Disease outbreak news: Update 

The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces in Democratic Republic of the Congo is ongoing amidst a complex crisis, and we continue to observe sustained local transmission and a high number of cases. Most notably, Beni Health Zone accounted for over half of all new cases reported in the last three weeks, as well as a number of cases and contacts that travelled to other health zones. This is the second wave of the outbreak in Beni Health Zone, and it is larger in case numbers and longer in duration than the first. New healthcare worker and nosocomial infections continue to be reported in Beni and other affected health zones, despite substantial infection prevention and control by multiple agencies during the last wave of the outbreak; a total of 141 (5% of total cases) have been reported to date.

The intensive follow-up of contacts of the confirmed case who arrived in Goma on 14 July (see the 18 July Disease Outbreak News) will continue until the end of the 21-day period. In response to this case, 19 health workers were deployed from other posts to Goma to provide support. Rumours of his contacts travelling to Bukavu, South Kivu, were investigated and ruled out by response teams. No new cases have been reported in Goma to date. There are currently no confirmed cases of EVD outside of the Democratic Republic of the Congo.

The first pillar of the fourth Strategic Response Plan (SRP4) for the control of the EVD outbreak in the Democratic Republic of the Congo was shared earlier this week by the Ministry of Health of the Democratic Republic of the Congo, with support from an international consortium of partners working on the response. The first pillar covers the core public health response to the outbreak. Other pillars of the plan are being finalized and will be progressively released.

In the 21 days from 3 July through 23 July 2019, 64 health areas within 18 health zones reported new cases, representing 10% of the 664 health areas within North Kivu and Ituri provinces (Figure 2). During this period, a total of 242 confirmed cases were reported, the majority of which were from the health zones of Beni (53%, n=129), Mandima (11%, n=26), Mabalako (10%, n=23), and Katwa (7%, n=17) (Table 1). As of 23 July 2019, a total of 2612 EVD cases were reported, including 2518 confirmed and 94 probable cases, of which 1756 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 56% (1470) were female, and 29% (744) were children aged less than 18 years. Bunia, Kyondo and Musienene health zones all recently cleared 21 days since their last reported case. However, high risks remain for the virus to be reintroduced to these areas, requiring teams to remain fully resourced and vigilant.

Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset by health zone. Data as of 23 July 2019*

*Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning. Other health zones include: Alimbongo, Ariwara, Biena, Bunia, Goma, Kalunguta, Kayna, Komanda, Kyondo, Lubero, Mangurujipa, Masereka, Mutwanga, Nyankunde, Oicha, Rwampara and Tchomia.

Figure 2: Confirmed and probable Ebola virus disease cases by week of illness onset by health zone. Data as of 23 July 2019*

Table 1: Confirmed and probable Ebola virus disease cases, and number of health areas affected, by health zone, North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 23 July 2019**

**Total cases and areas affected based during the last 21 days are based on the initial date of case alert and may differ from date of confirmation and daily reporting by the Ministry of Health.