Ebola virus disease - Democratic Republic of the Congo

On 3 May 2021, the Minister of Health of the Democratic Republic of the Congo (DRC) declared the end of the Ebola Virus Disease (EVD) outbreak that affected four health zones (HZ) Biena, Musienene, Katwa, and Butembo within North Kivu province. The declaration was made in accordance with WHO recommendations, 42 days after the last confirmed case tested negative for the second time on 21 March 2021.

The outbreak was declared on 7 February 2021 after a resident in Mwenye/Makumo in Masoya Health Area in Biena HZ tested positive for EVD. To date, the source of infection of the initial case in this outbreak is yet to be determined. Overall, 12 cases were reported (11 confirmed and 1 probable). Of these 12 cases, eight (73%) were known and followed contacts at time of detection, and all were linked epidemiologically within a unique chain of transmission. All 12 EVD cases were reported in four health zones of North Kivu Province with onset of symptoms reported between 25 January and 26 February 2021. Of these cases, six died and six recovered after receiving appropriate treatment. Two of the 12 cases were health workers who contracted the infection while caring for the initial case in this outbreak, both survived. The last confirmed cases were reported on 1 March 2021, all among family members of a confirmed cases.

This was the 12^th EVD outbreak reported in the Democratic Republic of the Congo since the virus was first identified in 1976, and the second in North Kivu Province.

During the outbreak, from 7 February to 3 May 2021, case investigations into all confirmed and probable cases identified 1 194 contacts in 48 health areas of five health zones. To date, all contacts have completed their 21 day follow up period. A dedicated team continued to search for contacts who were lost to follow up, never seen or displaced during the 42 days since the last exposure to a confirmed EVD case to ensure that transmission chains were not missed. Over the course of the outbreak, 33 229 alerts were reported from 17 health zones of the Butembo and Beni division of the provincial department of Health. Additionally, over 1.5 million travellers were screened at points of entry of DRC, and nearly 2 000 individuals were vaccinated against EVD. 

The Public Health response was coordinated by the Provincial Department of Health, Butembo division in collaboration with WHO.

In response to this EVD outbreak, from 7 February 2021 to 3 May 2021:

• Daily coordination meetings held, chaired by the coordinator of the pool of supervisors based in Butembo, with the participation of partners.
• Bordering countries increased surveillance capacity and established EVD preparedness plans
• Surveillance activities conducted by heath zone and health area personnel with the financial, logistical and human resources support of WHO. In addition, WHO supported the establishment of the alert surveillance system and training of health zone data managers for the accurate and timely daily report of alerts.
• Twenty two points of entry/ points of control (PoE/ PoC) set up, which performed a total of 1 519 869 screenings throughout the outbreak.
• From the start of the outbreak through 1 May, 4 332 samples  received and analysed for EVD.
• From 7 February to 31 March 2021, 1 898 people vaccinated, including 1 169 in Biena, 360 in Katwa, 297 in Butembo and 72 in Musienene. Front line workers accounted for 542 of those vaccinated.
• Infection prevention and control (IPC) activities included the assessment of 136 priority health facilities in four health zones and the monitoring and support of 456 health facilities in eight health zones.
• Risk communication and community engagement activities took place in all health zones, which included visits to households by community action committees and sensitization of EVD in the health zones of Butembo, Mabalako and Katwa.

On 3 May 2021, the Ministry of Health of the Democratic Republic of the Congo declared the end of human-to-human transmission of EVD over in North Kivu Province considering that more than 42 days (two maximum incubation periods) had elapsed since the date of the second consecutive negative test of the last confirmed case. The World Health Organization assess that the surveillance system in place has proven its capacity to detect cases. The Ministry of Health drafted a 90-day plan which includes the strengthening and consolidation of public health surveillance systems.

WHO notes  that there remains a risk of re-emergence of EVD.  Ebola virus is enzootic in the Democratic Republic of the Congo, and it can persist in some body fluids of survivors for several months which, in rare events, may result in secondary transmission. In addition, it is not unusual for sporadic cases to occur following a major outbreak. Re-emergence of EVD is a major public health issue in the DRC and there are still gaps in the country’s capacity to prepare for and respond to outbreaks. A confluence of environmental and socioeconomic factors such as poverty, community mistrust, weak health systems, and political instability is accelerating the rate of the emergence of EVD in the DRC.

Other health emergencies such as coronavirus 2019 (COVID-19), cholera and measles outbreaks may jeopardize the country’s ability to rapidly detect and respond to re-emergence of EVD cases.

Since 10 March 2020, when the first confirmed COVID-19 case was registered in DRC a total of 29 962 confirmed COVID-19 cases and 766 deaths have been reported nationwide as of 1^st May 2021.

WHO advises the following risk reduction measures as an effective way to reduce Ebola virus disease transmission in humans:

• Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat. Animals should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.
• Reducing the risk of human-to-human transmission from direct or close contact with people with Ebola symptoms, particularly with their bodily fluids. Appropriate personal protective equipment should be worn when taking care of ill patients. Regular hand washing is required after visiting patients in hospital, as well as after touching or coming into contact with any body fluids.
• Continue training and re-training of health workforce for early detection, isolation, and treatment of EVD cases as well as re-training on safe and dignified burials and the IPC ring approach. Ensure training in IPC is provided routinely in health facilities and is emended into the curriculum of health professionals.
• Ensure availability of PPE and IPC supplies to manage ill patients and for decontamination
• Conduct health facility assessments (“Scorecard”) of adherence to IPC measures in preparedness for managing Ebola patients (this includes WASH, waste management PPE supplies, triage/screening capacity, etc) and continue to support facilities in developing and implementing action plans to address identified gaps
• Establish a National IPC program and National IPC focal point to assist the health system in moving towards implementing the IPC Minimum Requirements and an IPC preparedness plan for future outbreaks.
• Prepare for vaccination of Health workers
• Engage with communities to reinforce safe and dignified burial practices
  

Based on the current risk assessment and prior evidence on Ebola outbreaks, WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo.

• End of the 12th Ebola outbreak – Democratic Republic of the Congo
• Disease Outbreak News Ebola virus disease – Democratic Republic of the Congo, 10 February 2021
• Ebola virus disease factsheet
• History of Ebola virus disease in the Democratic Republic of the Congo
• Optimized Supportive Care for Ebola Virus Disease. Clinical management standard operation procedures
• Ebola: technical guidance documents for medical staff
• WHO interim advice on sexual transmission of the Ebola virus disease