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On 27 September 2022, the Ministry of Health (MoH) of the Democratic Republic of the Congo declared the end of the Ebola virus disease (EVD) outbreak that affected Butanuka health area, Beni health zone, North Kivu province. In accordance with WHO recommendations, the declaration was made 42 days (twice the maximum incubation period for Ebola virus infections) after the burial of the last and only confirmed case.

Description of the outbreak

On 21 August 2022, the MoH of the Democratic Republic of the Congo declared an Ebola outbreak following laboratory confirmation via reverse transcriptase-polymerase chain reaction (RT-PCR) of Ebola virus in a fatal case in Beni health zone, North Kivu province.

The case was a 46-year-old woman hospitalized and treated from 23 July to 15 August (23 days) for symptoms that included cough, headache, polyarthralgia (joint pain), and physical asthenia (general fatigue), thought to be related to her known co-morbidities. The patient died in hospital on 15 August 2022. The body was returned to the family and buried in a traditional manner on 16 August prior to receipt of the laboratory results.

Samples of blood and oropharyngeal secretions tested positive for Zaire ebolavirus by RT-PCR at the National Institute for Biomedical Research in Beni (INRB) on 15 August and these were confirmed at Rodolphe Mérieux INRB Laboratory in Goma on 16 August. The outbreak was declared by the MoH following EVD confirmation testing and genetic sequencing.

No additional confirmed or probable cases have been identified since 16 August. Of the 182 contacts of the case, 172 were identified and monitored for 21 days. The 10 contacts who were not followed up were unable to be reached.

Investigations are still ongoing to determine the source of the outbreak.

Public health response

Overall response: The MoH, together with WHO and other partners, conducted response measures to control the outbreak and prevent further spread. National and district emergency management committees were activated to coordinate the response. Multidisciplinary teams were deployed to actively search and provide care for cases; identify, reach and follow-up contacts; and sensitize communities on outbreak prevention and control interventions.

Alerts and testing: During this outbreak, from 21 August to 27 September 2022, a total of 9173 alerts were reported from Beni health zone, and all (100%) were investigated, including 607 (7%) validated as suspected cases of EVD. A total of 682 samples were tested for EVD.

Points of entry: A total of 2390 (92%) of 2608 travelers registered at points of entry were screened for EVD, and no alerts were detected.

Vaccination: As of 27 September, 550 persons in the affected health zone have been vaccinated against EVD using the ring strategy, targeting contacts and contacts of contact. Frontline health care workers made up the majority of those vaccinated (483).

WHO risk assessment

This latest EVD outbreak in the Democratic Republic of the Congo is declared over, with no new cases reported for 42 days after the burial of the last and only confirmed case on 16 August 2022. This case is genetically linked to the 2018-2020 outbreak in North Kivu, Ituri and South Kivu provinces. (For more information on this outbreak, please see the WHO outbreak account related to the 2018-2020 event). The source of this most recent outbreak has not yet been identified.

A future outbreak is not unexpected given that EVD is endemic in the country. Ebola virus is enzootic and a resurgence from viral persistence in survivors described in recent epidemics. Re-emergence of EVD is a major public health concern in the Democratic Republic of the Congo; gaps remain in the country’s capacity to recover, prepare for, and respond to outbreaks. The concurrent outbreaks in the country (COVID-19, cholera, measles, polio, yellow fever, monkeypox, etc) as well as the protracted humanitarian situation in the Eastern part of the country have put increasing pressure on the health system and the available resources.

A confluence of environmental and socioeconomic factors — including community mistrust, weak health systems, and political instability — in some specific areas such as North Kivu province can increase the risk for new outbreaks of EVD. Moreover, improved capacities in detection, laboratory confirmation and increased surveillance may explain the increased frequency in detecting EVD outbreaks. Nevertheless, WHO is concerned that ongoing challenges regarding insecurity as well as health system challenges (epidemiological surveillance, IPC programmes and practices in health care settings), coupled with the emergence of COVID-19 and other ongoing outbreaks, may jeopardize the country’s ability to rapidly detect and respond to any re-emergence.

WHO advice

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

  • Reduce the risk of wildlife-to-human transmission from contact with infected fruit bats or non-human primates and the consumption of their raw meat. Animals should be handled with gloves and other appropriate protective clothing.
  • Reduce 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 retraining of health personnel for early detection, isolation and treatment of EVD cases as well as retraining on safe and dignified burials.
  • Reduce the risk of possible transmission from virus persistence in some body fluids of survivors. WHO recommends providing medical care, psychological support and biological testing (until two consecutive negative tests) through an EVD survivors care programme. WHO does not recommend isolation of male or female convalescent patients whose blood has been tested negative for the Ebola virus.
  • Reduce amplification of transmission through health care by strengthening IPC programmes within the health care system.
  • Provide ongoing training of the 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.
  • Engage with communities to reinforce safe and dignified burial practices.
  • Build and maintain capacities for logistic support in at-risk areas or countries.
  • 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.

Further information

Citable reference: World Health Organization (29 September 2022). Disease Outbreak News; Ebola Virus Disease –Democratic Republic of the Congo. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON411

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