We provide updates on the Ebola outbreak in Democratic Republic of the Congo, now the second largest in history.
On the Ongoing Outbreak of Ebola in the Democratic Republic of the Congo
ISSUES • Health, Epidemics
PLACE • The Democratic Republic of the Congo (North Kivu Province and spreading)
DATES • May 2018 — present
ORGANIZATIONS • DRC Ministry of Health, Médecins Sans Frontières, and World Health Organization
On the Ongoing Outbreak of Ebola in the Democratic Republic of the Congo
ISSUES • Health, Epidemics
PLACE • The Democratic Republic of the Congo (North Kivu Province and spreading)
DATES • May 2018 — present
ORGANIZATIONS • DRC Ministry of Health, Médecins Sans Frontières, and World Health Organization
State of Health
First confirmed on August 1, 2018 by the government of the Democratic Republic of the Congo, a serious Ebola outbreak has been ongoing for over a year now, beginning in and around the town of Mangina, in North Kivu Province, located in the northeastern region of the country, and spreading to Ituri Province and recently to Goma, a city of two million people located on the border with Rwanda. A recent Ebola-related death in the city has been a cause of great, inter- and transnational concern.
At the beginning of the epidemic, a philanthropic medical organization already established in the region, Médecins Sans Frontières, was able to rapidly join efforts with the DRC Ministry of Health and the World Health Organization to launch and maintain a program of accurate diagnosis, adequate urgent treatment, and effective prevention. The initial response and positive results had led an assessment by the World Health Organization, in October 2018, to declare that the situation on ground did not constitute a Public Health Emergency of International Concern.
But along with those encouraging signs have come eruptions in new epicenters (though still limited to North Kivu and Ituri provinces), postponed elections in some of those areas, civil unrest, and fear, mistrust and avoidance in some communities where persons need to be diagnosed and treated. The situation thus oscillates monthly between foreseeable containment and continued morbidity and mortality, with the outbreak maintaining moderate though concerning intensity.
By February of 2019 the epidemic had officially become the second largest Ebola outbreak in Africa and in modern history anywhere, behind only the West Africa Ebola epidemic of 2014-16. That prior epidemic ended with an estimated 28,616 reported Ebola cases in Guinea, Liberia and Sierra Leone, with 11,310 deaths, and with over 10,000 survivors.
As of July 14 2019, the figures for the outbreak are: 2501 confirmed and probable Ebola cases • 1668 confirmed and probable deaths • fatality rate of 67% • 131 infected health workers • Current data from the WHO and DRC Ministry of Health
On July 17 2019, WHO’s Director-General, Dr. Tedros Adhanom Ghebreyesus, and its Emergency Committee declared the Ebola outbreak in DRC a Public Health Emergency of International Concern (PHEIC). In its decision to declare the Emergency, the WHO specifically cited the confirmed Ebola case in Goma, near the DRC border with Rwanda, for concerns about transmission along the city’s popular transit routes throughout both country and region.
On July 30 2019, response teams in DRC reported that a second Ebola case was confirmed in Goma; the person died the following day. Teams also report that a third case was diagnosed.
We provide further data visualization and updates below.
Cases, Deaths Since Onset
Publiks Updates
17July 2019: INTERNATIONAL TELECONFERENCE — WHO’s Director-General, Dr. Tedros Adhanom Ghebreyesus, and its Emergency Committee concluded that the DRC Ebola outbreak had met the criteria to be declared a Public Health Emergency of International Concern (PHEIC). Per WHO guidelines, a PHEIC is declared only in the case of “an extraordinary event that poses a public health risk to other countries through international spread and that potentially requires a coordinated international response.” In its review of the situation in the DRC, the Committee commended the efforts of the DRC Ministry of Health, WHO, and partners in rapid response, treatment, surveillance, vaccination and other prevention protocols, despite considerable population density and movement in certain affected areas, insufficient detection, treatment and prevention resources and procedures in several health facilities in the region, community access and outreach difficulties, political and security issues, and underfunding and inadequate resources.
The Committee noted, however, that a year into the epidemic there is new incidence and reinfection of Ebola at the epidemic’s epicenters as well as worrying sings of possible extension. Of particular concern are cases associated with neighboring areas in Uganda and with Goma, a city of two million on the border with Rwanda and a significant thorough-way for the DRC and the international region. Though there is, as yet, no evidence of actual Ebola transmission spreading from this DRC outbreak beyond its epicenters, these cases have already led to WHO recommendations and to prompt surveillance and prevention programs in non-epicenter DRC, Goma, Rwanda, and Uganda — the success of which would be considerably increased via international and global coordination and attention. The Committee thus concluded that the conditions for PHEIC have been met.
The WHO Director-General accepted the Committee recommendations, declared the PHEIC today, and in his public statement reiterated their concern, recommendation, and warning that such a declaration not lead to restrictions in travel or trade or closure of borders — which significantly hampered treatment and prevention efforts during the epidemic of 2014-15 in West Africa.
For more details on the meeting, please see the Statement of the Emergency Committee. For the public statement by WHO’s Director-General, Dr. Tedros Adhanom Ghebreyesus, please see the transcript of his speech.
7July 2019: NORTH KIVU AND ITURI, DRC — WHO report a total of 2418 Ebola cases, including 2324 confirmed and 94 probable. A total of 1630 deaths were reported for an overall case fatality ratio of 67%). Of the cases with known age and sex, 56% (1363) were female, and 29% (700) were children aged less than 18 years. Incidence keeps rising among health workers: 131 have been infected with Ebola (5% of total cases).
23June 2019: NORTH KIVU AND ITURI, DRC — WHO report resumed violent community resistance incidents in certain affected areas, coinciding with increased surveillance and response activities and confirmed Ebola cases. Armed groups’ movements have constrained access to health areas and the security situation remains tense where attacks had occurred in early June 2019.
WHO now has a total of 2247 Ebola cases, including 2153 confirmed and 94 probable, and 1510 deaths (overall case fatality ratio 67%). Of those cases with known age and sex, 57% (1273) were female, and 29% (654) were children aged less than 18 years. There have now been 126 health workers affected (6% of total cases).
16June 2019: NORTH KIVU AND ITURI, DRC — WHO report a total of 2168 Ebola cases, including 2074 confirmed and 94 probable, and 1449 deaths (fatality ratio 67%). Of those cases with known age and sex, 57% (1226) were female, and 29% (632) were children aged less than 18 years. 121 health workers have been affected (6% of total cases).
On June 14, the WHO Director-General convened a meeting of the Emergency Committee under the International Health Regulations (IHR). The Committee expressed deep concern about an outbreak that, notwithstanding some positive epidemiological trends, continues to persist and possibly extend. It noted community acceptance and security issues, as well as lack of adequate funding and strained human resources. There is now a cluster of confirmed cases in Uganda, which the Committee described as not unexpected.
The Committee concluded that the outbreak is indeed a health emergency in the Democratic Republic of the Congo and the neighboring region, but that the situation does not meet all the criteria for a Public Health Emergency of International Concern (PHEIC). The Committee offered public health advice to be strictly followed by all countries and partners involved.
Please see the Committee statement here.
12June 2019: KASESE DISTRICT, UGANDA — A day earlier, the Ministry of Health of Uganda confirmed their own official index case of Ebola, in Kasese District, at the border with the DRC.
The patient was a 5-year-old boy who had recently visited the DRC to attend the burial of his grandfather, a confirmed Ebola case (death on June 1). The boy and his mother had re-entered Uganda on June 10, intending to return home, but the child presented instead at a hospital with nose bleeding, blood vomiting, blood in stool and urine, muscle pain, headache, fatigue and abdominal pain. The young patient was immediately referred to a designated Ebola treatment centre (ETC), with blood specimens taken that same day. By June 11, test results revealed the sample to be positive for Ebola virus, Zaire strain. Uganda’s Minister of Health and the WHO Representative in Uganda held a joint press conference at 9pm on June 11 to formally declared an Ebola outbreak in the country. By the early morning of June 12, the child died.
Two family relations (mother and a sibling) developed symptoms and were isolated in the ETC on June 11. Blood specimens tested positive for Ebola on June 12. Another suspected case has been admitted, with test results pending. Eight contacts have been identified and are being closely monitored.
The Ministry of Health of Uganda, WHO and other partners have developed and deployed a rapid response team to the affected district and border area of Uganda/DRC.
26May 2019: NORTH KIVU AND ITURI, DRC — WHO report a lower rate of increase in cases, but again caution that such decreased incidence could be due to surveillance teams’ constraint and access issues caused by earlier security incidents. Figures reveal a total of 1920 cases, 1826 confirmed and 94 probable cases, with 1281 deaths (fatality ratio 67%). Among cases with known age and sex, 58% (1113) were female and 29% (565) were children aged less than 18 years. 105 healthcare workers have been affected.
12May 2019: NORTH KIVU AND ITURI, DRC — WHO report disruption in access due to several security incidents. Response teams thus experience “stop and go” movement through the affected northeastern areas of DRC and thus predict that the rate of reported cases will be higher for at least a few weeks. Figures now include 1705 cases, 1617 confirmed and 88 probable, with 1124 deaths producing a fatality ratio of 66%. Cases with known age and sex reveal 56% (951) being female and 29% (502) being children aged less than 18 years. 101 healthcare workers have contracted Ebola.
28April 2019: NORTH KIVU AND ITURI, DRC — WHO continue to report new cases, still limited to the two northeastern provinces. Figures include a total of 1400 confirmed and 66 probable cases and 957 deaths (for a fatality ratio of 65%). Among cases with known age and sex, 56% (815) were female, and 28% (416) were children aged less than 18 years. 92 healthcare workers were affected, resulting in 33 deaths.
18April 2019: NORTH KIVU AND ITURI, DRC — WHO report continued rise in incidence, though limited geographically to affected areas within the two provinces. Reported figures for the North Kivu and Ituru Ebola outbreak include 1290 confirmed and probable Ebola cases, with 725 (56%) being female and 361 (28%) being children under the age of 18 years. 833 confirmed deaths and an overall case fatality ratio is 65%. Infections among healthcare workers rises to 89 (7% of total cases), with 32 deaths. 379 patients discharged from Ebola Treatment Centers (ETCs).
28March 2019: NORTH KIVU AND ITURI, DRC — WHO report a rise in the number of new cases in the preceding week, citing challenges to public health response from sporadic violence and community mistrust. Reported figures for the North Kivu and Ituru Ebola outbreak include 1029 confirmed and probable Ebola cases, with 584 (57%) being female and 307 (30%) being children under the age of 18 years. 642 confirmed deaths and an overall case fatality ratio is 62%. Infections among healthcare workers rises to 78 (8% of total cases), with 27 deaths.
14March 2019: NORTH KIVU AND ITURI, DRC — Outbreak continues with moderate intensity, though WHO report that coordinated public health response continues to make gains, with 10 of the 20 health zones affected by the outbreak reporting no new cases in the past 21 days and a lower frequency of cases reported in past five weeks, when compared to January 2019. Reported figures for the North Kivu and Ituru Ebola outbreak include 927 confirmed and probable Ebola cases, with 525 (57%) being female and 280 (30%) being children under the age of 18 years. 583 confirmed deaths and an overall case fatality ratio is 63%.
28February 2019: NORTH KIVU, DRC — Outbreak continues with moderate intensity. Reported figures for the North Kivu Ebola outbreak include 879 confirmed and probable Ebola cases, with 499 (57%) being female and 264 (30%) being children under the age of 18 years. 553 confirmed deaths and an overall case fatality ratio is 63%.
14February 2019: NORTH KIVU, DRC — Outbreak continues with moderate intensity. Reported figures for the North Kivu Ebola outbreak include 823 confirmed and probable Ebola cases with 517 confirmed deaths. Overall case fatality ratio is 63%. To date, there have been 283 discharges from Ebola Treatment Centers (ETCs), the persons being subsequently enrolled in monitoring and support programs. 68 health workers have been reported as infected. For a sense of the geographic scope of the outbreak within the affected provinces: Ebola cases have been reported in 118 of 287 health areas across 18 health zones; 37 of the health areas reported infections in the past 21 days.
3February 2019: NORTH KIVU, DRC — Reported figures for the North Kivu Ebola outbreak include 785 confirmed and probable Ebola cases with 484 confirmed deaths. The figures make this Ebola outbreak the second largest in history. Per a WHO report, an Immunization Commission has been effective in vaccinating response staff and a cumulative total of 73 309 people since the outbreak’s beginning.
28January 2019: NORTH KIVU, DRC — Reported figures for the North Kivu Ebola outbreak include 743 confirmed and probable Ebola cases with 461 confirmed deaths.
14January 2019: NORTH KIVU, DRC — Reported figures for the North Kivu Ebola outbreak include 658 confirmed and probable Ebola cases with 402 confirmed deaths.
25December 2018: NORTH KIVU, DRC — Reported figures for the North Kivu Ebola outbreak include 585 confirmed and probable Ebola cases with 356 confirmed deaths.
16December 2018: NORTH KIVU, DRC — Reported figures for the North Kivu Ebola outbreak include 539 confirmed and probable Ebola cases with 315 confirmed deaths.
26November 2018: NORTH KIVU, DRC — Reported figures for the North Kivu Ebola outbreak include 421 confirmed and probable Ebola cases with 241 confirmed deaths.
11November 2018: NORTH KIVU, DRC — Reported figures for the North Kivu Ebola outbreak include 333 confirmed and probable Ebola cases with 209 confirmed deaths.
28October 2018: NORTH KIVU, DRC — Reported figures for the North Kivu Ebola outbreak include 274 confirmed and probable Ebola cases with 174 confirmed deaths.
17October 2019: WHO ANNOUNCEMENT — WHO announces the results from an assessment of then-current response and numbers by a WHO International Health Regulations Emergency Committee — that the Ebola situation in North Kivu Province does not constitute a Public Health Emergency of International Concern. Per the Committee chair, factors against making that specific declaration included confirmation that not a single case of Ebola had been exported from the DRC to another country and a concern that such a declaration would affect travel, transport, and other access routes essential to the Ebola response.
The non-declaration raised concerns among observers and the WHO Director-General, Tedros Adhanom Ghebreyesus, who headed the announcement personally, seemed aware of them. In an additional Twitter posting also dated October 17, the director stated: “I have accepted the Emergency Committee’s recommendation not to declare a public health emergency of international concern. But this does not mean WHO is not taking the #Ebola outbreak in #DRC seriously. We still have more than 250 people working in DRC to end this outbreak.”
As of the date of this WHO announcement, there were 216 confirmed and probable Ebola cases with 139 confirmed deaths reported.
20September 2018: NORTH KIVU, DRC — MSF opens another ETC in Butembo in partnership with the Ministry of Health. Overall, the DRC Ministry of Health is leading the response to this Ebola outbreak, coordinating with the WHO and organizations like MSF with nearby facilities and the ability to respond quickly and adequately to detected cases.
20September 2018: NORTH KIVU, DRC — MSF opens another ETC in Butembo in partnership with the Ministry of Health. Overall, the DRC Ministry of Health is leading the response to this Ebola outbreak, coordinating with the WHO and organizations like MSF with nearby facilities and the ability to respond quickly and adequately to detected cases.
14August 2018: MANGINA, DRC — MSF, already established in the North Kivu Province, opens an Ebola Treatment Centre (ETC) in Mangina.
7August 2018: NORTH KIVU, DRC — The Ebola strain in the North Kivu Province outbreak is confirmed via analysis to be of the Zaire type.
1August 2018: DRC — The DRC Ministry of Health officially declares an Ebola outbreak focalized near Mangina, North Kivu Province. It is the country’s second official outbreak in 2018 and its tenth in forty (40) years. The Ministry of Health is careful to make this outbreak distinct from its ninth official outbreak in the Equateur Province, stating that at the moment there is no confirmation that the two are linked.
30July-2 August 2018: NORTH KIVU, DRC — A joint Ministry of Health/World Health Organization investigation on site finds 6 more suspect cases, of which 4 test positive.
Late July 2018: MANGINA, DRC — Members of the female patient’s family later develop similar symptoms and also die soon after their presentation.
25July 2018: MANGINA, DRC — The female patient is discharged but dies at home, after presenting symptoms now more consistent with Ebola hemorrhagic fever.
19July 2018: MANGINA, DRC — Per the records of a local health center, a female patient from Mangina, North Kivu Province, in the northeastern region of the DRC, is admitted with a diagnosis of heart disease.
May 2018: EQUATEUR PROVINCE, DRC — Retrospective studies — consisting primarily of reviewing charts of probable and confirmed cases for characteristic signs, symptoms, diagnosis, and follow-up, where available — indicate that a start of the outbreak could be pinpointed to a period between late April and May of 2018, among a cluster of cases in the Equateur Province of the DRC. Notably, the Equateur Province had a distinct, thus-far contained outbreak of Ebola, and the province is not in the northeastern region of the DRC, where another Ebola outbreak will later grow to a size warranting worldwide attention and intensified responses from the Ministry of Health, MSF, and WHO. A possible explanation is to be had by looking through the WHO analysis of these retrospective studies, in which a confirmed case in Mbandaka, Equateur Province is singled out as a notable concern. For its nature as a sizeable urbanized center and its location along major transport avenues (rivers, roads, and air routes of domestic and international importance) led WHO and observers to, early on, countenance direct routes of transmission and increased risk of spread throughout the Democratic Republic of the Congo, to regions that include where an outbreak will come to establish itself.
Sources & Further
For this news series’s sources, and further reading on the issues raised by this outbreak, see:
