, requiring us to remain extremely vigilant about the revival of the disease. .
Due to the ongoing challenges of responding to the outbreak, MSF believes that Ebola-related activities should be integrated with the existing healthcare system, in order to improve the closeness of services to the public and to improve the quality of the service. ensure that it remains functional during the outbreak.
Background to the epidemic
Retrospective investigations indicate that the outbreak can start back in May 2018 – around the same time as the Equateur outbreak earlier in the year – although the outbreak was not confirmed until August. There is no link or link between the two outbreaks.
The delay in the alert and the subsequent response can be attributed to a number of factors, including a breakdown of the surveillance system due to the security context (there are restrictions on movement, and access is difficult), and strike at health workers in the area who started in May, due to non-payment of salary.
A person died at home following the presentation of blood fever properties. Family members developed the same symptoms and died. A joint investigation by the Ministry of Health / World Health Organization (WHO) on the spot identified six more suspected cases, four of which were positive tests. As a result of this result, the outbreak was announced.
On 7 August 2018, the national laboratory (INRB) confirmed that the current outbreak of the Zaire Ebola virus, the biggest pressure on West Africa during the 2014-2016 outbreak. Zaire Ebola was the virus found in the outbreak in the Equateur province, in the west of the DRC in 2018, although it is a different strain than the one that affects the current outbreak.
Originally announced in Mangina, a small town of 40,000 people in the north of North Kivu province, the center of the outbreak appeared to have progressed progressively to the south, to the city of Beni, with around 400,000 people and the region's administrative center. . As population movements are very common, the epidemic continued southwards to the large city of Butembo, a trading hub. Nearby, Katwa emerged as a new space center near the end of 2018 and cases were found further south, in the Kanya area. Meanwhile, there were also unfavorable cases in the neighboring province of Ituri in the north.
During the 2019 period, only a large number of cases would fall down, with only weeks or even months later – often after 42 days (two times the incubation period of 21 days for the disease) – and t with little or no sign on the transmission chain. This suggests that surveillance and case tracking remain significant challenges in overcoming this outbreak.
Overall, the geographical spread of the epidemic does not appear to be predictable, and small dispersed clusters may occur anywhere in the region. This pattern, coupled with the lack of visibility of the epidemiological situation, and the hours of post-follow-up points of concern, is extremely worrying and makes the outbreak more challenging.