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The '''Kivu Ebola epidemic'''{{refn|group=note|Ituri province was added to N. Kivu province, in terms of viral infection, when the first case of EVD was confirmed on 13 August.<ref name=cit/>}} began on 1 August 2018, when four cases of [[w:Ebola|Ebola virus disease]] (EVD) were confirmed in the eastern region of [[w:Kivu|Kivu]] in the [[w:Democratic Republic of the Congo|Democratic Republic of the Congo]] (DRC).<ref>{{cite news | title=Congo declares new Ebola outbreak in eastern province |url=https://www.reuters.com/article/us-health-ebola/congo-declares-new-ebola-outbreak-in-eastern-province-idUSKBN1KM59B?il=0 |newspaper=Reuters |access-date=1 August 2018|date=August 2018 }}</ref><ref>{{cite web |title=Congo announces 4 new Ebola cases in North Kivu province |url=https://www.washingtonpost.com/world/africa/congo-announces-4-new-ebola-cases-in-north-kivu-province/2018/08/01/d911b7dc-959c-11e8-818b-e9b7348cd87d_story.html |website=The Washington Post |access-date=1 August 2018 }}</ref><ref name="pre">{{cite web |title=Cluster of presumptive Ebola cases in North Kivu in the Democratic Republic of the Congo |url=https://www.who.int/news-room/detail/01-08-2018-cluster-of-presumptive-ebola-cases-in-north-kivu-in-the-democratic-republic-of-the-congo |publisher=World Health Organization (WHO)|access-date=2 August 2018}}</ref> The disease affected the DRC, Uganda, and is suspected to have also affected Tanzania, though the Ministry of Health their never shared information with WHO.<ref>{{cite web |title=U.S. alerts travelers to Tanzania about possible unreported Ebola |url=https://www.statnews.com/2019/09/27/ebola-tanzania-travelers-alerted-to-possible-unreported-cases/ |website=STAT |access-date=13 August 2021 |date=27 September 2019}}</ref> The outbreak was declared ended on 25 June 2020, with a total of 3,470 cases and 2,280 deaths.<ref>{{cite web |title=History of Ebola Virus Disease (EVD) Outbreaks Error processing SSI file |url=https://www.cdc.gov/vhf/ebola/history/chronology.html |website=www.cdc.gov |access-date=13 August 2021 |language=en-us |date=17 June 2021}}</ref><ref name="finish">{{cite web |title=DR Congo's deadliest Ebola outbreak declared over |url=https://www.bbc.com/news/world-africa-53179323 |website=BBC News |access-date=25 June 2020 |date=25 June 2020}}</ref> |
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Other locations in the DRC affected included the [[w:Ituri Province|Ituri Province]], whose first case was confirmed on 13 August, 2018.<ref name="cit">{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans la province du Nord Kivu au Lundi 13 août 2018 |url=https://mailchi.mp/de936e52fb17/ebola_kivu_13aout |website=mailchi.mp |access-date=17 August 2018|language=fr}}</ref> In November 2018, it became the biggest Ebola outbreak in the DRC's history,<ref name="frenchref">{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Vendredi 9 novembre 2018 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_9nov |website=mailchi.mp |access-date=9 November 2018|language=fr}}</ref><ref>{{cite web |title=Current Ebola Outbreak Is Worst in Congo's History: Ministry |url=https://www.usnews.com/news/world/articles/2018-11-10/current-ebola-outbreak-is-worst-in-congos-history-ministry |website=usnews.com |publisher=Us News and World report |access-date=10 November 2018}}</ref><ref>{{cite news |first1=Fiston |last1=Mahamba |first2=Tim |last2=Cocks |first3=Chris |last3=Reese |title=Congo confirms 33 Ebola cases in past week, of whom 24 died |url=https://www.reuters.com/article/us-health-ebola-toll/congo-confirms-33-ebola-cases-in-past-week-of-whom-24-died-idUSKCN1MP2MP |newspaper=Reuters |access-date=16 October 2018|date=2018-10-15 }}</ref> and by November, it had become the second-largest Ebola outbreak in recorded history,<ref name=2alltime/><ref name="huf">{{cite news |last1=Weber |first1=Lauren |title=The Ebola Outbreak In Congo Just Became The Second Largest Ever |url=https://www.huffingtonpost.com/entry/ebola-democratic-republic-congo-outbreak-second-largest_us_5bfdf54be4b0d23c21379bd7 |newspaper=Huffington Post |access-date=29 November 2018 |date=29 November 2018}}</ref> behind only the 2013–2016 [[w:Western African Ebola virus epidemic|Western Africa epidemic]]. On 3 May 2019, nine months into the outbreak, the DRC death toll surpassed 1,000.<ref>{{cite web |title=2014–2016 Ebola Outbreak in West Africa |url=https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html |publisher=[[Centers for Disease Control and Prevention]] (CDC) |access-date=3 May 2019 |date=29 March 2019}}</ref><ref>{{cite news |title=World Digest: CONGO: Death toll tops 1,000 in Ebola outbreak |url=https://www.washingtonpost.com/national/world-digest-may-3-2019/2019/05/03/3aae762c-6db2-11e9-8f44-e8d8bb1df986_story.html |work=[[The Washington Post]] |access-date=3 May 2019 }}</ref> In June 2019, the virus reached [[w:Uganda|Uganda]], having infected a 5-year-old Congolese boy who entered with his family,<ref name=ugandaepi/> but was contained. |
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Since January 2015, the affected province and general area have been experiencing [[w:Kivu conflict|a military conflict]], which hindered treatment and prevention efforts. The [[w:World Health Organization|World Health Organization]] (WHO) has described the combination of military conflict and civilian distress as a potential "perfect storm" that could lead to a rapid worsening of the situation.<ref name=":0">{{cite news |url=https://www.vox.com/2018/9/25/17903092/drc-ebola-outbreak-war-kivu |title=An Ebola "perfect storm" is brewing in Democratic Republic of the Congo |last1=Belluz |first1=Julia |author-link=Julia Belluz|date=25 September 2018 |work=Vox |access-date=26 September 2018}}</ref><ref name=":1">{{cite news |url=https://reliefweb.int/report/democratic-republic-congo/ebola-hit-drc-faces-perfect-storm-uptick-violence-halts-who |title=Ebola-hit DRC faces 'perfect storm' as uptick in violence halts WHO operation – Democratic Republic of the Congo |date=25 September 2018 |work=ReliefWeb |access-date=26 September 2018 }}</ref> In May 2019, the WHO reported that since January of that year there had been 42 attacks on health facilities and 85 health workers had been wounded or killed. In some areas, aid organizations have had to stop their work due to violence.<ref name="washingtonpost.com">{{cite web |title=World Digest: CONGO: Death toll tops 1,000 in Ebola outbreak |url=https://www.washingtonpost.com/national/world-digest-may-3-2019/2019/05/03/3aae762c-6db2-11e9-8f44-e8d8bb1df986_story.html |website=The Washington Post |access-date=5 May 2019}}</ref> Health workers also had to deal with misinformation spread by opposing politicians.<ref>{{cite journal |last1=Spinney |first1=Laura |title=In Congo, fighting a virus and a groundswell of fake news |journal=Science |date=17 January 2019 |volume=363 |issue=6424 |pages=213–214 |doi=10.1126/science.363.6424.213 |pmid=30655420 |bibcode=2019Sci...363..213S }}</ref> |
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Due to the deteriorating security situation in [[w:North Kivu|North Kivu]] and surrounding areas, the WHO raised the risk assessment at the national and regional level from "high" to "very high" in September 2018.<ref>{{cite web |title=Ebola virus disease – Democratic Republic of the Congo |url=https://www.who.int/csr/don/27-september-2018-ebola-drc/en/?platform=hootsuite |publisher=World Health Organization (WHO) |access-date=28 September 2018}}</ref> In October, the [[w:United Nations Security Council|United Nations Security Council]] stressed that all armed hostility in the DRC should come to a stop to better address the ongoing outbreak.<ref>{{cite web |title=UN calls for end to Congo fighting to combat Ebola outbreak |url=https://www.washingtonpost.com/world/un-calls-for-end-to-congo-fighting-to-combat-ebola-outbreak/2018/10/03/fdcb1e6c-c74a-11e8-9c0f-2ffaf6d422aa_story.html |website=The Washington Post |access-date=4 October 2018 }}</ref><ref name=NYTimes14June2019>{{Cite news|url=https://www.nytimes.com/2019/06/12/world/africa/ebola-uganda-congo.html|title=Boy, 5, and Grandmother Die in Uganda as More Ebola Cases Emerge|last=Gladstone|first=Rick|date=12 June 2019|work=[[The New York Times]]|access-date=14 June 2019|issn=0362-4331}}</ref><ref name="WHO14June2019"/> A confirmed case in [[w:Goma|Goma]] triggered the decision by the WHO to convene an emergency committee for the fourth time,<ref name="WHO15July2019">{{Cite web|url=https://www.who.int/news-room/detail/15-07-2019-high-level-meeting-on-the-ebola-outbreak-in-the-democratic-republic-of-the-congo-affirms-support-for-government-led-response-and-un-system-wide-approach|title=High-level meeting on the Ebola outbreak in the Democratic Republic of the Congo affirms support for Government-led response and UN system-wide approach|publisher=World Health Organization (WHO)|access-date=16 July 2019}}</ref><ref name="CIDRAP15July2019">{{Cite web|url=http://www.cidrap.umn.edu/news-perspective/2019/07/ebola-spread-goma-triggers-new-emergency-talks-cases-top-2500|title=Ebola spread to Goma triggers new emergency talks, cases top 2,500|last1=Schnirring|first1=Lisa|date=15 July 2019|website=CIDRAP|access-date=16 July 2019}}</ref> and on 17 July 2019, the WHO announced a [[w:Public Health Emergency of International Concern|Public Health Emergency of International Concern]] (PHEIC), the highest level of alarm the WHO can sound.<ref name=Goldberg17July2019>{{Cite web|url=https://www.undispatch.com/the-world-health-organization-just-declared-an-ebola-emergency-in-the-democratic-republic-of-congo-heres-what-that-means/|title=The World Health Organization Just Declared an Ebola "Emergency" in the Democratic Republic of Congo. Here's What That Means|last1=Goldberg|first1=Mark Leon|date=17 July 2019|website=UN Dispatch|access-date=17 July 2019}}</ref> |
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On 15 September 2019, some slowdown of cases was noted in the DRC.<ref name=none/> However, contact tracing continued to be less than 100%; at the time, it was at 89%.<ref name=none/> In mid-October the transmission of the virus had significantly reduced; by then it was confined to the Mandima region near where the outbreak began, and was only affecting 27 health zones in the DRC (down from a peak of 207).<ref>{{cite news |url=http://www.cidrap.umn.edu/news-perspective/2019/10/who-ebola-outbreak-back-where-it-began|title=WHO: Ebola outbreak back to where it began |agency=[[Center for Infectious Disease Research and Policy|CIDRAP News]]|first1=Stephanie|last1=Soucheray|date=10 October 2019|access-date=12 October 2019}}</ref> New cases decreased to zero by 17 February 2020,<ref>{{cite web |title=Ebola virus disease – Democratic Republic of the Congo |url=https://www.who.int/csr/don/05-March-2020-ebola-drc/en/ |website=WHO |access-date=8 March 2020 |date=8 March 2020}}</ref> but after 52 days without a case, surveillance and response teams on the ground confirmed three new cases of Ebola in Beni health zone in mid-April.<ref>{{Cite web|url=https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---10-april-2020|title=WHO Director-General's opening remarks at the media briefing on COVID-19 – 10 April 2020|website=www.who.int|access-date=2020-04-10}}</ref><ref>{{cite web |title=New Ebola case in the DRC dashes hopes that outbreak was over |url=https://www.statnews.com/2020/04/10/new-ebola-case-dashes-hopes-drc-outbreak-over/ |website=STAT |access-date=11 April 2020 |date=10 April 2020}}</ref><ref>{{cite news |title=Ebola virus disease – Democratic Republic of the Congo |url=https://www.who.int/csr/don/16-April-2020-ebola-drc/en/ |access-date=17 April 2020 |work=WHO |date=16 April 2020}}</ref> |
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As a new and separate outbreak, the Congolese health ministry reported on 1 June 2020 that there were cases of Ebola in [[w:Équateur Province|Équateur Province]] in north-western DRC, described as the eleventh Ebola outbreak since records began.<ref name="msf.org">{{cite web|title=New outbreak declared in Equateur province|url=https://www.msf.org/drc-ebola-outbreak-crisis-update|website=Médecins Sans Frontières|access-date=7 June 2020|date=4 June 2020}}</ref> Five people died in [[w:Mbandaka|Mbandaka]] during the second half of May.<ref>{{cite web|title=Ebola resurfaces in Équateur Province, north-western Democratic Republic of the Congo|url=https://www.unicef.org/press-releases/ebola-resurfaces-%C3%A9quateur-province-north-western-democratic-republic-congo|website=UNICEF|access-date=7 June 2020|date=1 June 2020}}</ref> This outbreak had increased within the province to 50 cases and 20 deaths by 14 July.<ref>{{cite web |title='Great concern' as new Ebola outbreak grows in western DR Congo |url=https://www.aljazeera.com/news/2020/07/concern-ebola-outbreak-grows-western-dr-congo-200714034610314.html |website=www.aljazeera.com |access-date=14 July 2020}}</ref>}} |
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{{TOC limit|3}} |
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==Epidemiology== |
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The final death toll was 2,280 with a total of 3,470 cases in DRC in almost a two year period. Managing the outbreak was made very difficult due to the ongoing military attacks in the region, despite there being a vaccine.<ref>{{cite web |title=DR Congo: Eastern Ebola outbreak defeated, 'mission impossible' now a 'sign of hope' |url=https://news.un.org/en/story/2020/06/1067152 |website=UN News |access-date=2 March 2021 |language=en |date=25 June 2020}}</ref> rVSV-ZEBOV or Ebola Zaire vaccine live, is a vaccine that prevents Ebola caused by the [[Zaire ebolavirus]].<ref>{{cite web | url=https://www.fda.gov/media/133748/download | format=PDF | title=Ervebo (Ebola Zaire Vaccine, Live) Suspension for intramuscular injection | publisher=Merck Sharp & Dohme }}</ref> The graph of reported cases marks those not able to have a laboratory test sample before burial as ''probable cases''.<ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Samedi 10 novembre 2018 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_10nov |website=mailchi.mp |access-date=10 November 2018|language=fr}}</ref> |
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[[File:Kivu Ebola epidemic.jpg|thumb|alt=Kivu Ebola epidemic|850px|center|<small>'''Note''' ''Above graph begins in Aug. 2018 at one month intervals, then progresses to two month intervals as the outbreak intensifies at beginning of 2019, then finally has a four month interval until it is declared over (due to a flare up just days prior to the first two 21 day period to call the outbreak over per WHO, which caused a restart of the coutdown)''</small><br>*<small>2018–19 Kivu Ebola epidemic (total cases-deaths as of 25 June 2020)<ref name=finish/></small><br>*<sup>x</sup> <small>indicates (2) 21 day periods have passed and outbreak is over</small>]] |
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===Democratic Republic of the Congo=== |
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[[File:DRC cases south and north kivu , ituri.jpg|thumb|290px| Map of the Democratic Republic of the Congo; North Kivu (orange, middle) South Kivu (dark red, bottom) and Ituri (green, top) {{attrib|Ozzie Anis, NordNordWest, and DaB. |CC BY-SA 3.0}} ]] |
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On 1 August 2018, the [[w:North Kivu|North Kivu]] health division notified Congo's health ministry of 26 cases of [[w:hemorrhagic fever|hemorrhagic fever]], including 20 deaths. Four of the six samples that were sent for analysis to the National Institute of Biological Research in [[w:Kinshasa|Kinshasa]] came back positive for Ebola and an outbreak was declared on that date.<ref>{{cite news |url=http://www.wibw.com/content/news/Congo-confirms-4-new-cases-of-Ebola-489753681.html |title=Congo announces 4 new Ebola cases in North Kivu province |agency=[[Associated Press]] |first1=Saleh |last1=Mwanamilongo |date=1 August 2018|access-date=5 August 2018 }}</ref><ref name="kivu">{{cite web |title=The Democratic Republic of the Congo: Ebola Virus Disease Outbreak – Epidemiological Situation DG ECHO Daily Map {{!}} 3 August 2018 |url=https://reliefweb.int/map/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-outbreak-0 |website=ReliefWeb |access-date=5 August 2018 }}</ref> |
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The [[w:index case|index case]] is believed to have been the death and unsafe burial of a 65-year-old woman on 25 July in the town of Mangina; soon afterwards seven members of her immediate family died.<ref>{{cite journal |title=Ebola: new outbreak appears in Congo a week after epidemic was declared over |url=https://www.bmj.com/content/362/bmj.k3421 |journal=The BMJ |volume=362 |pages=k3421 |access-date=2 February 2019|doi=10.1136/bmj.k3421 |pmid=30087112 |year=2018 |last1=Dyer |first1=Owen |doi-access=free }}</ref> This outbreak started just days after the end of the [[w:2018 Équateur province Democratic Republic of the Congo Ebola virus outbreak|outbreak in Équateur province]].<ref name="again1">{{cite web |title=Media Advisory: Expected end of Ebola outbreak |url=https://reliefweb.int/report/democratic-republic-congo/media-advisory-expected-end-ebola-outbreak |website=ReliefWeb |access-date=1 August 2018 }}</ref><ref name="again2">{{cite news |last1=Weber |first1=Lauren |title=New Ebola Outbreak Confirmed In Democratic Republic Of Congo |url=https://www.huffingtonpost.com/entry/ebola-democratic-republic-congo_us_5b61d252e4b0fd5c73d56d92 |newspaper=Huffington Post |access-date=1 August 2018 |date=1 August 2018}}</ref> |
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By 3 August, the virus had developed in multiple locations; cases were reported in five health zones – [[w:Beni, Democratic Republic of the Congo|Beni]], [[w:Butembo|Butembo]], [[w:Oicha|Oicha]], Musienene and Mabalako – in North Kivu province as well as Mandima and [[w:Mambasa|Mambasa]] in [[w:Ituri Province|Ituri Province]].<ref>{{cite web |title=UNICEF DR Congo (North Kivu) Ebola Situation Report #1 – 3 August 2018 |url=https://reliefweb.int/report/democratic-republic-congo/unicef-dr-congo-north-kivu-ebola-situation-report-1-3-august-2018 |website=ReliefWeb |access-date=4 August 2018 }}</ref> However, one month later there had been confirmed cases only in the Mabalako, Mandima, Beni and Oicha health zones. The five suspected cases in the Mambasa Health Zone proved not to be EVD; it was not possible to confirm the one probable case in the Musienene Health Zone and the two probable cases in the Butembo Health Zone. No new cases had been recorded in any of those health zones. The first confirmed case in Butembo was announced on 4 September, the same day that it was announced that one of the cases registered at Beni had actually come from the Kalunguta Health Zone.<ref name="mer5">{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans la province du Nord Kivu au Mercredi 5 septembre 2018 (ERRATUM) |url=https://mailchi.mp/534570505aa4/ebola_kivu_5sept-erratum |website=mailchi.mp |access-date=6 September 2018|language=fr}}</ref> |
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On 1 August, just after the epidemic had been declared, [[w:Médecins Sans Frontières|Doctors Without Borders/Médecins Sans Frontières]] (MSF) arrived in Mangina, the point of origin of the outbreak, to mount a response.<ref>{{cite web |title=DRC: MSF treats 65 people with Ebola in first month of intervention in North Kivu |url=https://reliefweb.int/report/democratic-republic-congo/drc-msf-treats-65-people-ebola-first-month-intervention-north-kivu |website=ReliefWeb |access-date=7 September 2018 }}</ref> On 2 August, [[w:Oxfam|Oxfam]] indicated it would be taking part in the response to this outbreak in the DRC.<ref>{{cite web |title=Oxfam responds to the new Ebola Outbreak in Beni, North Kivu, DRC |url=https://reliefweb.int/report/democratic-republic-congo/oxfam-responds-new-ebola-outbreak-beni-north-kivu-drc |website=ReliefWeb |access-date=2 August 2018 }}</ref> On 4 August, the WHO indicated that the current situation in the DRC, due to several factors, warranted a "high risk assessment" at the national and regional level for public health.<ref>{{cite web |title=Ebola virus disease – Democratic Republic of the Congo |url=https://www.who.int/csr/don/4-august-2018-ebola-drc/en/ |publisher=World Health Organization (WHO) |access-date=6 August 2018}}</ref> |
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In November, it was reported that the EVD outbreak ran across two provinces (and 14 health zones). ''Table 1. Timeline of reported cases'' reflects cases that were not able to have a laboratory test sample prior to burial as ''probable cases''.<ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Samedi 10 novembre 2018 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_10nov |website=mailchi.mp |access-date=10 November 2018|language=fr}}</ref> By 23 December, the EVD outbreak had spread to more health zones, and at that time 18 such areas had been affected.<ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Dimanche 23 décembre 2018 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_23dec |website=us13.campaign-archive.com |access-date=23 December 2018|language=fr}}</ref> |
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====Becoming 2nd biggest EVD outbreak==== |
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On 7 August 2018, the DRC Ministry of Public Health indicated that the total count had climbed to almost 90 cases,<ref name="ebo2">{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans la province du Nord Kivu au Mardi 7 août 2018 |url=https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=2caaec594a |website=us13.campaign-archive.com |access-date=8 August 2018}}</ref> and the [[w:Ministry of Health (Uganda)|Uganda Ministry of Health]] issued an alert for extra surveillance as the outbreak was just {{Convert|100|km|}} away from its border.<ref>{{cite web |title=Ebola: Health ministry issues alert |url=https://reliefweb.int/report/uganda/ebola-health-ministry-issues-alert |website=ReliefWeb |access-date=7 August 2018 }}</ref> Two days later the total count was nearly 100 cases.<ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans la province du Nord Kivu au Jeudi 9 août 2018 |url=https://mailchi.mp/4cc2513a9f7d/ebola_kivu_9aout |website=mailchi.mp |access-date=17 August 2018|language=fr}}</ref> On 16 August, the [[w:United Kingdom|United Kingdom]] indicated it would help with EVD diagnosis and monitoring in the DRC.<ref>{{cite web |title=UK response to the Ebola outbreak in North Kivu, DRC |url=https://www.gov.uk/government/news/uk-response-to-the-ebola-outbreak-in-north-kivu-drc |website=GOV.UK |access-date=16 August 2018 }}</ref> |
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On 17 August 2018, the WHO reported that there were around 1,500 "[[w:contact tracing|contacts]]", while noting that certain conflict zones in the DRC that could not be reached might have more contacts.<ref>{{cite news |last1=Editorial |first1=Reuters |title=WHO expects more Ebola cases in Congo, can't reach no-go areas |url=https://uk.reuters.com/article/us-health-ebola-who/who-expects-more-ebola-cases-in-congo-cant-reach-no-go-areas-idUKKBN1L20VB |newspaper=Reuters |access-date=17 August 2018|date=2018-08-17 }}</ref> Some 954 contacts were successfully followed up on 18 August; however, Mandima Health Zone indicated resistance, so contacts were not followed up there.<ref name=who0/> |
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On 4 September, [[w:Butembo|Butembo]], a city with almost one million people and an international airport, recorded its first fatality in the Ebola outbreak. The city of Butembo, in the DRC, has trade links to nearby Uganda.<ref>{{cite news |last1=Gulland |first1=Anne |title=Ebola death in city of one million prompts fears of urban spread |url=https://www.telegraph.co.uk/news/2018/09/06/ebola-death-city-one-million-prompts-fears-urban-spread/ |newspaper=The Telegraph |access-date=6 September 2018 |date=6 September 2018}}</ref><ref name=mer5/> |
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On 24 September, it was reported that all contact tracing and vaccinations would stop for the foreseeable future in Beni due to a deadly attack by rebel groups the day before.<ref>{{cite web |title=Rebel attack halts DR Congo Ebola work |url=https://www.bbc.com/news/world-africa-45625735 |website=BBC News Online |access-date=24 September 2018 |date=24 September 2018}}</ref> On 25 September, [[w:Peter Salama|Peter Salama]] of the WHO indicated that insecurity was obstructing efforts to stop the virus and believed a combination of factors could establish conditions for an epidemic.<ref>{{cite web |last1=Schlein |first1=Lisa |title=WHO Warns Ebola Spreading in Eastern DR Congo |url=https://www.voanews.com/a/who-warns-ebola-is-spreading-in-eastern-dr-congo/4586363.html |website=VOA |access-date=25 September 2018 |quote=A perfect storm of active conflict limiting our ability to access civilians, distress by segments of the community already traumatized by decades of conflict and of murder, driven by a fear of a terrifying disease}}</ref> On 18 October, the U.S. [[w:Centers for Disease Control and Prevention|Centers for Disease Control and Prevention]] (CDC) raised its travelers' alert to the DRC from a level 1 to level 2 for all U.S. travelers.<ref>{{cite web |title=Ebola in Democratic Republic of the Congo |url=https://wwwnc.cdc.gov/travel/notices/alert/ebola-democratic-republic-of-the-congo |publisher=[[Centers for Disease Control and Prevention]] (CDC) |access-date=19 October 2018 }}</ref> On 26 October, the WHO indicated that half of confirmed cases were not showing any fever symptom, thus making diagnosis more difficult.<ref name=nofever/> |
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Per a September 2018 survey in the ''[[w:The Lancet|Lancet]]'', 25% of respondents in Beni and Butembo believed the Ebola outbreak to be a hoax. These beliefs correlated with decreased likelihood of seeking healthcare or accepting vaccination.<ref>{{cite journal |last1=Vinck |first1=Patrick |last2=Pham |first2=Phuong N. |last3=Bindu |first3=Kenedy K. |last4=Bedford |first4=Juliet |last5=Nilles |first5=Eric J. |display-authors=3 |title=Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo: a population-based survey |journal=The Lancet Infectious Diseases |volume=19 |issue=5 |pages=529–536 |date=March 2019 |doi=10.1016/S1473-3099(19)30063-5|pmid=30928435 |doi-access=free }}</ref> |
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On 6 November 2018, the CDC indicated that the outbreak in the east region of the DRC was potentially non-containable. This would be the first time since 1976 that an outbreak was not able to be curbed.<ref>{{cite news |title=CDC director warns that Congo's Ebola outbreak may not be containable |url=https://www.washingtonpost.com/health/2018/11/05/cdc-director-warns-that-congos-ebola-outbreak-may-not-be-containable/ |work=[[The Washington Post]] |access-date=6 November 2018 }}</ref> On 13 November, the WHO indicated that the viral outbreak would last at least six months.<ref>{{cite web |title=Congo's Ebola outbreak to last at least 6 more months |url=https://www.cnbc.com/2018/11/13/congos-ebola-outbreak-to-last-at-least-6-more-months.html |website=CNBC |access-date=13 November 2018 |date=13 November 2018}}</ref> |
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On 29 December 2018, the DRC Ministry of Public Health announced that there had been ''"0 new confirmed cases detected because of the paralysis of the activities of the response in Beni, Butembo, Komanda and Mabalako"'' and no vaccination had occurred for three consecutive days.<ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Samedi 29 décembre 2018 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_29dec |website=us13.campaign-archive.com |access-date=29 December 2018|language=fr}}</ref> On 22 January, the total case count began to approach 1,000 cases, (951 suspected) in the DRC Ministry of Public Health situation report.<ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Mardi 22 janvier 2019 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_22jan19 |website=us13.campaign-archive.com |access-date=22 January 2019|language=fr}}</ref> The graphs below demonstrate the EVD intensity in different locations in the DRC, as well as in the West African epidemic of 2014–15 as a comparison: |
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{{fig|x |
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|align=center |
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|direction=horizontal |
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|caption=New Ebola cases per week in regions |
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|image1=File:Weekly Ebola cases 18 Mabalako.svg | caption1= [[w:Mabalako|Mabalako]] between 2018-07-16 and 2018-12-31, |
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|image2=File:Weekly Ebola cases 18-19 Beni.svg | caption2= town [[w:Beni,_Democratic_Republic_of_the_Congo|Beni]] between 2018-07-23 and 2019-01-28, |
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|image3=File:Weekly Ebola cases 18-19 Butembo und Katwa.svg | caption3= [[w:Katwa|Katwa]] (orange) and [[w:Butembo|Butembo]] (purple) between 2018-07-23 and 2019-02-04, and |
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|image4=File:2014 West Africa Ebola Epidemic - New Cases per Week.svg| caption4= [[w:Western Africa Ebola Epidemic|Western Africa Ebola Epidemic]] (for comparison with current outbreak). |
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{{attrib|A-C) Gregor Rom, D) malanoqa|cc by sa}} |
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}} |
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On 16 March 2019, the director of the CDC indicated that the outbreak in the DRC could last another year, additionally suggesting that vaccine supplies could run out.<ref>{{cite web |last1=Grady |first1=Denise |title=Ebola Epidemic in Congo Could Last Another Year, C.D.C. Director Warns |url=https://www.nytimes.com/2019/03/16/health/ebola-congo-cdc.html |website=The New York Times |access-date=17 March 2019 |date=16 March 2019}}</ref> According to the WHO, resistance to vaccination in the Kaniyi Health Zone was ongoing as of March 2019.<ref name=1000cases/> There was still a belief by some in surrounding areas that the epidemic was a hoax.<ref>{{cite news |title=1 in 4 people near Congo's Ebola outbreak believe virus isn't real, new study says |url=https://abcnews.go.com/International/people-congos-ebola-outbreak-virus-real-study/story?id=62031431 |access-date=1 April 2019 |work=ABC News |date=29 March 2019 }}</ref> |
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On 25 November 2019, violence had broken out in Beni again, to such a degree that some aid agencies had evacuated. According to the same report, around 300 individuals might have been exposed to EVD via an infected individual.<ref>{{cite web |title=Aid agencies evacuate DR Congo Ebola and measles hotspots as violence flares – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/aid-agencies-evacuate-dr-congo-ebola-and-measles-hotspots-violence |website=ReliefWeb |access-date=25 November 2019 }}</ref> |
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[[File:Bar graph of Democratic Republic of the Congo outbreaks 1976-present.jpg|thumb|right|400 px|Democratic Republic of the Congo EVD outbreaks 1976-9 November 2018 <br />(Note: total cases for this date does not reflect ''52 suspected cases'' nor does it reflect the final case numbers)<ref name=frenchref/><ref name=anotherref/><br />('''''Uganda''''' has second most EVD cases '00–'01/425<ref>{{cite journal |last1=Okware |first1=S. I. |last2=Omaswa |first2=F. G. |last3=Zaramba |first3=S. |last4=Opio |first4=A. |last5=Lutwama |first5=J. J. |last6=Kamugisha |first6=J. |last7=Rwaguma |first7=E. B. |last8=Kagwa |first8=P. |last9=Lamunu |first9=M. |title=An outbreak of Ebola in Uganda |journal=Tropical Medicine and International Health |date=December 2002 |volume=7 |issue=12 |pages=1068–1075 |doi=10.1046/j.1365-3156.2002.00944.x |pmid=12460399 |s2cid=31488443 |display-authors=3 |doi-access=free }}</ref><br />'''''West African Ebola virus epidemic''''' '13-'16/ >28,000<ref>{{cite web |title=Ebola data and statistics |url=http://apps.who.int/gho/data/view.ebola-sitrep.ebola-summary-latest?lang=en |publisher=World Health Organization (WHO) |access-date=5 November 2018}}</ref>){{attrib|Ozzie Anis|cc by sa}}]] |
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Until the outbreak in North Kivu in 2018, no outbreak had surpassed 319 total cases in the Democratic Republic of the Congo. By 24 February 2019, the epidemic had surpassed 1,000 total cases (1,048),<ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Lundi 25 février 2019 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_25fev19 |website=us13.campaign-archive.com |access-date=25 February 2019|language=fr}}</ref><ref name=cdc01/> and a year later, it had surpassed 3,000. |
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On 10 May 2019, the U.S. Centers for Disease Control and Prevention indicated that the outbreak could eventually surpass the West African epidemic.<ref>{{cite web |title=U.S. officials fear Ebola epidemic in Congo could become largest ever |url=https://finance.yahoo.com/video/u-officials-fear-ebola-epidemic-214656079.html |website=finance.yahoo.com |access-date=10 May 2019}}</ref> |
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The 12 May 2019 issue of WHO Weekly Bulletin on Outbreaks and Other Emergencies, indicates that "''continued increase in the number of new EVD cases in the Democratic Republic of the Congo is worrying...no end in sight to the difficult security situation''".<ref name=may12/> |
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====Spread to Goma==== |
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On 14 July 2019, the first case of EVD was confirmed in the capital of North Kivu, [[w:Goma|Goma]], a city with an international airport and a highly mobile population of 2{{nbsp}}million people located near the DRC's eastern border with [[w:Rwanda|Rwanda]].<ref name=GradyNYT17July19>{{Cite news|url=https://www.nytimes.com/2019/07/15/health/ebola-congo-outbreak.html|title=Ebola Outbreak Reaches Major City in Congo, Renewing Calls for Emergency Order|last=Grady|first=Denise|date=15 July 2019|work=The New York Times|access-date=17 July 2019|issn=0362-4331}}</ref><ref>{{cite web |agency=Associated Press |title=Congo confirms 1st Ebola case in city of Goma |url=https://kpic.com/news/nation-world/congo-confirms-1st-ebola-case-in-city-of-goma |website=KPIC |access-date=14 July 2019 |date=14 July 2019}}</ref><ref>{{cite web |title=First Ebola case in Congo city of Goma detected |url=https://www.reuters.com/article/us-health-ebola-congo/first-ebola-case-in-congo-city-of-goma-detected-idUSKCN1U90MH |website=Reuters |access-date=14 July 2019 |date=14 July 2019}}</ref><ref>{{cite web |title=Congo confirms first Ebola case in city of Goma |url=https://www.statnews.com/2019/07/14/congo-confirms-first-ebola-case-goma/ |website=STAT |access-date=14 July 2019 |date=14 July 2019}}</ref> This case was a man who had passed through three health checkpoints, with different names on traveller lists.<ref name="CIDRAP15July2019"/> The WHO stated that he died in a treatment centre,<ref name=WHOStatementPHEIC17July2019>{{Cite web|url=https://www.who.int/ihr/procedures/statement-emergency-committee-ebola-drc-july-2019.pdf|title=Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 17 July 2019|publisher=World Health Organization (WHO)|access-date=17 July 2019}}</ref> whereas according to [[w:Reuters|Reuters]] he died en route to a treatment centre.<ref name="CIDRAP16July2019">{{Cite web|url=http://www.cidrap.umn.edu/news-perspective/2019/07/who-will-take-ebola-emergency-declaration-question-fourth-time|title=WHO will take up Ebola emergency declaration question for a fourth time|last1=Soucheray|first1=Stephanie|date=16 July 2019|website=CIDRAP|access-date=17 July 2019}}</ref> This case triggered the decision by the WHO to again reconvene an emergency committee,<ref name="WHO15July2019"/><ref name="CIDRAP15July2019"/> where the situation was officially declared a [[w:Public Health Emergency of International Concern|Public Health Emergency of International Concern]].<ref name=Goldberg17July2019/> |
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On 30 July, a second case of EVD was confirmed in the city of Goma, apparently not linked to the first case.<ref>{{cite web |title=New Ebola case diagnosed in DR Congo's Goma: health official |url=https://www.yahoo.com/news/ebola-case-diagnosed-dr-congos-goma-health-official-201042542.html |website=news.yahoo.com |access-date=30 July 2019}}</ref> Across the border from Goma in the country of Rwanda, Ebola simulation drills were being conducted at health facilities.<ref>{{cite web |title=Roundup: Rwandan hospitals conduct Ebola simulation drills to prevent outbreak – Xinhua {{!}} English.news.cn |url=http://www.xinhuanet.com/english/2019-07/30/c_138270302.htm |website=www.xinhuanet.com |access-date=30 July 2019}}</ref> A third case of EVD was confirmed in Goma on 1 August.<ref>{{cite web |title=DR Congo Ebola epidemic spreads as second Goma patient dies, third case is confirmed |url=https://www.france24.com/en/20190801-drcongo-ebola-epidemic-second-goma-patient-dies-third-case-confirmed |website=France 24 |access-date=1 August 2019 |date=1 August 2019}}</ref> On 22 August 2019, [[w:Nyiragongo Territory|Nyiragongo]] Health Zone, the affected area on the outskirts of Goma, reached 21 days without further cases being confirmed.<ref>{{Cite web | url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-71 |title = Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 56 – Democratic Republic of the Congo}}</ref> |
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====Spread to South Kivu Province==== |
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On 16 August 2019, it was reported that the Ebola virus disease had spread to a third province – [[w:South Kivu|South Kivu]] – via two new cases who had travelled from Beni, North Kivu.<ref>{{cite web |last1=Beaumont |first1=Peter |title=Congo Ebola outbreak spreads to new province as epidemic continues to spiral |url=https://www.theguardian.com/global-development/2019/aug/16/congo-ebola-outbreak-reaches-second-province-south-kivu-woman-dead |website=The Guardian |access-date=16 August 2019 |date=16 August 2019}}</ref><ref>{{cite web |title=Ebola virus outbreak spreads, claiming first victims in a new region of Congo |url=https://www.cbsnews.com/news/ebola-virus-outbreak-spreads-congo-south-kivu-confirmed-cases-one-death-today-2019-08-16/ |website=www.cbsnews.com |access-date=16 August 2019}}</ref> By 22 August the number of cases in [[w:Mwenga|Mwenga]] had risen to four, including one person at a health facility visited by the first case.<ref>{{Cite web | url=http://www.cidrap.umn.edu/news-perspective/2019/08/fourth-ebola-case-reported-drcs-south-kivu-province | title=Fourth Ebola case reported in DRC's South Kivu province}}</ref> |
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===Uganda=== |
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{{details|w:Refugees of Uganda}} |
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[[File:Uganda Distrikt Kasese.svg|thumb|Map of Uganda; District Kasese in Western Region{{attrib|Gregor Rom|cc by sa}}]] |
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In August 2018 a [[w:United Nations|UN]] agency indicated that active screening was deployed to ensure that those leaving the DRC into [[w:Uganda|Uganda]] were not infected with Ebola.<ref name="ref">{{cite web |last1=Schlein |first1=Lisa |title=UN Stepping Up Ebola Screening of Refugees Fleeing DR Congo |url=https://www.voanews.com/a/un-stepping-up-ebola-screening-of-refugees-fleeing-dr-congo/4525009.html |website=VOA |access-date=14 August 2018 }}</ref> The government of Uganda opened two Ebola treatment centers at the border with the DRC, though there had not yet been any confirmed cases in the country of Uganda.<ref>{{cite web |title=Uganda opens Ebola treatment units at border with DRC – Xinhua {{!}} English.news.cn |url=http://www.xinhuanet.com/english/2018-08/22/c_137410772.htm |website=www.xinhuanet.com |access-date=23 August 2018}}</ref><ref>{{cite web |title=Uganda opens Ebola treatment units at border with DRC |url=https://www.premiumtimesng.com/foreign/africa/281071-uganda-opens-ebola-treatment-units-at-border-with-drc.html |website=Premium Times Nigeria |access-date=23 August 2018 |date=23 August 2018}}</ref> By 13 June 2019, nine treatment centers were in place near the affected border.<ref name=Uganda_DON_13_June_2019 /> |
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According to the [[w:International Federation of Red Cross and Red Crescent Societies|International Red Cross]], a "most likely scenario" entailed an asymptomatic case entering the country of Uganda undetected among the numerous refugees then coming from the DRC.<ref>{{cite web |title=Uganda: Ebola Preparedness Emergency Plan of Action (EPoA) – DREF Operation n° MDRUG041 |url=https://reliefweb.int/report/uganda/uganda-ebola-preparedness-emergency-plan-action-epoa-dref-operation-n-mdrug041 |website=ReliefWeb |access-date=12 September 2018 }}</ref> On 20 September, Uganda indicated it was ready for immediate vaccination, should the Ebola virus be detected in any individual.<ref>{{cite web |title=Uganda prepares to vaccinate against Ebola in case the virus strikes the country – Uganda |url=https://reliefweb.int/report/uganda/uganda-prepares-vaccinate-against-ebola-case-virus-strikes-country |website=ReliefWeb |access-date=20 September 2018 }}</ref><ref>{{cite web |title=WHO Setting Up Ebola Vaccination Strategy In Uganda After Outbreak In DRC |url=https://article.worldnews.com/view/2018/09/20/who_setting_up_ebola_vaccination_strategy_in_uganda_amid_out/ |website=article.worldnews.com |access-date=20 September 2018 }}</ref> |
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On 21 September, officials of the DRC indicated a confirmed case of EVD at [[w:Lake Albert (Africa)|Lake Albert]], an entry point into Uganda, though no cases were then confirmed within Ugandan territory.<ref>{{cite web |title=Congo confirms Ebola case at Ugandan border |url=https://www.channelnewsasia.com/news/health/congo-confirms-ebola-case-at-ugandan-border-10746180 |website=Channel NewsAsia |access-date=21 September 2018}}</ref><ref>{{cite news |last1=Editorial |first1=Reuters |title=Congo confirms Ebola case at Ugandan border |url=https://www.reuters.com/article/us-health-ebola-congo-uganda/congo-confirms-ebola-case-at-border-crossing-point-on-lake-albert-idUSKCN1M11WC |newspaper=Reuters |access-date=21 September 2018|date=2018-09-21 }}</ref> |
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On 2 November, it was reported that the Ugandan government would start vaccinating health workers along the border with the DRC as a proactive measure against the virus.<ref>{{cite web|last=Athumani|first=Halima|title=Uganda to Deploy Ebola Vaccine to Health Workers on DRC Border|url=https://www.voanews.com/a/uganda-ebola-vaccine-to-health-workers-on-drc-border/4640180.html|website=VOA|access-date=2 November 2018}}</ref> Vaccinations started on 7 November, and by 13 June 2019, 4,699 health workers at 165 sites had been vaccinated.<ref name=Uganda_DON_13_June_2019>{{cite web|url=https://www.who.int/csr/don/13-june-2019-ebola-uganda/en/|title=Ebola virus disease – Republic of Uganda|publisher=World Health Organization (WHO)|date=13 June 2019|access-date=18 June 2019}}</ref> Proactive vaccination was also carried out in [[w:South Sudan|South Sudan]], with 1,471 health workers vaccinated by 7 May 2019.<ref name=ilun/> |
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On 2 January 2019, it was reported that refugee movement from the DRC to Uganda had increased after the presidential elections.<ref>{{cite web |title=Flood of refugees fleeing Congo raises fears of spreading Ebola |url=https://www.cbsnews.com/news/ebola-in-the-congo-flood-of-refugees-fleeing-congo-raises-fears-of-spreading-ebola/ |website=www.cbsnews.com |date=2 January 2019|access-date=7 January 2019}}</ref> On 12 February, it was reported that 13 individuals had been isolated due to their contact with a suspected Ebola case in Uganda;<ref>{{cite web |title=Uganda quarantines 13 people who contacted dead body of suspected Ebola case – Xinhua {{!}} English.news.cn |url=http://www.xinhuanet.com/english/2019-02/12/c_137816388.htm |website=www.xinhuanet.com |access-date=12 February 2019}}</ref> lab results came back negative several hours later.<ref>{{cite web |title=Results of suspected Ebola case in Uganda turn negative: health official – Xinhua {{!}} English.news.cn |url=http://www.xinhuanet.com/english/2019-02/13/c_137816547.htm |website=www.xinhuanet.com |access-date=13 February 2019}}</ref> |
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On 11 June 2019, the WHO reported that the virus had spread to Uganda. A 5-year-old Congolese boy entered Uganda on the previous Sunday with his family to seek medical care. On 12 June, the WHO reported that the 5-year-old had died, while 2 more cases of Ebola infection within the same family were confirmed.<ref name="ugandaepi">{{cite web |last=Hunt |first=Katie |title=Ebola outbreak enters 'truly frightening phase' as it turns deadly in Uganda |url=https://edition.cnn.com/2019/06/12/health/ebola-outbreak-death-uganda-africa-intl-bn/index.html |website=CNN |access-date=12 June 2019 }}</ref><ref>{{Cite web|url=https://abcnews.go.com/International/ebola-stricken-boy-1st-cross-border-case-growing/story?id=63656559|title=Ebola-stricken boy who became 1st cross-border case in growing outbreak dies|last=Winsor|first=Morgan|date=12 June 2019|website=ABC News|access-date=13 June 2019}}</ref> On 14 June it was reported that there were 112 contacts since EVD was first detected in Uganda.<ref>{{cite web |title=Ugandan medics now tackling Ebola say they lack supplies |url=http://www.startribune.com/ugandan-medics-now-tackling-ebola-say-they-lack-supplies/511342101/ |website=Star Tribune |access-date=15 June 2019 |archive-url=https://web.archive.org/web/20190615113815/http://www.startribune.com/ugandan-medics-now-tackling-ebola-say-they-lack-supplies/511342101/ |archive-date=15 June 2019 |url-status=dead }}</ref> [[w:Ring vaccination|Ring vaccination]] of Ugandan contacts was scheduled to start on 15 June.<ref name="WHO14June2019"/> As of 18 June 2019, 275 contacts had been vaccinated per the Uganda Ministry of Health.<ref>{{cite web |title=Ebola Virus Disease Outbreak Uganda Situation Reports |url=https://www.afro.who.int/sites/default/files/2019-06/Ebola%20Virus%20Disease%20Sitrep%207%2019th%20June%202019.pdf |publisher=World Health Organization (WHO) |access-date=19 June 2019}}</ref> |
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On 14 July, an individual entered the country of Uganda from DRC while symptomatic for EVD; a search for contacts in Mpondwe followed.<ref>{{cite web |title=Congo Ebola victim may have entered Rwanda and Uganda, says WHO |url=https://af.reuters.com/article/topNews/idAFKCN1UD11A-OZATP |website=Reuters |access-date=19 July 2019 |date=18 July 2019}}</ref> On 24 July, Uganda marked the needed ''42 day period'' without any EVD cases to be declared Ebola-free.<ref>{{cite web |title=Press Release {{!}} Ministry of Health |url=https://health.go.ug/press-release |website=health.go.ug |access-date=25 July 2019 |archive-url=https://web.archive.org/web/20190725154722/https://health.go.ug/press-release |archive-date=25 July 2019 |url-status=dead }}</ref> On 29 August, a 9-year-old Congolese girl became the fourth individual in Uganda to test positive for EVD when she crossed from the DRC into the district of [[w:Kasese|Kasese]].<ref>{{cite web |title=Uganda says a traveling Congolese girl has Ebola |url=https://medicalxpress.com/news/2019-08-uganda-congolese-girl-ebola.html |website=medicalxpress.com |access-date=29 August 2019 }}</ref> |
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===Tanzania=== |
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[[File:Tanzania relief location map.svg|thumb|Map of United Republic of Tanzania{{attrib|semhur|cc by sa}}]] |
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In regards to possible EVD cases in Tanzania, the WHO stated on 21 September 2019 that "to date, the clinical details and the results of the investigation, including laboratory tests performed for differential diagnosis of these patients, have not been shared with WHO. The insufficient information received by WHO does not allow for a formulation of a hypotheses regarding the possible cause of the illness".<ref>{{cite web |title=WHO {{!}} Cases of Undiagnosed Febrile Illness – United Republic of Tanzania |url=https://www.who.int/csr/don/21-september-2019-undiag-febrile-illness-tanzania/en/ |website=WHO |access-date=22 September 2019}}</ref><ref>{{cite web |title=WHO accuses Tanzania of withholding information about suspected Ebola cases |url=https://www.washingtonpost.com/world/tanzanias-refusal-to-acknowledge-possible-ebola-casesrepresents-a-challenge-who/2019/09/22/70bf9a80-dd19-11e9-be96-6adb81821e90_story.html |website=Washington Post |access-date=22 September 2019 }}</ref><ref>{{cite web |title=Tanzania not sharing information on suspected Ebola cases: WHO |url=https://www.aljazeera.com/news/2019/09/tanzania-declined-share-data-suspected-ebola-cases-190922053618812.html |website=www.aljazeera.com |access-date=22 September 2019}}</ref> On 27 September, the CDC and [[w:U.S. State Department|U.S. State Department]] alerted potential travellers to the possibility of unreported EVD cases within Tanzania.<ref>{{cite web |title=U.S. alerts travelers to Tanzania about possible unreported Ebola |url=https://www.statnews.com/2019/09/27/ebola-tanzania-travelers-alerted-to-possible-unreported-cases/ |website=STAT |access-date=27 September 2019 |date=27 September 2019}}</ref> |
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The Tanzanian Health Minister [[w:Ummy Mwalimu|Ummy Mwalimu]] stated on 3 October 2019 that there was no Ebola outbreak in Tanzania.<ref>{{cite web |title=Tanzania provides Ebola preparedness updates to WHO|url=https://www.newsghana.com.gh/tanzania-provides-ebola-preparedness-updates-to-who/|website=newsghana.com |date=24 October 2019 |access-date=30 October 2019}}</ref> The WHO were provided with a preparedness update on 18 October which outlined a range of actions, and included commentary that since the outbreak commenced, there had been "29 alerts of Ebola suspect cases reported, 17 samples tested and were negative for Ebola (including 2 in September 2019)".<ref name="WHO18Oct2019">{{cite web |title=WHO {{!}} Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 18 October 2019 |url=https://www.who.int/news-room/detail/18-10-2019-statement-on-the-meeting-of-the-international-health-regulations-(2005)-emergency-committee-for-ebola-virus-disease-in-the-democratic-republic-of-the-congo |website=WHO |date=18 October 2019|access-date=2 November 2019}}</ref> |
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===Countries with medically evacuated individuals=== |
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On 29 December, an American physician who was exposed to the Ebola virus (and who was non-symptomatic) was evacuated, and taken to the [[w:University of Nebraska Medical Center|University of Nebraska Medical Center]].<ref>{{cite web |last1=Diamond |first1=Dan |title=Doctor exposed to Ebola brought to United States |url=https://www.politico.com/story/2018/12/29/ebola-doctor-united-states-1076875 |website=POLITICO |access-date=29 December 2018 }}</ref><ref>{{cite web |title=Doctor possibly exposed to Ebola being monitored in Nebraska |url=https://www.washingtonexaminer.com/news/doctor-possibly-exposed-to-ebola-being-monitored-in-nebraska#! |website=Washington Examiner |access-date=29 December 2018 |date=29 December 2018}}</ref> On 12 January, the individual was released after 21 days without symptoms.<ref>{{cite web |title=American monitored for possible Ebola did not have disease, released |url=https://www.nbcnews.com/health/health-news/american-monitored-possible-ebola-did-not-have-disease-n958081 |website=NBC News |access-date=14 January 2019 }}</ref> |
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The table which follows indicates ''confirmed'', ''probable'' and ''suspected'' cases, as well as ''deaths''; the table also indicates the countries where these cases took place. |
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{{cot|'''Table 1''' {{!}}''' Timeline of reported cases<ref name="anotherref">{{cite web|url=https://www.who.int/|title=WHO {{!}} World Health Organization|publisher=World Health Organization (WHO)|access-date=13 August 2018}}</ref>''' [click to expand]|bg=#F0F2F5|border=0px}} |
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{| class="wikitable" style="text-align:center; margin-left: auto; margin-right: auto; border: none;" |
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! rowspan="2" |Date !! colspan="4" | Cases {{efn|group=timelinenote|name=timelinenote1}}{{spaces|1|type}}!! rowspan="2" | Deaths !! rowspan="2" |[[Case fatality rate|CFR]] {{efn|group=timelinenote|name=timelinenote3}}!! rowspan="2" |[[Contact tracing|Contacts]]!! rowspan="2" | Sources |
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|- |
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!Confirmed !! Probable !! Suspected !! Totals |
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|- |
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|{{spaces|9|type}}2018-08-01{{efn|group=timelinenote|name=timelinenote2}}'''''{{font color|blue|DRC}}'''''|| 4||22||0||'''26'''||'''20'''||-||-||<ref>{{cite web |title=EBOLA RDC – Communication spéciale du Ministre de la Santé en rapport à la situation épidémiologique dans la Province du Nord-Kivu |url=https://mailchi.mp/49b37201b847/declaration_ebola_kivu |website=mailchi.mp |access-date=19 August 2018|language=fr}}</ref> |
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|2018-08-03 ||13||30||33||'''76'''||'''33'''||76.7%||879||<ref name="1case">{{cite web |title=WHO AFRO Outbreaks and Other Emergencies, Week 31: 28 July – 3 August (Data as reported by 17:00; 3 August 2018) |url=https://reliefweb.int/report/democratic-republic-congo/who-afro-outbreaks-and-other-emergencies-week-31-28-july-3-august |website=ReliefWeb |access-date=6 August 2018 }}</ref><ref name="ebo1">{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans la province du Nord Kivu au Samedi 4 août 2018 |url=https://mailchi.mp/8bfa0c09fe7b/ebola_kivu_4aout |website=mailchi.mp |access-date=5 August 2018|language=fr}}</ref> |
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|2018-08-05||16||27||31||'''74'''||'''34'''||79%{{spaces|3|type}}||966||<ref name="1sit">{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 1 |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-15 |website=ReliefWeb |access-date=8 August 2018 }}</ref><ref>{{cite web |first1=Al-Hadji Kudra |last1=Maliro |title=Congo's health ministry confirms 3 more cases of Ebola |url=https://abcnews.go.com/Health/wireStory/congos-health-ministry-confirms-cases-ebola-57077307 |website=ABC News |access-date=8 August 2018 |archive-url=https://web.archive.org/web/20180820214732/https://abcnews.go.com/Health/wireStory/congos-health-ministry-confirms-cases-ebola-57077307 |archive-date=20 August 2018 |url-status=dead }}</ref> |
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|2018-08-10||25||27||48||'''100'''||'''39'''||75%{{spaces|3|type}}||953||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 32: 04 – 10 August 2018 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-32-04-10-august-2018 |publisher=World Health Organization (WHO) |access-date=19 August 2018 }}</ref> |
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|2018-08-12||30||27||58||'''115'''||'''41'''||-||997||<ref>{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 2 |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-16 |website=ReliefWeb |access-date=15 August 2018 }}</ref> |
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|2018-08-17||64||27||12||'''103'''||'''50'''||55.6%||1,609||<ref name="who0">{{cite web|title=Outbreaks and Emergencies Bulletin, Week 33: 11 – 17 August 2018|url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-33-11-17-august-2018 |publisher=World Health Organization (WHO) |access-date=20 August 2018 }}</ref> |
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|- |
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|2018-08-20||75||27||9||'''111'''||'''59'''||-||2,408||<ref>{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 3 |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-17 |website=ReliefWeb |access-date=22 August 2018 }}</ref> |
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|2018-08-24||83||28||6||'''117'''||'''72'''||65%{{spaces|3|type}}||3,421||<ref>{{cite web |title=WHO AFRO Outbreaks and Other Emergencies, Week 34: 18 – 24 August (Data as reported by 17:00; 24 August 2018) |url=https://reliefweb.int/report/democratic-republic-congo/who-afro-outbreaks-and-other-emergencies-week-34-18-24-august-data |website=ReliefWeb |access-date=27 August 2018 }}</ref> |
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|2018-08-26||83||28||10||'''121'''||'''75'''||67.6%||2,445||<ref>{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 4 |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-18 |website=ReliefWeb |access-date=28 August 2018 }}</ref> |
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|2018-08-31||90||30||8||'''128'''||'''78'''||65%{{spaces|3|type}}||2,462||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 35: 25 – 31 August 2018 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-35-25-31-august-2018 |publisher=World Health Organization (WHO) |access-date=3 September 2018 }}</ref> |
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|- |
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|2018-09-02||91||31||9||'''131'''||'''82'''||-||2,512||<ref name="healt">{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 5 |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-19 |website=ReliefWeb |access-date=4 September 2018 }}</ref> |
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|2018-09-07||100||31||14||'''145'''||'''89'''||68%{{spaces|3|type}}||2,426||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 36: 1 – 7 September 2018 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-36-1-7-september-2018 |publisher=World Health Organization (WHO) |access-date=10 September 2018 }}</ref> |
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|- |
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|2018-09-09||101||31||9||'''141'''||'''91'''||-||2,265||<ref name="response">{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 6 |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-21 |website=ReliefWeb |access-date=12 September 2018 }}</ref><ref>{{cite web |title=Ebola virus disease – Democratic Republic of the Congo: Disease outbreak news – 7 September 2018 |url=https://reliefweb.int/report/democratic-republic-congo/ebola-virus-disease-democratic-republic-congo-disease-outbreak-14 |website=ReliefWeb |access-date=12 September 2018 }}</ref> |
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|2018-09-14||106||31||17||'''154'''||'''92'''||67.2%||1,751||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 37: 8 – 14 September 2018 |url=https://afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-37-8-14-september-2018 |publisher=World Health Organization (WHO) |access-date=17 September 2018 }}</ref> |
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|- |
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|2018-09-16||111||31||7||'''149'''||'''97'''||-||2,173||<ref>{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 7 – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-22 |website=ReliefWeb |access-date=19 September 2018 }}</ref><ref>{{cite web |title=DR Congo – 2018 Ebola Outbreak in North Kivu Province (September 17, 2018 update) – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/dr-congo-2018-ebola-outbreak-north-kivu-province-september-17-2018 |website=ReliefWeb |access-date=19 September 2018 }}</ref> |
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|2018-09-21||116||31||<small>n/a</small>||'''147'''||'''99'''||67.3%||1,641||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 38: 15 – 21 September 2018 |url=https://afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-38-15-21-september-2018 |publisher=World Health Organization (WHO) |access-date=24 September 2018 }}</ref> |
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|- |
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|2018-09-23||119||31||9||'''159'''||'''100'''||67%{{spaces|3|type}}||1,836||<ref>{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 8 – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-23 |website=ReliefWeb |access-date=26 September 2018 }}</ref> |
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|- |
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|2018-09-28||126||31||23||'''180'''||'''102'''||65%{{spaces|3|type}}||1,410||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 39: 22 – 28 September 2018 |url=https://afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-39-22-28-september-2018 |publisher=World Health Organization (WHO) |access-date=1 October 2018 }}</ref> |
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|- |
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|2018-10-02||130||32||17||'''179'''||'''106'''||65.4%||1,463||<ref>{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 9 – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-24 |website=ReliefWeb |access-date=4 October 2018 }}</ref> |
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|2018-10-05||142||35||11||'''188'''||'''113'''||63.8%||2,045||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 40: 29 September – 05 October 2018 |url=https://afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-40-29-september-05-october-2018 |publisher=World Health Organization (WHO) |access-date=8 October 2018 }}</ref> |
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|- |
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|2018-10-07||146||35||21||'''202'''||'''115'''||63.5%||2,115||<ref>{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 10 – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-25 |website=ReliefWeb |access-date=9 October 2018 }}</ref> |
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|- |
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|2018-10-12||176||35||32||'''243'''||'''135'''||64%{{spaces|3|type}}||2,663||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 41: 06 – 12 October 2018 |url=https://afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-41-06-12-october-2018 |publisher=World Health Organization (WHO) |access-date=15 October 2018 }}</ref> |
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|- |
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|2018-10-15||181||35||32||'''248'''||'''139'''||64%{{spaces|3|type}}||4,707||<ref>{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 11 – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-26 |website=ReliefWeb |access-date=18 October 2018 }}</ref> |
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|2018-10-19||202||35||33||'''270'''||'''153'''||65%{{spaces|3|type}}||5,518||<ref name="expandingoutbreak">{{cite web |title=Outbreaks and Emergencies Bulletin, Week 42: 13 – 19 October 2018 |url=https://afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-42-13-19-october-2018 |publisher=World Health Organization (WHO) |access-date=22 October 2018 }}</ref> |
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|- |
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|2018-10-21||203||35||14||'''252'''||'''155'''||65%{{spaces|3|type}}||5,341||<ref>{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 12 – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-27 |website=ReliefWeb |access-date=23 October 2018 }}</ref> |
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|2018-10-26||232||35||43||'''310'''||'''170'''||64%{{spaces|3|type}}||6,026||<ref name="nofever">{{cite web |title=Outbreaks and Emergencies Bulletin, Week 43: 20 – 26 October 2018 |url=https://afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-43-20-26-october-2018 |publisher=World Health Organization (WHO) |access-date=29 October 2018 }}</ref> |
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|2018-10-28||239||35||32||'''306'''||'''174'''||63.5%||5,991||<ref name="rising">{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 13 – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-28 |website=ReliefWeb |access-date=30 October 2018 }}</ref> |
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|2018-11-02||263||35||70||'''368'''||'''186'''||62.4%||5,036||<ref name="congoborder">{{cite web |title=Outbreaks and Emergencies Bulletin, Week 44: 27 October – 02 November 2018 |url=https://afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-44-27-october-02-november-2018 |publisher=World Health Organization (WHO) |access-date=5 November 2018 }}</ref> |
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|- |
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|2018-11-04||265||35||61||'''361'''||'''186'''||62%{{spaces|3|type}}||4,971||<ref>{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 14 – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-29 |website=ReliefWeb |access-date=7 November 2018 }}</ref> |
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|2018-11-09||294||35||60||'''389'''||'''205'''||62%{{spaces|3|type}}||4,779||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 45: 03 – 09 November 2018 |url=https://afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-45-03-09-november-2018 |publisher=World Health Organization (WHO) |access-date=12 November 2018 }}</ref> |
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|- |
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|2018-11-11||295||38||<small>n/a</small>||'''333'''||'''209'''||-||4,803||<ref>{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 15 – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-30 |website=ReliefWeb |access-date=13 November 2018 }}</ref> |
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|- 2018-11-16||319||47||49||'''415'''||'''214'''||59%{{spaces|3|type}}||4,430||<ref name="auto">{{cite web |title=Outbreaks and Emergencies Bulletin, Week 46: 10 – 16 November 2018 |url=https://afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-46-10-16-november-2018 |publisher=World Health Organization (WHO) |access-date=19 November 2018 }}</ref> |
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|2018-11-16||319||47||49||'''415'''||'''214'''||59%{{spaces|3|type}}||4,430||<ref name="auto" /> |
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|- |
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|2018-11-21||326||47||90||'''463'''||'''217'''||-||4,668||<ref>{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 16 – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-31 |website=ReliefWeb |access-date=22 November 2018 }}</ref> |
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|2018-11-23||365||47||45||'''457'''||'''236'''||57%{{spaces|3|type}}||4,354||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 47: 17 – 23 November 2018 |url=https://afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-47-17-23-november-2018 |publisher=World Health Organization (WHO) |access-date=27 November 2018 }}</ref> |
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|2018-11-26||374||47||74||'''495'''||'''241'''||57%{{spaces|3|type}}||4,767||<ref>{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 17 – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-32 |website=ReliefWeb |access-date=28 November 2018 }}</ref> |
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|2018-11-30||392||48||63||'''503'''||'''255'''||58%{{spaces|3|type}}||4,820||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 48: 24 – 30 November 2018 |url=https://afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-48-24-30-november-2018 |publisher=World Health Organization (WHO) |access-date=3 December 2018 }}</ref> |
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|2018-12-03||405||48||79||'''532'''||'''268'''||59%{{spaces|3|type}}||5,335||<ref>{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 18 – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-33 |website=ReliefWeb |access-date=5 December 2018 }}</ref> |
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|2018-12-07||446||48||95||'''589'''||'''283'''||57%{{spaces|3|type}}||6,417||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 49: 01 – 07 December 2018 |url=https://afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-49-01-07-december-2018 |publisher=World Health Organization (WHO) |access-date=11 December 2018 }}</ref> |
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|2018-12-10||452||48||<small>n/a</small>||'''500'''||'''289'''||58%{{spaces|3|type}}||6,509||<ref name="12/10">{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 19 – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-34 |website=ReliefWeb |access-date=12 December 2018 }}</ref> |
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|2018-12-14||483||48||111||'''642'''||'''313'''||59%{{spaces|3|type}}||6,695||<ref name="dec14">{{cite web |title=Outbreaks and Emergencies Bulletin, Week 50: 08 – 14 December 2018 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-50-08-14-december-2018 |publisher=World Health Organization (WHO) |access-date=17 December 2018 }}</ref> |
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|2018-12-21||526||48||118||'''692'''||'''347'''||60%{{spaces|3|type}}||8,422||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 51: 15 – 21 December 2018 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-51-15-21-december-2018 |publisher=World Health Organization (WHO) |access-date=24 December 2018 }}</ref> |
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|2018-12-28||548||48||52||'''648'''||'''361'''||61%{{spaces|3|type}}||7,007||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 52: 22 – 28 December 2018 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-52-22-28-december-2018-0 |publisher=World Health Organization (WHO) |access-date=31 December 2018 }}</ref> |
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|2019-01-04||575||48||118||'''741'''||'''374'''||60%{{spaces|3|type}}||5,047||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 01: 29 December 2018 – 04 January 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-01-29-december-2018-04-january-2019 |publisher=World Health Organization (WHO) |access-date=7 January 2019 }}</ref> |
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|2019-01-11||595||49||<small>n/a</small>||'''644'''||'''390'''||61%{{spaces|3|type}}||4,937||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 02: 05 – 11 January 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-02-05-11-january-2019 |publisher=World Health Organization (WHO) |access-date=14 January 2019 }}</ref> |
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|2019-01-18||636||49||209||'''894'''||'''416'''||61%{{spaces|3|type}}||4,971||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 03: 12 – 18 January 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-03-12-18-january-2019 |publisher=World Health Organization (WHO) |access-date=21 January 2019 }}</ref><ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Vendredi 18 janvier 2019 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_18jan19 |website=us13.campaign-archive.com |access-date=21 January 2019|language=fr}} WHO did not report suspected cases, added same day reference from DRC Ministry of Public Health</ref> |
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|2019-01-25||679||54||204||'''937'''||'''459'''||63%{{spaces|3|type}}||6,241||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 04: 19 – 25 January 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-04-19-25-january-2019 |publisher=World Health Organization (WHO) |access-date=29 January 2019 }}</ref><ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Vendredi 25 janvier 2019 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_25jan19 |website=us13.campaign-archive.com |access-date=29 January 2019|language=fr}}</ref> |
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|2019-02-01||720||54||168||'''942'''||'''481'''||62%{{spaces|3|type}}||>7,000{{spaces|2|type}}||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 05: 26 January – 01 February 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-05-26-january-01-february-2019 |publisher=World Health Organization (WHO) |access-date=4 February 2019 }}</ref><ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Vendredi 1 février 2019 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_1fev19 |website=us13.campaign-archive.com |access-date=4 February 2019|language=fr}}</ref> |
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|2019-02-10||750||61||148||'''959'''||'''510'''||63%{{spaces|3|type}}||7,846||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 06: 04 – 10 February 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-06-04-10-february-2019 |publisher=World Health Organization (WHO) |access-date=11 February 2019 }}</ref><ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Dimanche 10 février 2019 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_10fev19 |website=us13.campaign-archive.com |access-date=10 February 2019|language=fr}}</ref> |
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|2019-02-18||773||65||135||'''973'''||'''534'''||64%{{spaces|3|type}}||6,772||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 07: 11 – 17 February 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-07-11-17-february-2019 |publisher=World Health Organization (WHO) |access-date=18 February 2019 }}</ref><ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Dimanche 17 février 2019 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_17fev19 |website=us13.campaign-archive.com |access-date=18 February 2019|language=fr}}</ref> |
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|- |
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|2019-02-24||804||65||219||'''1,088 '''||'''546'''||63%{{spaces|3|type}}||5,739||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 08: 18 – 24 February 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-08-18-24-february-2019 |publisher=World Health Organization (WHO) |access-date=25 February 2019 }}</ref><ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Samedi 23 février 2019 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_23fev19 |website=us13.campaign-archive.com |access-date=25 February 2019|language=fr}}</ref> |
|||
|- |
|||
|2019-03-03||830||65||182||'''1,077'''||'''561'''||63%{{spaces|3|type}}||5,613||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 09: 25 February – 03 March 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-09-25-february-03-march-2019 |publisher=World Health Organization (WHO) |access-date=4 March 2019 }}</ref><ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Dimanche 3 mars 2019 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_3mar19 |website=us13.campaign-archive.com |access-date=6 March 2019|language=fr}}</ref> |
|||
|- |
|||
|2019-03-10||856||65||191||'''1,112'''||'''582'''||63%{{spaces|3|type}}||4,830||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 10: 04 – 10 March 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-10-04-10-march-2019 |publisher=World Health Organization (WHO) |access-date=11 March 2019 }}</ref><ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Dimanche 10 mars 2019 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_10mar19 |website=us13.campaign-archive.com |access-date=10 March 2019|language=fr}}</ref> |
|||
|- |
|||
|2019-03-17||886||65||231||'''1,182'''||'''598'''||63%{{spaces|3|type}}||4,158||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 11: 11 – 17 March 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-11-11-17-march-2019 |publisher=World Health Organization (WHO) |access-date=18 March 2019}}</ref><ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Dimanche 17 mars 2019 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_17mar19 |website=us13.campaign-archive.com |access-date=17 March 2019|language=fr}}</ref> |
|||
|- |
|||
|2019-03-25||944||65||226||'''1,235'''||'''629'''||62%{{spaces|3|type}}||4,132||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 12: 18 – 24 March 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-12-18-24-march-2019 |publisher=World Health Organization (WHO) |access-date=26 March 2019 }}</ref><ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Lundi 25 mars 2019 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_25mar19 |website=us13.campaign-archive.com |access-date=26 March 2019|language=fr}}</ref> |
|||
|- |
|||
|2019-03-31||1,016||66||279||'''1,361'''||'''676'''||62%{{spaces|3|type}}||6,989||<ref name="1000cases">{{cite web |title=Outbreaks and Emergencies Bulletin, Week 13: 25 – 31 March 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-13-25-31-march-2019 |publisher=World Health Organization (WHO) |access-date=1 April 2019 }}</ref><ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Dimanche 31 mars 2019 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_31mar19 |website=us13.campaign-archive.com |access-date=31 March 2019|language=fr}}</ref> |
|||
|- |
|||
|2019-04-07||1,080||66||282||'''1,428'''||'''721'''||63%{{spaces|3|type}}||7,099||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 14: 01 – 07 April 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-14-01-07-april-2019 |publisher=World Health Organization (WHO) |access-date=8 April 2019 }}</ref> |
|||
|- |
|||
|2019-04-14||1,185||66||269||'''1,520'''||'''803'''||64%{{spaces|3|type}}||10,461||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 15: 08 – 14 April 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-15-08-14-april-2019 |publisher=World Health Organization (WHO) |access-date=16 April 2019 }}</ref> |
|||
|- |
|||
|2019-04-21||1,270||66||92||'''1,428'''||'''870'''||65%{{spaces|3|type}}||5,183||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 16: 15 – 21 April 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-16-15-21-april-2019 |publisher=World Health Organization (WHO) |access-date=24 April 2019 }}</ref> |
|||
|- |
|||
|2019-04-28||1,373||66||176||'''1,615'''||'''930'''||65%{{spaces|3|type}}||11,841||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 17: 22 – 28 April 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-17-22-28-april-2019 |publisher=World Health Organization (WHO) |access-date=29 April 2019 }}</ref> |
|||
|- |
|||
|2019-05-05||1,488||66||205||'''1,759'''||'''1,028'''||66%{{spaces|3|type}}||12,969||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 18: 29 April – 5 May 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-18-29-april-5-may-2019 |publisher=World Health Organization (WHO) |access-date=6 May 2019 }}</ref> |
|||
|- |
|||
|2019-05-12||1,592||88||534||'''2,214'''||'''1,117'''||67%{{spaces|3|type}}||13,174||<ref name="may12">{{cite web |title=Outbreaks and Emergencies Bulletin, Week 19: 6 May – 12 May 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-19-6-12-may-2019 |publisher=World Health Organization (WHO) |access-date=14 May 2019 }}</ref> |
|||
|- |
|||
|2019-05-19||1,728||88||278||'''2,094'''||'''1,209'''||67%{{spaces|3|type}}||12,608||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 20: 13 – 19 May 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-20-13-19-may-2019 |publisher=World Health Organization (WHO) |access-date=20 May 2019 }}</ref> |
|||
|- |
|||
|2019-05-26||1,818||94||277||'''2,189'''||'''1,277'''||67%{{spaces|3|type}}||20,415||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 21: 20 – 26 May 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-21-20-26-may-2019 |publisher=World Health Organization (WHO) |access-date=27 May 2019 }}</ref> |
|||
|- |
|||
|2019-06-02||1,900||94||316||'''2,310'''||'''1,339'''||67%{{spaces|3|type}}||19,465||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 22: 27 May – 02 June 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-22-27-may-02-june-2019 |publisher=World Health Organization (WHO) |access-date=3 June 2019 }}</ref> |
|||
|- |
|||
|2019-06-09||1,962||94||271||'''2,327'''||'''1,384'''||67%{{spaces|3|type}}||15,045||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 23: 03 – 09 June 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-23-03-09-june-2019 |publisher=World Health Organization (WHO) |access-date=12 June 2019 }}</ref> |
|||
|- |
|||
|{{spaces|27|type}}2019-06-16 '''''{{font color|blue|DRC}}''''' & '''''{{font color|red|Uganda}}'''''||2,051 / 3||94 / 0||319 / 1||'''2,468'''||'''1,440'''||67%{{spaces|3|type}}/100%{{spaces|3|type}}||15,992 / 90||{{spaces|10|type}}<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 24: 10 – 16 June 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-24-10-16-june-2019 |publisher=World Health Organization (WHO) |access-date=17 June 2019 }}</ref>{{refn|group=note|...in the Congolese statistics cases of Mabalako. Uganda's index case and 7 other family members were classified in Mabalako, the health zone where they started to develop symptoms. Of these 8 confirmed cases of the same family, 5 remained in the DRC and 3 had crossed the border. [...] The 2 deaths of Bwera are the 5-year-old boy and the 50-year-old grandmother who were classified...<ref>{{cite web|title=Situation épidémiologique dans les provinces du Nord-Kivu et de l'Ituri|publisher=Dr. [[Oly Ilunga Kalenga]], Ministre de la Santé|url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_13juin19|date=2019-06-13|language=fr}}</ref> {{As of |2020|6|25}}}} |
|||
|- |
|||
|2019-06-23||2,145 / 3||94 / 0||276 / 0||'''2,515'''||'''1,506'''||67%{{spaces|3|type}}/100%{{spaces|3|type}}||{{spaces|2|type}}15,903 / 110||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 25: 17 – 23 June 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-25-17-23-june-2019 |publisher=World Health Organization (WHO) |access-date=24 June 2019 }}</ref> |
|||
|- |
|||
|2019-06-30||2,231 / 3||94 / 0||309 / 0||'''2,634'''||'''1,563'''||67%{{spaces|3|type}}/100%{{spaces|3|type}}||{{spaces|2|type}}18,088 / 108||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 26: 24 – 30 June 2019 |url=https://afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-26-24-30-june-2019 |publisher=World Health Organization (WHO) |access-date=1 July 2019 }}</ref><ref>{{cite web |title=Uganda's groundwork in preparedness bodes well for stopping Ebola's spread within its borders |url=https://afro.who.int/news/ugandas-groundwork-preparedness-bodes-well-stopping-ebolas-spread-within-its-borders |publisher=World Health Organization (WHO) |access-date=1 July 2019 }}</ref> |
|||
|- |
|||
|2019-07-07||2,314 / 3||94 / 0||323 / 0||'''2,731'''||'''1,625'''||68%{{spaces|3|type}}/100%{{spaces|3|type}}||19,227 / 0{{spaces|2|type}}||<ref>{{cite web |title=Weekly bulletins on outbreaks and other emergencies |url=https://www.afro.who.int/health-topics/disease-outbreaks/outbreaks-and-other-emergencies-updates |publisher=World Health Organization (WHO) |access-date=8 July 2019 }}</ref><ref name="3cases">{{cite web |title=Joint advisory on Ebola virus disease in Uganda – Uganda |url=https://reliefweb.int/report/uganda/joint-advisory-ebola-virus-disease-uganda |website=ReliefWeb |access-date=8 July 2019 }}</ref> |
|||
|- |
|||
|2019-07-14||2,407 / 3||94 / 0||335 / 0||'''2,836'''||'''1,665'''||67%{{spaces|3|type}}/100%{{spaces|3|type}}||19,118 / 0{{spaces|2|type}}||<ref>{{cite web |title=WHO AFRO Outbreaks and Other Emergencies, Week 28: 8 – 14 July 2019; Data as reported by 17:00; 14 July 2019 – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/who-afro-outbreaks-and-other-emergencies-week-28-8-14-july-2019 |website=ReliefWeb |access-date=17 July 2019 }}</ref><ref name=3cases/> |
|||
|- |
|||
|2019-07-21||2,484 / 3||94 / 0||361 / 0||'''2,939'''||'''1,737'''||67%{{spaces|3|type}}/100%{{spaces|3|type}}||20,505 / 19||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 29: 15 – 21 July 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-29-15-21-july-2019 |publisher=World Health Organization (WHO) |access-date=23 July 2019 }}</ref><ref>{{cite web |title=WHO reports new Ebola incident near Uganda-DRC border |url=https://www.theeastafrican.co.ke/scienceandhealth/fears-of-Ebola-virus-spreading/3073694-5199556-42crqdz/index.html |website=The East African |access-date=23 July 2019 }}</ref> |
|||
|- |
|||
|{{spaces|9|type}}2019-07-28 '''''{{font color|blue|DRC}}'''''||2,565||94||358||'''3,017'''||'''1,782'''||67%{{spaces|3|type}}||20,072||<ref>{{cite web |title=WHO AFRO Outbreaks and Other Emergencies, Week 30: 22 – 28 July 2019; Data as reported by 17:00; 28 July 2019 – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/who-afro-outbreaks-and-other-emergencies-week-30-22-28-july-2019 |website=ReliefWeb |access-date=30 July 2019 }}</ref> |
|||
|- |
|||
|2019-08-04||2,659||94||397||'''3,150'''||'''1,843'''||67%{{spaces|3|type}}||19,156||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 31: 29 July – 04 August 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-31-29-july-04-august-2019 |publisher=World Health Organization (WHO) |access-date=6 August 2019 }}</ref> |
|||
|- |
|||
|2019-08-11||2,722||94||326||'''3,142'''||'''1,888'''||67%{{spaces|3|type}}||15,988||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 32: 05 – 11 August 2019 |url=https://www.afro.who.int/node/11581 |website=WHO {{!}} Regional Office for Africa |access-date=13 August 2019}}</ref> |
|||
|- |
|||
|2019-08-19||2,783||94||387||'''3,264'''||'''1,934'''||67%{{spaces|3|type}}||15,817||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 33: 12 – 18 August 2019 |url=https://www.afro.who.int/node/11624 |website=WHO {{!}} Regional Office for Africa |access-date=20 August 2019 }}</ref> |
|||
|- |
|||
|2019-08-25||2,863||105||396||'''3,364'''||'''1,986'''||67%{{spaces|3|type}}||17,293||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 34: 19 – 25 August 2019 |url=https://www.afro.who.int/node/11652 |website=WHO {{!}} Regional Office for Africa |access-date=26 August 2019 }}</ref> |
|||
|- |
|||
|2019-09-01||2,926||105||365||'''3,396'''||'''2,031'''||67%{{spaces|3|type}}||16,370||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 35: 26 August – 01 September 2019 |url=https://www.afro.who.int/node/11680 |website=WHO {{!}} Regional Office for Africa |access-date=3 September 2019 }}</ref> |
|||
|- |
|||
|2019-09-08||2,968||111||403||'''3,486'''||'''2,064'''||67%{{spaces|3|type}}||14,737||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 36: 2 – 8 September 2019 |url=https://www.afro.who.int/node/11704 |website=WHO {{!}} Regional Office for Africa |access-date=10 September 2019 }}</ref> |
|||
|- |
|||
|2019-09-15||3,005||111||497||'''3,613'''||'''2,090'''||67%{{spaces|3|type}}||13,294||<ref name="none">{{cite web |title=Outbreaks and Emergencies Bulletin, Week 37: 9 – 15 September 2019 |url=https://www.afro.who.int/node/11740 |website=WHO {{!}} Regional Office for Africa |access-date=17 September 2019 }}</ref> |
|||
|- |
|||
|2019-09-22||3,053||111||415||'''3,583'''|||'''2,115'''||67%{{spaces|3|type}}||11,335||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 38: 16 – 22 September 2019 |url=https://www.afro.who.int/node/11769 |website=WHO {{!}} Regional Office for Africa |access-date=24 September 2019 }}</ref> |
|||
|- |
|||
|2019-09-29||3,074||114||426||'''3,618'''||'''2,133'''||67%{{spaces|3|type}}||{{spaces|2|type}}7,775||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 39: 23 – 29 September 2019 |url=https://www.afro.who.int/node/11807 |website=WHO {{!}} Regional Office for Africa |access-date=1 October 2019 }}</ref> |
|||
|- |
|||
|2019-10-06||3,090||114||414||'''3,622'''||'''2,146'''||67%{{spaces|3|type}}||{{spaces|2|type}}7,807||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 40: 30 September – 6 October 2019 |url=https://www.afro.who.int/node/11838 |website=WHO {{!}} Regional Office for Africa |access-date=8 October 2019 }}</ref> |
|||
|- |
|||
|2019-10-13||3,104||114||429||'''3,647'''||'''2,150'''||67%{{spaces|3|type}}||{{spaces|2|type}}5,622||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 41: 7 – 13 October 2019 |url=https://www.afro.who.int/node/11863 |website=WHO {{!}} Regional Office for Africa |access-date=16 October 2019 }}</ref> |
|||
|- |
|||
|2019-10-20||3,123||116||420||'''3,659'''||'''2,169'''||67%{{spaces|3|type}}||{{spaces|2|type}}5,570||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 42: 14 – 20 October 2019 |url=https://www.afro.who.int/node/11898 |website=WHO {{!}} Regional Office for Africa |access-date=21 October 2019 }}</ref> |
|||
|- |
|||
|2019-10-28||3,146||117||357||'''3,624'''||'''2,180'''||67%{{spaces|3|type}}||{{spaces|2|type}}4,437||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 43: 21 – 27 October 2019 |url=https://www.afro.who.int/node/11915 |website=WHO {{!}} Regional Office for Africa |access-date=29 October 2019 }}</ref> |
|||
|- |
|||
|2019-11-03||3,157||117||513||'''3,787'''||'''2,185'''||67%{{spaces|3|type}}||{{spaces|2|type}}6,078||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 44: 28 October – 3 November 2019 |url=https://www.afro.who.int/node/11952 |website=WHO {{!}} Regional Office for Africa |access-date=5 November 2019 }}</ref> |
|||
|- |
|||
|2019-11-10||3,169||118||482||'''3,769'''||'''2,193'''||67%{{spaces|3|type}}||{{spaces|2|type}}6,137||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 45: 4 – 10 November 2019 |url=https://www.afro.who.int/node/11976 |website=WHO {{!}} Regional Office for Africa |access-date=12 November 2019 }}</ref> |
|||
|- |
|||
|2019-11-17||3,174||118||422||'''3,714'''||'''2,195'''||67%{{spaces|3|type}}||{{spaces|2|type}}4,857||<ref>{{cite web |title=Weekly bulletins on outbreaks and other emergencies |url=https://www.afro.who.int/health-topics/disease-outbreaks/outbreaks-and-other-emergencies-updates |website=WHO {{!}} Regional Office for Africa |access-date=19 November 2019 }}</ref> |
|||
|- |
|||
|2019-11-24||3,183||118||349||'''3,650'''||'''2,198'''||67%{{spaces|3|type}}||{{spaces|2|type}}3,371||<ref>{{cite web |title=Weekly bulletins on outbreaks and other emergencies |url=https://www.afro.who.int/health-topics/disease-outbreaks/outbreaks-and-other-emergencies-updates |website=WHO {{!}} Regional Office for Africa |access-date=26 November 2019 }}</ref> |
|||
|- |
|||
|2019-12-08||3,202||118||391||'''3,711'''||'''2,209'''||67%{{spaces|3|type}}||{{spaces|2|type}}2,955||<ref>{{cite web |title=Weekly bulletins on outbreaks and other emergencies |url=https://www.afro.who.int/health-topics/disease-outbreaks/outbreaks-and-other-emergencies-updates |website=WHO {{!}} Regional Office for Africa|access-date=12 December 2019}}</ref> |
|||
|- |
|||
|2019-12-22||3,240||118||446||'''3,804'''||'''2,224'''||66%{{spaces|3|type}}||{{spaces|2|type}}5,137||<ref name="novupdate">{{cite web |title=Outbreaks and Emergencies Bulletin, Week 51: 16 – 22 December 2019 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-51-16-22-december-2019 |website=WHO {{!}} Regional Office for Africa |access-date=27 December 2019 }}</ref> |
|||
|- |
|||
|2020-01-05||3,270||118||464||'''3,852'''||'''2,233'''||66%{{spaces|3|type}}||{{spaces|2|type}}4,133||<ref>{{cite web |title=Outbreaks and Emergencies Bulletin, Week 01: 30 December 2019 – 05 January 2020 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-01-30-december-2019-05-january-2020 |website=WHO {{!}} Regional Office for Africa |access-date=8 January 2020 }}</ref> |
|||
|- |
|||
|2020-01-19||3,293||119||438||'''3,854'''||'''2,241'''||66%{{spaces|3|type}}||{{spaces|2|type}}5,018||<ref>{{cite web |title=Weekly bulletins on outbreaks and other emergencies |url=https://www.afro.who.int/health-topics/disease-outbreaks/outbreaks-and-other-emergencies-updates |website=WHO {{!}} Regional Office for Africa |access-date=21 January 2020 }}</ref> |
|||
|- |
|||
|2020-02-02||3,305||123||447||'''3,879'''||'''2,250'''||66%{{spaces|3|type}}||{{spaces|2|type}}2,374||<ref name=":3">{{cite web |title=Outbreaks and Emergencies Bulletin, Week 5: 27 January – 02 February 2020 |url=https://www.afro.who.int/publications/outbreaks-and-emergencies-bulletin-week-5-27-january-02-february-2020 |website=WHO {{!}} Regional Office for Africa |access-date=5 February 2020 }}</ref> |
|||
|- |
|||
|2020-02-16||3,309||123||504||'''3,936'''||'''2,253'''||66%{{spaces|3|type}}||{{spaces|2|type}}1,972||<ref>{{cite web |title=Weekly bulletins on outbreaks and other emergencies |url=https://www.afro.who.int/health-topics/disease-outbreaks/outbreaks-and-other-emergencies-updates |website=WHO {{!}} Regional Office for Africa |access-date=21 February 2020 }}</ref> |
|||
|- |
|||
|2020-03-29 |
|||
|3,310 |
|||
|143 |
|||
|232 |
|||
|'''3,685''' |
|||
|'''2,273''' |
|||
|66%{{spaces|3|type}} |
|||
| - |
|||
|<ref name=":9">{{cite web |title=Outbreaks and Emergencies Bulletin, Week 13: 23 – 29 March 2020 |url=https://apps.who.int/iris/bitstream/handle/10665/331619/OEW13-2329032020.pdf |website=WHO {{!}} Regional Office for Africa |access-date=1 April 2020 }}</ref> |
|||
|- |
|||
|{{spaces|1|type}}2020-06-25{{efn|group=timelinenote|name=timelinenote4}} |
|||
|3,313 |
|||
|153 |
|||
|0 |
|||
|'''3,470''' |
|||
|'''2,280''' |
|||
|66%{{spaces|3|type}} |
|||
| - |
|||
|<ref name=finish/>{{efn|group=timelinenote|name=timelinenote1}} |
|||
|- |
|||
| colspan="9" align="left" | |
|||
{{notelist|group=timelinenote |refs = |
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{{efn|name=timelinenote1|These figures may increase when new cases are discovered, and fall consequently, when tests show cases were not Ebola-related.}} |
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{{efn|name=timelinenote2|DRC Ministry of Public Health}} |
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{{efn|name=timelinenote3|indicates ''suspected cases'' were not counted towards CFR}} |
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{{efn|name=timelinenote4|indicates 42 days have passed since the last case and outbreak is declared over}} |
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}} |
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{{cob}} |
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===Outbreak and military conflict=== |
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{{details|w:Second Congo War}} |
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{{details|w:Kivu conflict}}[[File:Goma - North Kivu (21070159821).jpg|thumb|left|Goma, the capital of North Kivu province{{attrib|MONUSCO|cc by sa}}]] |
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At the time of the epidemic, there were about 70 armed military groups, among them the [[w:Alliance of Patriots for a Free and Sovereign Congo|Alliance of Patriots for a Free and Sovereign Congo]] and the [[w:Mai-Mayi Nduma défense du Congo-Rénové|Mai-Mayi Nduma défense du Congo-Rénové]], in North Kivu. The armed fighting displaced thousands of individuals<ref>{{cite web |title=Atrocity Alert, No. 116, 1 August 2018 |url=https://reliefweb.int/report/democratic-republic-congo/atrocity-alert-no-116-1-august-2018 |website=ReliefWeb |access-date=6 August 2018 }}</ref> and seriously affected the response to the outbreak.<ref>{{Cite news|title=Ebola virus disease – Democratic Republic of the Congo: Disease outbreak news, 4 August 2018|work=ReliefWeb|url=https://reliefweb.int/report/democratic-republic-congo/ebola-virus-disease-democratic-republic-congo-disease-outbreak-9|access-date=5 August 2018}}</ref><ref>{{Cite news|date=3 August 2018|title=Conflict in new Ebola zone of DR Congo exacerbates complexity of response: WHO emergency response chief|work=UN News|url=https://news.un.org/en/story/2018/08/1016262|access-date=5 August 2018}}</ref> According to the WHO, health care workers are to be accompanied by military personnel for protection and ring vaccination may not be possible.<ref name="sc">{{cite web |title=Out of the frying pan, into the fire with a new Ebola outbreak in Congo |url=http://www.sciencemag.org/news/2018/08/out-frying-pan-fire-new-ebola-outbreak-congo |website=Science {{!}} AAAS |access-date=6 August 2018 |date=6 August 2018}}</ref> On 11 August 2018, it was reported that seven individuals were killed in [[w:Mayi-Moya|Mayi-Moya]] due to a militant group, about 24 miles from the city of [[w:Beni, Democratic Republic of the Congo|Beni]] where there were several EVD cases.<ref>{{cite web |title=Congo's latest Ebola outbreak taking place in a war zone |url=https://www.thestate.com/news/article216509420.html |website=thestate |access-date=11 August 2018 |archive-url=https://web.archive.org/web/20180812021839/https://www.thestate.com/news/article216509420.html |archive-date=12 August 2018 |url-status=dead |df=dmy-all }}</ref><ref>{{cite web |title=Vaccinations underway in Congo's latest Ebola outbreak {{!}} CBC News |url=https://www.cbc.ca/news/health/congo-ebola-vaccinations-1.4779040 |website=CBC |access-date=11 August 2018}}</ref><ref>{{cite web |title=WHO calls for free and secure access in responding to Ebola outbreak in the Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/who-calls-free-and-secure-access-responding-ebola-outbreak |website=ReliefWeb |access-date=12 August 2018 }}</ref> |
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On 24 August 2018, it was reported that a physician infected with Ebola had been in contact with some 97 individuals in an inaccessible military area, who hence could not be diagnosed.<ref>{{cite web |title=DRC: Doctor stricken with Ebola in rebel stronghold |url=https://www.aljazeera.com/news/2018/08/drc-doctor-stricken-ebola-rebel-stronghold-180824095226217.html |website=www.aljazeera.com |access-date=24 August 2018}}</ref><ref>{{cite web |last1=Burke |first1=Jason |title=Ebola: medics brace for new cases as DRC outbreak spreads |url=https://www.theguardian.com/world/2018/aug/24/ebola-drc-outbreak-spreads |website=the Guardian |access-date=24 August 2018 |date=24 August 2018}}</ref> In September, it was reported that 2 [[w:United Nations peacekeeping|peacekeepers]] were attacked and wounded by rebel groups in Beni,<ref>{{cite news |first1=Fiston |last1=Mahamba |first2=Stephanie |last2=Nebehay |first3=Aaron |last3=Ross |first4=Andrew |last4=Heavens |title=Rebels ambush South African peacekeepers in Congo Ebola zone |url=https://af.reuters.com/article/topNews/idAFKCN1LK1J1-OZATP |newspaper=Reuters |access-date=4 September 2018|date=2018-09-04 |archive-url=https://web.archive.org/web/20180904225841/https://af.reuters.com/article/topNews/idAFKCN1LK1J1-OZATP |archive-date=4 September 2018 }}</ref> and 14 individuals were killed in a military attack.<ref>{{cite web |title=Rebel Attack in Congo Ebola Zone Kills at Least 14 Civilians |url=https://www.voanews.com/a/rebel-attack-in-congo-ebola-zone-kills-at-least-14-civilians/4583500.html |website=VOA |access-date=23 September 2018 }}</ref> In September 2018, the WHO's Deputy Director-General for Emergency Preparedness and Response described the combination of military conflict and civilian distress as a potential "perfect storm" that could lead to a rapid worsening of the outbreak.<ref name=":0" /><ref name=":1" /> |
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On 20 October 2018, an armed rebel group in the DRC killed some 13 civilians and took 12 children as hostages in Beni, which was then experiencing one of the worst outbreaks.<ref>{{cite web |title=Congo rebels kill 13, abduct children at Ebola treatment center |url=https://nypost.com/2018/10/21/congo-rebels-kill-13-abduct-children-at-ebola-treatment-center/ |website=New York Post |access-date=21 October 2018 |date=21 October 2018}}</ref><ref>{{cite web |title=Congo Rebels Kill 15, Abduct Kids in Ebola Outbreak Region|url=https://www.voanews.com/africa/congo-rebels-kill-15-abduct-kids-ebola-outbreak-region-0 |website=VOA |access-date=21 October 2018 }}</ref> On 11 November, six people were killed in an attack by an armed rebel group in Beni; as a consequence vaccinations were suspended there.<ref>{{cite web |title=Rebels kill six, kidnap five in east DRC |url=https://www.news24.com/Africa/News/rebels-kill-six-kidnap-five-in-east-drc-20181112 |website=News24 |access-date=12 November 2018 |date=2018-11-12 }}</ref><ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Lundi 12 novembre 2018 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_12nov |website=mailchi.mp |access-date=12 November 2018|language=fr}}</ref> Yet another attack reported on 17 November, in Beni by an armed rebel group forced the cessation of EVD containment efforts and WHO staff to evacuate to another DRC city for the time being.<ref>{{cite web |title=Anti-Ebola efforts suspended amid violence |url=https://www.bbc.com/news/world-africa-46249319 |website=BBC News |access-date=17 November 2018 |date=17 November 2018}}</ref> Beni continues to be the site of attacks by militant groups as 18 civilians were killed on 6 December.<ref>{{cite news |title=Militants kill at least 18 civilians in Congo's Ebola zone |url=https://www.reuters.com/article/us-congo-violence-ebola/militants-kill-at-least-18-civilians-in-congos-ebola-zone-idUSKBN1O61PF |newspaper=Reuters |access-date=7 December 2018 |date=7 December 2018}}</ref> On 22 December it was reported that [[w:2018 Democratic Republic of the Congo general election|elections]] for the [[w:President of the Democratic Republic of the Congo|President of the DRC]] would go forward despite the EVD outbreak, including in the Ebola-stricken area of Beni.<ref>{{cite web |title=Voting will take place in DR Congo's Ebola-hit region: official {{!}} DR Congo News {{!}} Al Jazeera |url=https://www.aljazeera.com/news/2018/12/voting-place-dr-congo-ebola-hit-region-official-181222150359685.html |website=www.aljazeera.com |access-date=25 December 2018}}</ref> Four days later, on 26 December, the DRC government reversed itself to indicate those Ebola-stricken areas, such as Beni, would not vote for several months;<ref>{{cite web |last1=Mwanamilongo |first1=Saleh |last2=Boussion |first2=Mathilde |title=Congo delays Sunday's election for months in Ebola zone |url=https://www.apnews.com/5de00ccd38e84bc48efe870020edd8b2 |website=AP NEWS |access-date=27 December 2018 |date=26 December 2018}}</ref> as a consequence election protesters ransacked an Ebola assessment center in Beni.<ref>{{cite web |title=Protesters attack DR Congo Ebola centre |url=https://www.bbc.com/news/world-africa-46692506 |website=BBC News |access-date=27 December 2018 |date=27 December 2018}}</ref><ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Jeudi 27 décembre 2018 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_27dec |website=us13.campaign-archive.com |access-date=27 December 2018|language=fr}}</ref><ref>{{cite web |title=Statement on disruptions to the Ebola response in the Democratic Republic of the Congo |url=https://www.who.int/news-room/detail/28-12-2018-statement-on-disruptions-to-the-ebola-response-in-the-democratic-republic-of-the-congo |publisher=World Health Organization (WHO) |access-date=28 December 2018 }}</ref> Post election tensions continued when it was reported that the DRC government had cut off internet connectivity for the population, as the vote results were yet to be released.<ref>{{cite web |title=Warning of 'Fictitious' Election Results Online, Congo Cuts Internet for 2nd Day |url=https://www.nytimes.com/2019/01/01/world/africa/congo-elections-internet.html |website=The New York Times |access-date=2 January 2019 |date=1 January 2019}}</ref> |
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On 29 December 2018, Oxfam said it would suspend its work due to the ongoing violence in the DRC;<ref>{{cite web |title=Oxfam suspends Ebola work amid protests over Democratic Republic of Congo vote delays |url=https://news.sky.com/story/oxfam-suspends-ebola-work-amid-protests-over-democratic-republic-of-congo-vote-delays-11593539 |website=Sky News |access-date=29 December 2018 }}</ref> on the same day, the [[w:International Rescue Committee|International Rescue Committee]] suspended their Ebola support efforts as well.<ref>{{cite web |title=Election-related violence in Democratic Republic of Congo forces IRC to temporarily suspend life-saving Ebola response programming |url=https://www.rescue.org/press-release/election-related-violence-democratic-republic-congo-forces-irc-temporarily-suspend?edme=true |website=International Rescue Committee (IRC) |access-date=29 December 2018 |date=29 December 2018}}</ref> On 18 January, the [[w:African Union|African Union]] indicated that presidential election results announcements should be suspended in the DRC.<ref>{{cite web |first1=Stephanie |last1=Busari |first2=Bukola |last2=Adebayo |title=African Union calls for suspension of DR Congo election results announcement |url=https://www.cnn.com/2019/01/18/africa/au-congo-vote-fallout/index.html |website=CNN |access-date=22 January 2019}}</ref> |
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==Virology== |
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{{details|w:Ebola virus}} |
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{{see also|w:Ebola virus disease#Pathophysiology}} |
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[[File:Rousettus aegyptiacus 1.jpg|thumb|left|Fruit bats (group of ''[[w:Rousettus aegyptiacus|Rousettus aegyptiacus]]''){{attrib|Ismail Ali Gago|cc by sa}}]] |
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[[File:Genomic epidemiology of the 2018-19 Ebola epidemic.jpg|thumb|600px|Genomic epidemiology from July 2018 to Oct. 2019 of the Kivu Ebola epidemic.<ref>Hadfield et al., [https://academic.oup.com/bioinformatics/article/34/23/4121/5001388 "Nextstrain: real-time tracking of pathogen evolution"], Bioinformatics (2018), accessed 2 January 2021</ref> (One of the first ''sequence'':<ref name="aru">{{cite journal |last1=Aruna |first1=Aaron |last2=Mbala |first2=Placide |last3=Minikulu |first3=Luigi |last4=Mukadi |first4=Daniel |last5=Bulemfu |first5=Dorothée |last6=Edidi |first6=Franck |last7=Bulabula |first7=Junior |last8=Tshapenda |first8=Gaston |last9=Nsio |first9=Justus |last10=Kitenge |first10=Richard |last11=Mbuyi |first11=Gisèle |last12=Mwanzembe |first12=Celestin |last13=Kombe |first13=John |last14=Lubula |first14=Léopold |last15=Shako |first15=Jean Christophe |last16=Mossoko |first16=Mathias |last17=Mulangu |first17=Felix |last18=Mutombo |first18=Annie |last19=Sana |first19=Emilia |last20=Tutu |first20=Yannick |last21=Kabange |first21=Laetycia |last22=Makengo |first22=Jonathan |last23=Tshibinkufua |first23=Fortunat |last24=Ahuka-Mundeke |first24=Steve |last25=Muyembe |first25=Jean-Jacques |last26=CDC |first26=Ebola Response |last27=Alarcon |first27=Walter |last28=Bonwitt |first28=Jesse |last29=Bugli |first29=Dante |last30=Bustamante |first30=Nirma D. |last31=Choi |first31=Mary |last32=Dahl |first32=Benjamin A. |last33=DeCock |first33=Kevin |last34=Dismer |first34=Amber |last35=Doshi |first35=Reena |last36=Dubray |first36=Christine |last37=Fitter |first37=David |last38=Ghiselli |first38=Margherita |last39=Hall |first39=Noemi |last40=Ben Hamida |first40=Amen |last41=McCollum |first41=Andrea M. |last42=Neatherlin |first42=John |last43=Raghunathan |first43=Pratima L. |last44=Ravat |first44=Fatima |last45=Reynolds |first45=Mary G. |last46=Rico |first46=Adriana |last47=Smith |first47=Nailah |last48=Soke |first48=Gnakub Norbert |last49=Trudeau |first49=Aimee T. |last50=Victory |first50=Kerton R. |last51=Worrell |first51=Mary Claire |title=Ebola Virus Disease Outbreak — Democratic Republic of the Congo, August 2018–November 2019 |journal=Morbidity and Mortality Weekly Report |date=20 December 2019 |volume=68 |issue=50 |pages=1162–1165 |doi=10.15585/mmwr.mm6850a3 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6936163/ |access-date=3 February 2021 |issn=0149-2195}}</ref> BEN164, health zone: '''Mabalako''', divergence: 5.285e-5, date: 10/08/18, no nucleotide mutations, to its spread to '''Goma''', ''sequence'': GOM1887, health zone: [aforementioned] Goma, divergence: 2.062e-3, date: 7/13/19, [[w:nucleotide|nucleotide]] mutations: A3376G T3378C C3380A T3386A G3388C G3389T T3391C G3398A C3399A, [[w:Amino acid|AA]] mutations: [[w:Zaire ebolavirus#Genome|VP35]] V87A Q88K L901 to the more recent ''sequence'': MAN9501, health zone: '''Mandima''', divergence: 1.4803-4, date: 10/10/19, no nucleotide mutations<ref>{{cite web |title=auspice |url=https://nextstrain.org/community/inrb-drc/ebola-nord-kivu |website=nextstrain.org |access-date=2 February 2021}}</ref> This does not reflect the possible final ''sequence'' or information, however as of Oct. 2019 the outbreak was slowing down.<ref>{{cite journal |last1=Maxmen |first1=Amy |title=The Ebola outbreak is finally slowing down |url=https://www.nature.com/articles/d41586-019-03197-w |journal=Nature |access-date=16 July 2020 |doi=10.1038/d41586-019-03197-w |date=21 October 2019|pmid=33077971 }}</ref>){{attrib|Nextstrain.org|cc by sa}} ]] |
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The outbreak was caused by the ''[[w:Zaire ebolavirus|Zaire ebolavirus]]'' species. This is the same strain that was involved in the [[w:2018 Équateur province Democratic Republic of the Congo Ebola virus outbreak|early 2018 outbreak in western DRC]].<ref name="sci">{{cite journal |title=Updated: Officials move to use vaccine against new Ebola outbreak |url=http://www.sciencemag.org/news/2018/08/updated-deadly-ebola-surfaces-africa-s-center-yet-again |journal=[[Science (journal)|Science]] |date=3 August 2018 | doi=10.1126/science.aau9734|last1=Cohen |first1=Jon }}</ref> |
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''Zaire ebolavirus'' strain is the most lethal of the six known strains (including the newly discovered ''[[w:Bombali ebolavirus|Bombali]]'' strain);<ref>{{cite web | title=New Ebola species is reported for first time in a decade – STAT | url=https://www.statnews.com/2018/07/27/ebola-virus-discovery/ | website=statnews.com | access-date=27 July 2018 | date=27 July 2018}}</ref> it is fatal in up to 90% of cases.<ref>{{cite journal |last1=Rewar |first1=Suresh |last2=Mirdha |first2=Dashrath |title=Transmission of Ebola Virus Disease: An Overview |journal=Annals of Global Health |date=8 May 2015 |volume=80 |issue=6 |pages=444–51 |doi=10.1016/j.aogh.2015.02.005 |pmid=25960093 |doi-access=free }}</ref> Both Ebola and [[w:Marburg virus|Marburg virus]] are part of the ''[[w:Filoviridae|Filoviridae]]'' family.<ref>{{cite web |title=Filoviridae |url=https://www.cdc.gov/vhf/virus-families/filoviridae.html |publisher=[[Centers for Disease Control and Prevention]] (CDC) |access-date=5 August 2018 }}</ref> |
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The filovirus genome contains seven genes, including [[w:VP40|VP40]].<ref>{{cite book |doi=10.1016/B978-0-12-373741-0.50007-6 |chapter=Minus-Strand RNA Viruses |title=Viruses and Human Disease |pages=137–191 |year=2008 |last1=Strauss |first1=James H. |last2=Strauss |first2=Ellen G. |s2cid=89027525 |isbn=978-0-12-373741-0 }}</ref> The [[w:natural reservoir|natural reservoir]] of the virus is thought to be the [[w:Megabat|African fruit bat]],<ref>{{cite book |doi=10.1007/978-3-540-70962-6_15 |pmid=17848072 |chapter=Ebolavirus and Other Filoviruses |title=Wildlife and Emerging Zoonotic Diseases: The Biology, Circumstances and Consequences of Cross-Species Transmission |volume=315 |pages=363–387 |series=Current Topics in Microbiology and Immunology |year=2007 |last1=Leroy |first1=E. |last2=Gonzalez |first2=J. P. |last3=Pourrut |first3=X. |pmc=7121322 |isbn=978-3-540-70961-9 }}</ref> which is used in many parts of Africa as [[w:bushmeat|bushmeat]].<ref>{{cite web |title=Why West Africans keep hunting and eating bush meat despite Ebola concerns |url=https://www.washingtonpost.com/news/morning-mix/wp/2014/08/05/why-west-africans-keep-hunting-and-eating-bush-meat-despite-ebola-concerns/ |website=The Washington Post |access-date=5 August 2018 }}</ref> |
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===Viral mechanism=== |
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A significant part of the EVD infection is based on [[w:immune suppression|immune suppression]] along with systemic inflammation, leading to multiple organ failure.<ref>{{cite journal |last1=Feldmann |first1=Heinz |last2=Geisbert |first2=Thomas W. |title=Ebola haemorrhagic fever |journal=The Lancet |date=March 2011 |volume=377 |issue=9768 |pages=849–862 |doi=10.1016/S0140-6736(10)60667-8 |pmid=21084112 |pmc=3406178 }}</ref> Systemic inflammation and fever may damage many types of body tissues but the consequences are especially profound in the liver, where Ebola wipes out cells required to produce [[coagulation]] factors. In the gastrointestinal tract damaged cells lead to diarrhea putting people at risk of dehydration. And in the [[adrenal gland]] the virus harming the cells that make steroids which regulates blood pressure, resulting in circulatory failure.<ref>{{cite web |last1=Servick |first1=Kelly |title=What does Ebola actually do? |url=https://www.sciencemag.org/news/2014/08/what-does-ebola-actually-do |website=Science |access-date=February 20, 2021}}</ref> |
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===Genetic epidemiology=== |
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This is a medical field which tries to understand how genetic factors and the environment interact in this case while the outbreak was going through the population of the Democratic Republic of the Congo and the neighboring country of Uganda.<ref>{{cite web |title=Genetic Epidemiology |url=https://www.genome.gov/genetics-glossary/Genetic-Epidemiology |website=Genome.gov |access-date=4 February 2021 |language=en}}</ref><ref name="ilun">{{cite web |last1=Ilunga Kalenga |first1=Oly |last2=Moeti |first2=Matshidiso |last3=Sparrow |first3=Annie |last4=Nguyen |first4=Vinh-Kim |last5=Lucey |first5=Daniel |last6=Ghebreyesus |first6=Tedros A. |title=The Ongoing Ebola Epidemic in the Democratic Republic of Congo, 2018–2019 |url=https://www.nejm.org/doi/full/10.1056/NEJMsr1904253 |website=New England Journal of Medicine |access-date=4 February 2021 |pages=373–383 |doi=10.1056/NEJMsr1904253 |date=25 July 2019}}</ref> The WHO declared a Public Health Emergency of International Concern when the virus reached Goma with its first case.<ref>{{cite journal |last1=Rojas |first1=Manuel |last2=Monsalve |first2=Diana M. |last3=Pacheco |first3=Yovana |last4=Acosta-Ampudia |first4=Yeny |last5=Ramírez-Santana |first5=Carolina |last6=Ansari |first6=Aftab A. |last7=Gershwin |first7=M. Eric |last8=Anaya |first8=Juan-Manuel |title=Ebola virus disease: An emerging and re-emerging viral threat |journal=Journal of Autoimmunity |date=January 2020 |volume=106 |pages=102375 |doi=10.1016/j.jaut.2019.102375 |url=https://www.sciencedirect.com/science/article/pii/S0896841119306572#bib157 |access-date=4 February 2021 |language=en |issn=0896-8411}}</ref> Genomic surveillance and Ebola virus evolution have been facilitated due to Ebola virus disease genetic epidemiology.<ref>{{cite journal |last1=Mazandu |first1=Gaston K. |last2=Nembaware |first2=Victoria |last3=Thomford |first3=Nicholas E. |last4=Bope |first4=Christian |last5=Ly |first5=Ousmane |last6=Chimusa |first6=Emile R. |last7=Wonkam |first7=Ambroise |title=A potential roadmap to overcome the current eastern DRC Ebola virus disease outbreak: From a computational perspective |journal=Scientific African |date=March 2020 |volume=7 |pages=e00282 |doi=10.1016/j.sciaf.2020.e00282 |url=https://www.sciencedirect.com/science/article/pii/S246822762030020X#bib0015 |access-date=10 February 2021 |language=en |issn=2468-2276}}</ref> |
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The graph that follows is an indication of the ''genetic epidemiology'' of the virus until October 2019, when the outbreak decline began. |
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{{clear}} |
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== Transmission == |
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Ebola virus is found in a variety of bodily fluids including: blood, saliva, stool, semen, and breast milk. The virus is extremely infectious following contact with any of these bodily fluids. Some potential routes of transmission include:<ref>{{cite journal |last1=Judson |first1=Seth |last2=Prescott |first2=Joseph |last3=Munster |first3=Vincent |title=Understanding Ebola Virus Transmission |journal=Viruses |date=3 February 2015 |volume=7 |issue=2 |pages=511–521 |doi=10.3390/v7020511 |pmid=25654239 |pmc=4353901 }}</ref><ref>{{cite web |title=Transmission {{!}} Ebola Hemorrhagic Fever {{!}} CDC |url=https://www.cdc.gov/vhf/ebola/transmission/index.html |website=www.cdc.gov |access-date=20 November 2019 |date=6 November 2019}}</ref> |
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* Bodily fluids: The most common way of transmitting in humans is through contact with infected bodily fluids. |
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* Droplets: Droplet transmission occurs when contact is made with virus-containing droplets. |
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* [[w:Fomites|Fomites]]: Occurs when an individual comes in contact with a pathogen-contaminated surface. |
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Those infected by EVD generally gain immunity, although it is possible that such immunity is only temporary.<ref>{{cite journal |last1=MacIntyre |first1=C. Raina |last2=Chughtai |first2=Abrar Ahmad |title=Recurrence and reinfection—a new paradigm for the management of Ebola virus disease |journal=International Journal of Infectious Diseases |volume=43 |issue=4 |pages=58–61 |doi=10.1016/j.ijid.2015.12.011 |pmid=2 |issn=1878-3511|year=1975 |doi-access=free }}</ref> In October 2019, a survivor who had been assisting at a treatment center in Beni was reinfected with EVD and died; which was unprecedented.<ref>{{cite web |title=Exclusive: WHO, Congo eye tighter rules for Ebola care over immunity concerns |url=https://www.reuters.com/article/us-health-ebola-congo-immunity-exclusive/exclusive-who-congo-eye-tighter-rules-for-ebola-care-over-immunity-concerns-idUSKBN1XA0RC |website=Reuters |access-date=2 November 2019 |date=31 October 2019}}</ref> |
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==Containment and control== |
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Even with the advances made in vaccine technology and treatment options during previous Ebola outbreaks, effective control of the North Kivu Epidemic continued to rely heavily on traditional public health efforts including the timely identification and isolation of cases, control measures in hospital settings, identification and follow-up of contacts, community engagement, and safe burials. Data from the West African Ebola Outbreak showed that response strategies which achieved 60% efficacy for sanitary burial, case isolation, and contact-tracing combined, could have greatly reduced the daily number of Ebola cases and ended the outbreak after only 6 months;<ref>{{Cite journal|last=Pandey|first=A.|last2=Atkins|first2=K. E.|last3=Medlock|first3=J.|last4=Wenzel|first4=N.|last5=Townsend|first5=J. P.|last6=Childs|first6=J. E.|last7=Nyenswah|first7=T. G.|last8=Ndeffo-Mbah|first8=M. L.|last9=Galvani|first9=A. P.|date=2014-11-21|title=Strategies for containing Ebola in West Africa|url=https://www.sciencemag.org/lookup/doi/10.1126/science.1260612|journal=Science|language=en|volume=346|issue=6212|pages=991–995|doi=10.1126/science.1260612|issn=0036-8075|pmc=4316831|pmid=25414312}}</ref> therefore, the most effective outbreak response should include non-pharmaceutical containment and control strategies in addition to new preventive and therapeutic measures. |
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===Surveillance and contact tracing=== |
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[[w:Contact tracing|Contact tracing]] is defined as the identification and follow-up of persons who may have been in contact with a person infected with Ebola. All close contacts should be monitored for 21 days following their last known exposure to the case and be isolated if they become ill. The volume of contacts and the duration of monitoring presented challenges in Ebola surveillance as it requires careful record-keeping by properly trained and equipped staff.<ref>{{Cite web|last=WHO, CDC|first=|date=September 2015|title=Implementation and management of contact tracing for Ebola virus disease|url=https://apps.who.int/iris/bitstream/handle/10665/185258/WHO_EVD_Guidance_Contact_15.1_eng.pdf;jsessionid=36CB095B65A9ED753792803F0573FD12?sequence=1|url-status=live|archive-url=|archive-date=|access-date=December 16, 2020|website=}}</ref> To strengthen surveillance activities, the DRC Ministry of Health began disseminating standardized Ebola case definitions, developed reporting tools, and communication strategies, and began distribution of daily situation reports.<ref name=aru/> Rapid response teams were deployed to affected health zones to strengthen Ebola case management and infection prevention and control in health care facilities and treatment centers.<ref name=aru /> Similar to the West African Ebola Outbreak, less than 10% of cases presented with bleeding.<ref>{{Cite journal|date=2020-03-01|title=The 2018/19 Ebola epidemic the Democratic Republic of the Congo (DRC): epidemiology, outbreak control, and conflict|url=https://www.sciencedirect.com/science/article/pii/S2590088920300020|journal=Infection Prevention in Practice|language=en|volume=2|issue=1|pages=100038|doi=10.1016/j.infpip.2020.100038|issn=2590-0889|doi-access=free}}</ref> |
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Disease surveillance in North Kivu and Ituri was complicated by two major obstacles: 1) the outbreaks of sporadic violence against those responding and the affected communities and 2) suspicion of the response in parts of some affected communities. Poor record keeping by local health facilities also made it difficult or impossible to identify and trace contacts that might have been exposed to the disease while they were undergoing treatment for other illness at health centers. Additionally, the high degree of mobility of affected populations, combined with occasional mistrust of the response has meant that contacts that had been identified sometimes were lost to follow-up for extended periods.<ref>{{Cite web|last=WHO|first=|date=2019|title=WHO's response to the 2018-2019 Ebola outbreak in North Kivu and Ituri, the Democratic Republic of the Congo|url=https://www.who.int/docs/default-source/documents/emergencies/drc-ebola-response-srp-1-3-october2019.pdf?sfvrsn=41319fa1_2|url-status=live|archive-url=|archive-date=|access-date=December 16, 2020|website=}}</ref> Initially, it was estimated that 30-50% of contacts may not have originally been registered by contact tracing teams;<ref>{{Cite web|title=DRC Ebola outbreak crisis update {{!}} MSF|url=https://www.msf.org/drc-ebola-outbreak-crisis-update|access-date=2020-12-16|website=Médecins Sans Frontières (MSF) International|language=en}}</ref> improvements to the security situation and improved acceptance by affected communities had led to improvement in most surveillance metrics which was central to controlling the outbreak. |
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=== Community engagement and awareness === |
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Surveys among the affected population in North Kivu and Ituri showed both general mistrust with the Ebola response, partly related to years of mistrust of any governmental or external action, and specific opposition to the response because of conflicts with local cultural practices.<ref name=":4">{{Cite journal|last=Masumbuko Claude|first=Kasereka|last2=Underschultz|first2=Jack|last3=Hawkes|first3=Michael T.|date=2019-09-26|title=Social resistance drives persistent transmission of Ebola virus disease in Eastern Democratic Republic of Congo|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0223104|journal=PLOS ONE|volume=14|issue=9|pages=e0223104|doi=10.1371/journal.pone.0223104|issn=1932-6203|pmc=6762146|pmid=31557243}}</ref> Some of the cultural practices which complicated the response included eating bush meat, regular gatherings at family or village events, and traditional funeral practices, which were events that were particularly high risk for transmission.<ref name=":4" /> Additionally, people from the affected region reported that their perception of security and trust in the government, as well as humanitarian workers, declined over the course of the outbreak, complicating an already complex response.<ref>{{Cite web|last=Vinck P, Pham P, Makoond A|first=|date=March 2018|title=Voices from Congo: Peacebuilding and Reconstruction Polls|url=http://www.peacebuildingdata.org/sites/m/pdf/DRC_Poll13_english_final.pdf|url-status=live|archive-url=|archive-date=|access-date=December 16, 2020|website=}}</ref> |
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==== Misinformation ==== |
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Combating misinformation was a key element in overcoming Ebola in North Kivu. One study using surveys found that low institutional trust coupled with a belief in misinformation about Ebola were inversely associated with preventive behaviors in individuals, including Ebola vaccine acceptance.<ref name=":5">{{Cite journal|last=Vinck|first=Patrick|last2=Pham|first2=Phuong N|last3=Bindu|first3=Kenedy K|last4=Bedford|first4=Juliet|last5=Nilles|first5=Eric J|date=2019|title=Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo: a population-based survey|url=https://linkinghub.elsevier.com/retrieve/pii/S1473309919300635|journal=The Lancet Infectious Diseases|language=en|volume=19|issue=5|pages=529–536|doi=10.1016/S1473-3099(19)30063-5|doi-access=free}}</ref> Belief in misinformation regarding Ebola was widespread, with 25% of respondents reporting that they did not believe the Ebola outbreak was real. Some of the rumors that were being circulated included statements that the outbreak did not exist, it was fabricated by the authorities for financial gains, or was fabricated to destabilize the region.<ref name=":5" /> Approximately 68% of respondents reported that they did not trust the local authorities to represent their interest, and community trust in the Ebola response was often further undermined by misinformation spread by local politicians.<ref name=":5" /> |
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==== Delay in seeking treatment ==== |
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Early in the epidemic there were several delays in people seeking care for Ebola because the initial cases were misdiagnosed. Ebola symptoms were similar to symptoms of more common infectious diseases such as malaria, flu, and typhoid fever so people would wait until their situation deteriorated, usually after failure to respond to anti-malarial or antibiotic regimens, before going to the hospitals;<ref>{{Cite journal|last=Inungu|first=Joseph|last2=Iheduru-Anderson|first2=Kechi|last3=Odio|first3=Ossam J|date=2019-11-20|title=Recurrent Ebolavirus disease in the Democratic Republic of Congo: update and challenges|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6940573/|journal=AIMS Public Health|volume=6|issue=4|pages=502–513|doi=10.3934/publichealth.2019.4.502|issn=2327-8994|pmc=6940573|pmid=31909070}}</ref> during this delay in care seeking, the relatives and close contacts of were being exposed. |
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=== Burials === |
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The [[w:International Federation of Red Cross and Red Crescent Societies|IFRC]] has called funerals "super-spreading events" as burial traditions include kissing and generally touching bodies. Safe burial teams formed by health workers were subject to suspicion.<ref>{{Cite web|url=https://www.voanews.com/africa/congolese-anti-ebola-fighter-killed-new-vaccine-arrives|title=Congolese Anti-Ebola Fighter Killed as New Vaccine Arrives|website=Voice of America|access-date=2019-11-04}}</ref> |
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===Travel restrictions and border closings=== |
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On 26 July 2019, [[w:Saudi Arabia|Saudi Arabia]] stopping providing visas to people from the DRC after the WHO declared it an international emergency due to EVD.<ref>{{cite news |title=Saudi Arabia suspends visas to people from Congo over Ebola |url=https://www.washingtonpost.com/world/middle_east/saudi-arabia-suspends-visas-to-people-from-congo-over-ebola/2019/07/26/32ab67ac-af91-11e9-9411-a608f9d0c2d3_story.html |website=The Washington Post |access-date=26 July 2019 }}</ref> On 1 August 2019, Rwanda closed its border with the DRC after multiple cases in the city of Goma, which borders the country in the upper Northwestern region.<ref>{{cite news |last1=Doshi |first1=Vidhi |title=Rwanda closes border with DRC over deadly Ebola outbreak |url=https://www.theguardian.com/global-development/2019/aug/01/rwanda-closes-border-with-dr-congo-over-deadly-ebola-outbreak-goma |website=The Guardian |access-date=1 August 2019 |date=1 August 2019}}</ref> |
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To minimize the risk of the spread to neighboring countries, screening points which consisted of temperature and symptom monitoring were established at many border crossings. Over 2 million screenings were undertaken during the outbreak which is believed to have contributed to the containment of the epidemic within DRC.<ref>{{Cite web|title=Screening for Ebola on the Uganda-Democratic Republic of the Congo border - Uganda|url=https://reliefweb.int/report/uganda/screening-ebola-uganda-democratic-republic-congo-border|access-date=2020-12-16|website=ReliefWeb|language=en}}</ref> |
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==Treatment== |
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{{details|w:Ebola virus disease treatment research}} |
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In August 2018, the WHO evaluated the benefits and risks of several medications, including [[w:Remdesivir|remdesivir]], [[w:ZMapp|ZMapp]], [[w:REGN-EB3|REGN-EB3]] (REGN3470-3471-3479), [[w:mAb114|mAb114]] and [[w:favipiravir|favipiravir]].<ref>{{cite web |title=Notes for the record: Consultation on Monitored Emergency Use of Unregistered and Investigational Interventions (MEURI) for Ebola Virus Disease (EVD) |url=https://www.who.int/ebola/drc-2018/notes-for-the-record-meuri-ebola.pdf |publisher=World Health Organization (WHO) |access-date=11 September 2018}}</ref> The mAb114 (which is a [[w:monoclonal antibody|monoclonal antibody]]) was deployed for the first time to treat individuals during this EVD outbreak.<ref>{{Cite news|url=https://www.nih.gov/news-events/news-releases/nih-begins-testing-ebola-treatment-early-stage-trial|title=NIH begins testing Ebola treatment in early-stage trial|date=23 May 2018|work=National Institutes of Health (NIH)|access-date=15 October 2018}}</ref> |
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In November 2018, the DRC gave approval to start randomized [[w:clinical trials|clinical trials]] for EVD treatment.<ref>{{cite news |first1=Giulia |last1=Paravicini |first2=Aaron |last2=Ross |title=Congo approves clinical trials for Ebola treatments |url=https://af.reuters.com/article/topNews/idAFKCN1NT0H7-OZATP |newspaper=Reuters |access-date=25 November 2018|date=2018-11-24 |archive-url=https://web.archive.org/web/20181126005831/https://af.reuters.com/article/topNews/idAFKCN1NT0H7-OZATP |archive-date=26 November 2018 }}</ref> On 12 August 2019, two medications were found to improve the rate of survival: REGN-EB3, a cocktail of three monoclonal Ebola antibodies, and mAb114. When used shortly after infection they were found to have a 90% survival rate. ZMapp and remdesivir were subsequently discontinued.<ref>{{cite web |title=For the first time, clinical trial data show Ebola drugs improve survival rates |url=https://www.statnews.com/2019/08/12/for-the-first-time-clinical-trial-results-show-ebola-drugs-improve-survival-rates/ |website=STAT |access-date=12 August 2019 |date=12 August 2019 |first=Helen |last=Branswell}}</ref><ref>{{cite web |first=Sarah |last=Boseley |title=Ebola now curable after trials of drugs in DRC, say scientists |url=https://www.theguardian.com/world/2019/aug/12/ebola-now-curable-after-trials-of-drugs-in-drc-say-scientists |website=The Guardian |access-date=12 August 2019 |date=12 August 2019}}</ref><ref name="NYT_20190812">{{cite news | title=A Cure for Ebola? Two New Treatments Prove Highly Effective in Congo | work=[[The New York Times]] | date=12 August 2019 | url=https://www.nytimes.com/2019/08/12/health/ebola-outbreak-cure.html | first=Donald G. | last=McNeil Jr. | author-link=Donald McNeil Jr. | access-date=12 August 2019 | quote=The two new therapies were among four that were tested in a trial that has enrolled almost 700 patients since November. The two worked so well that a committee meeting on Friday to look at preliminary results in the first 499 patients immediately recommended that the other two treatments, ZMapp, made by Mapp Biopharmaceutical, and remdesivir, made by Gilead Sciences, be stopped. All patients will now be offered either the Regeneron or the Biotherapeutics drug.}}</ref><ref>{{cite journal | vauthors=Maxmen A | title=Two Ebola drugs show promise amid ongoing outbreak | journal=Nature | date=12 August 2019 | issn=0028-0836 | doi=10.1038/d41586-019-02442-6| pmid=32778704 }}</ref> |
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In October 2020, the U.S. [[w:Food and Drug Administration|Food and Drug Administration]] (FDA) approved [[w:atoltivimab/maftivimab/odesivimab]] (Inmazeb, formerly REGN-EB3) with an [[w:Indication (medicine)|indication]] for the treatment of infection caused by ''Zaire ebolavirus''.<ref name="FDA PR">{{cite press release | title=FDA Approves First Treatment for Ebola Virus | website=U.S. [[Food and Drug Administration]] (FDA) | date=14 October 2020 | url=https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-ebola-virus | access-date=14 October 2020}} {{PD-notice}}</ref> |
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===Vaccination=== |
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[[File:Ebola Geimpfte 311218 englisch.png|thumb|Number of vaccinated people in the epidemic area DRC<ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Lundi 31 décembre 2018 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_31dec |website=us13.campaign-archive.com |access-date=31 December 2018|language=fr}}</ref>{{attrib|Gregor Rom|cc by sa}}]] |
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On 8 August 2018, the process of vaccination began with [[w:rVSV-ZEBOV|rVSV-ZEBOV]] [[w:Ebola vaccine|Ebola vaccine]].<ref>{{cite web |title=Ebola vaccination begins in North Kivu |url=https://reliefweb.int/report/democratic-republic-congo/ebola-vaccination-begins-north-kivu |website=ReliefWeb |access-date=9 August 2018 }}</ref> While several studies have shown the vaccine to be safe and protective against the virus, additional research is was needed before it could be licensed. Consequently, the WHO reported that it was being used under a ring vaccination strategy under "[[w:compassionate use|compassionate use]]" to protect persons at highest risk of Ebola, i.e. contacts of those infected, contacts of those contacts, and front-line medical personnel.<ref>{{cite web |title=Ebola Virus Disease |url=https://www.who.int/ebola/drc-2018/faq-vaccine/en/ |publisher=World Health Organization (WHO) |access-date=29 January 2019}}</ref> As of 15 September, almost a quarter of a million individuals had been vaccinated in the outbreak.<ref name=none/> |
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On 20 September 2019 a second vaccine by [[w:Johnson & Johnson]] was introduced in the EVD epidemic in the DRC.<ref>{{cite news |title=DR Congo to introduce second Ebola vaccine |url=https://www.bbc.com/news/world-africa-49782070 |access-date=21 September 2019 |date=21 September 2019|work=BBC News }}</ref> |
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In November 2019, the World Health Organization prequalified an Ebola vaccine, rVSV-ZEBOV, for the first time.<ref>{{Cite web|url=https://www.who.int/news-room/detail/12-11-2019-who-prequalifies-ebola-vaccine-paving-the-way-for-its-use-in-high-risk-countries|title=WHO prequalifies Ebola vaccine, paving the way for its use in high-risk countries|website=www.who.int|access-date=2019-11-13}}</ref> As of 22 February 2020, a total of 297,275 people had been vaccinated since the start of the outbreak.<ref>{{cite journal |title=Weekly Bulletin of Outbreaks |journal=World Health Organization |date=26 February 2020 |url=https://apps.who.int/iris/bitstream/handle/10665/331169/OEW08-1723022020.pdf |access-date=3 March 2020}}</ref> |
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Vaccination has helped to contain the epidemic, though military attacks and community resistance have complicated distribution.<ref>{{cite news |title=Congo records 5 new Ebola cases, shelves declaration of end to epidemic |url=https://af.reuters.com/article/topNews/idAFKBN21Z1U9-OZATP |access-date=17 April 2020 |work=Reuters |date=17 April 2020 }}</ref> |
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====Pregnant and breastfeeding==== |
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Based on a lack of evidence about the safety of the vaccine during pregnancy, the DRC ministry of health and the WHO decided to cease vaccinating women who are pregnant or breastfeeding. Some authorities criticized this decision as "utterly indefensible" from an ethical perspective. They note that as caregivers of the sick, pregnant and breastfeeding women are more likely to contract Ebola. They also note that since it is known that almost 100% of pregnant women who contract Ebola will die, a lack of safety data in this population should not be a deciding factor.<ref>{{cite web |title=Pregnant and lactating women should be vaccinated in an Ebola outbreak – STAT |url=https://www.statnews.com/2018/08/27/ebola-vaccine-pregnant-lactating-women/ |website=STAT |access-date=2 September 2018 |date=27 August 2018}}</ref> As of June 2019, pregnant and breastfeeding women were also being vaccinated.<ref>{{Cite web | url=https://www.who.int/news-room/detail/19-06-2019-who-flags-critical-funding-gap-calls-for-political-parties-to-join-fight-against-ebola |title = WHO flags critical funding gap, calls for political parties to join fight against Ebola}}</ref> |
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====Vaccine stockpile==== |
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The [[w:Democratic Republic of the Congo Ministry of Public Health|DRC Ministry of Public Health]] reported on 16 August 2018 that 316 individuals had been vaccinated.<ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans la province du Nord Kivu au Jeudi 16 août 2018 |url=https://mailchi.mp/2d5b7a2d510a/ebola_kivu_16aout |website=mailchi.mp |access-date=17 August 2018|language=fr}}</ref> On 24 August, the DRC indicated it had vaccinated 2,957 individuals, including 1,422 in Mabalako against the Ebola virus.<ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans la province du Nord Kivu au Vendredi 24 août 2018 |url=https://mailchi.mp/970b172dfebc/ebola_kivu_24aout |website=mailchi.mp |access-date=24 August 2018|language=fr}}</ref> By late October, more than 20,000 individuals had been vaccinated.<ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Vendredi 26 octobre 2018 |url=https://mailchi.mp/sante.gouv.cd/ebola_kivu_26oct |website=mailchi.mp |access-date=26 October 2018|language=fr}}</ref> In December, Peter Salama, who is Deputy Director-General of Emergency Preparedness and Response for WHO, reported that the current 300,000 vaccine stockpile might not be enough to contain the EVD outbreak, especially since it takes several months to make more of the Zaire EVD vaccine (rVSV-ZEBOV).<ref>{{cite web |title=As Ebola outbreak spreads in Congo, concern grows over vaccine supplies |url=https://www.statnews.com/2018/12/03/ebola-congo-vaccine-supplies/ |website=STAT |access-date=4 December 2018 |date=3 December 2018}}</ref><ref>{{cite web |title=WHO {{!}} Deputy Director-General Dr Peter Salama, Deputy Director-General of Emergency Preparedness and Response |url=https://www.who.int/dg/ddg-emergencies/en/ |publisher=World Health Organization (WHO) |access-date=4 December 2018}}</ref> On 11 December, Beni only had 4,290 doses of vaccine in stock.<ref name=dec14/> |
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As of August 2019, [[w:Merck & Co]], the producers of the vaccine in use, reported a stockpile sufficient for 500,000 individuals, with more in production.<ref>{{Cite news | url=https://www.bbc.co.uk/news/world-africa-49164066 | title=Why is a new Ebola vaccine so controversial?| work=BBC News| date=4 August 2019| last1=Team| first1=Reality Check}}</ref> |
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====Effectiveness==== |
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In April 2019, the WHO published the preliminary results, in association with the DRC's [[w:Institut National pour la Recherche Biomedicale|Institut National pour la Recherche Biomedicale]], into the effectiveness of the ring vaccination program, including data from 93,965 at-risk people who had been vaccinated. WHO stated that the [[w:rVSV-ZEBOV-GP|rVSV-ZEBOV-GP]] vaccine had been 97.5% effective at stopping Ebola transmission.<ref>{{Cite web|url=https://arstechnica.com/science/2019/04/ebola-vaccine-is-97-5-effective-early-outbreak-data-suggests/|title=As Ebola outbreak rages, vaccine is 97.5% effective, protecting over 90K people|last=Mole|first=Beth|date=2019-04-16|website=Ars Technica|access-date=2019-04-17}}</ref><ref name=WHO_prelim_ring_efficacy_12_April_2019>{{Cite web|url=https://www.who.int/csr/resources/publications/ebola/ebola-ring-vaccination-results-12-april-2019.pdf|title=Ebola Ring Vaccination Results 12 April 2019|date=12 April 2019|publisher=World Health Organization (WHO)|access-date=17 April 2019}}</ref> The vaccine had also reduced mortality among those who were infected after vaccination. The ring vaccination strategy was effective at reducing EVD in contacts of contacts (tertiary cases), with only two such cases being reported.<ref name=WHO_prelim_ring_efficacy_12_April_2019 /> |
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===Treatment centres=== |
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In August 2018, the Mangina Ebola Treatment Center was reported to be operational.<ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans la province du Nord Kivu au Mardi 14 août 2018 |url=https://mailchi.mp/37b7545e3544/ebola_kivu_14aout |website=mailchi.mp |access-date=14 August 2018|language=fr}}</ref><ref>{{cite web |title=Human-derived Monoclonal Antibody for Treatment of Ebola Virus Infection {{!}} Office of Technology Transfer, NIH |url=https://www.ott.nih.gov/technology/e-045-2015-0 |website=www.ott.nih.gov |access-date=14 August 2018 |archive-url=https://web.archive.org/web/20180612190900/https://www.ott.nih.gov/technology/e-045-2015-0 |archive-date=12 June 2018 |url-status=dead }}</ref> A fourth Ebola Treatment Center (after those in Mangina, [[w:Beni, Democratic Republic of the Congo|Beni]] and [[w:Butembo|Butembo]]) was inaugurated in September in Makeke in the Mandima Health Zone of [[w:Ituri Province|Ituri Province]].<ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans la province du Nord Kivu au Mardi 18 septembre 2018 |url=https://mailchi.mp/eec05154b8e8/ebola_kivu_18sept |website=mailchi.mp |access-date=19 September 2018|language=fr}}</ref> Makeke is less than five kilometers from Mangina along a well-traveled local road; the site had been proposed in August when it appeared that a second Ebola Treatment Center would be needed in the area, and space was insufficient in Mangina itself to accommodate one.<ref>{{cite web |title=EBOLA RDC – Evolution de la riposte contre l'épidémie d'Ebola dans la province du Nord Kivu au Lundi 20 août 2018 |url=https://mailchi.mp/bad94a83ea28/ebola_kivu_20aout |website=mailchi.mp |access-date=19 September 2018|language=fr}}</ref> By mid-September, however, there had been only two additional cases in the Mandima Health Zone, and only sporadic cases were being reported in the Mabalako Health Zone.<ref>{{cite web |title=Ebola virus disease – Democratic Republic of the Congo. Disease Outbreak News, 14 September 2018 |url=https://www.who.int/csr/don/14-september-2018-ebola-drc/en/ |publisher=World Health Organization (WHO) |access-date=19 September 2018}}</ref> |
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In February 2019, attacks at treatment centers had been carried out in Butembo and Katwa. The motives behind the attacks were unclear. Due to the violence, international aid organizations stopped their work in the two communities.<ref>{{cite web |title=Congo Ebola Center Set on Fire After Armed Attack |url=https://www.voanews.com/a/congo-ebola-center-set-on-fire-after-armed-attack/4807263.html |website=VOA |access-date=1 March 2019 }}</ref><ref>{{cite news |agency=Associated Press |date= 28 February 2019 |title=Doctors Without Borders forced to close Ebola clinics in Congo after attacks |url=https://www.cbc.ca/news/world/doctors-without-borders-msf-ebola-congo-1.5038087 |publisher=CBC News |access-date=1 March 2019 }}</ref> In April, an epidemiologist from WHO was killed and two health workers injured in a militia attack on Butembo University Hospital in Katwa.<ref>{{cite web |url=https://www.who.int/news-room/detail/19-04-2019-who-ebola-responder-killed-in-attack-on-the-butembo-hospital |title=WHO Ebola responder killed in attack on the Butembo hospital |publisher=World Health Organization (WHO) |date=19 April 2019 |access-date=27 April 2019 }}</ref> In May, WHO's health emergencies chief said insecurity had become a "major impediment" to controlling the outbreak. He reported that since January there had been 42 attacks on health facilities and 85 health workers had been wounded or killed. "Every time we have managed to regain control over the virus and contain its spread, we have suffered major, major security events. We are anticipating a scenario of continued intense transmission".<ref name="washingtonpost.com"/> |
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====Healthcare workers==== |
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Health workers must wear [[w:personal protection equipment|personal protection equipment]] during treatment of those affected by the virus.<ref>{{cite web|url=https://www.who.int/wer/2016/wer9114.pdf?ua=1|title=Emergencies preparedness, response|publisher=World Health Organization (WHO)|access-date=5 September 2018}}</ref> On 3 September 2018, WHO stated that 16 [[w:health workers|health workers]] had contracted the virus.<ref name="healt" /> On 10 December, the WHO reported that the current DRC outbreak had led to 49 healthcare workers contracting the Ebola virus, and 15 had died.<ref name="12/10"/> |
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As of 30 April 2019, there have been 92 health care workers in the DRC infected with EVD, of which 33 had died.<ref>{{cite web |title=Democratic Republic of Congo: Ebola Virus Disease – External Situation Report 39 – Democratic Republic of the Congo |url=https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation-54 |website=ReliefWeb |access-date=3 May 2019 }}</ref> With false rumors being spread by word-of-mouth and social media, residents remain mistrustful and fearful of health care workers. In January 2020, it was reported that there had been nearly 400 attacks on medical workers since the outbreak began in 2018.<ref>{{cite web |last1=Elliott |first1=Vittoria |title=In Congo's Ebola zone, misinformation persists even as cases slow |url=https://www.thenewhumanitarian.org/news-feature/2020/1/15/Ebola-Congo-social-media-whatsapp-misinformation |website=The Humanitarian |access-date=15 January 2020}}</ref> |
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==Post-Ebola virus syndrome== |
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{{Main|w:Post-Ebola virus syndrome}} |
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In terms of prognosis, aside from the possible effects of [[w:post-Ebola syndrome|post-Ebola syndrome]],<ref>{{cite journal |last1=Burki |first1=Talha Khan |title=Post-Ebola syndrome |journal=The Lancet Infectious Diseases |date=July 2016 |volume=16 |issue=7 |pages=780–781 |doi=10.1016/S1473-3099(15)00259-5 |pmid=27352759 |doi-access=free }}</ref> there was also the reality of survivors returning to communities where they might be shunned due to the fear many have towards the Ebola virus,<ref>{{cite web |title=Ebola survivors returning home to fear, stigma in Congo |url=https://www.washingtonpost.com/world/ebola-survivors-returning-home-to-fear-stigma-in-congo/2018/09/02/e13b64de-ae8e-11e8-8b53-50116768e499_story.html |website=The Washington Post |access-date=2 September 2018 }}</ref><ref>{{cite web |first1=Al-Hadji Kudra |last1=Maliro |first2=Carley |last2=Petesch |title=Ebola survivors returning home to fear, stigma in Congo |url=https://web.archive.org/web/20180903025112/https://abcnews.go.com/Health/wireStory/ebola-survivors-returning-home-fear-stigma-congo-57557712 |website=ABC News |access-date=4 September 2018 |archive-url=https://web.archive.org/web/20180903222331/https://abcnews.go.com/Health/wireStory/ebola-survivors-returning-home-fear-stigma-congo-57557712 |archive-date=3 September 2018 |url-status=dead }}</ref> hence [[w:psychosocial|psychosocial]] assistance was often needed.<ref>{{cite web |title=DRC children deeply affected by Ebola outbreak – UNICEF {{!}} Africanews |url=http://www.africanews.com/2018/08/21/drcchildren-deeply-affected-by-ebola-outbreak-unicef/ |website=Africanews |access-date=5 September 2018 |date=2018-08-21 }}</ref> Many survivors of EVD face serious side effects, including but not limited to:<ref>{{cite journal |last1=Carod-Artal |first1=Francisco Javier |title=Post-Ebolavirus disease syndrome: what do we know? |journal=Expert Review of Anti-infective Therapy |date=13 August 2015 |volume=13 |issue=10 |pages=1185–1187 |doi=10.1586/14787210.2015.1079128 |pmid=26293407 |doi-access=free }}</ref><ref>{{cite journal |last1=Scott |first1=Janet T. |last2=Sesay |first2=Foday R. |last3=Massaquoi |first3=Thomas A. |last4=Idriss |first4=Baimba R. |last5=Sahr |first5=Foday |last6=Semple |first6=Malcolm G. |title=Post-Ebola Syndrome, Sierra Leone |journal=Emerging Infectious Diseases |date=April 2016 |volume=22 |issue=4 |pages=641–646 |doi=10.3201/eid2204.151302 |pmid=26983037 |pmc=4806950 |display-authors=3 }}</ref>{{columns-list|colwidth=20em| |
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* [[w:Joint pain|Joint pain]] |
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* [[w:Muscle pain|Muscle pain]] |
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* [[w:Chest pain|Chest pain]] |
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* [[w:Hearing loss|Hearing loss]] |
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* [[w:Hair loss|Hair loss]] |
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* [[w:Memory|Memory]] problems |
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* [[w:Anxiety attack|Anxiety attack]]s |
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* [[w:Vision loss|Vision loss]] |
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}} |
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==History== |
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[[File:Ebola Virus - Electron Micrograph.tiff|thumb|150 px|Colorized scanning electron micrograph of Ebola virus particles (green){{attrib|BernbaumJG|cc by sa}}]] |
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{{details|w:List of Ebola outbreaks|w:List of epidemics}} |
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The Ebola virus disease outbreak in [[w:Zaire|Zaire]] (Yambuku) started in late 1976, and was the second outbreak ever after the earlier one in [[w:Sudan|Sudan]] the same year.<ref>{{cite journal |last1=Shears |first1=P. |last2=O'Dempsey |first2=T.J.D. |title=Ebola virus disease in Africa: epidemiology and nosocomial transmission |journal=Journal of Hospital Infection |date=May 2015 |volume=90 |issue=1 |pages=1–9 |doi=10.1016/j.jhin.2015.01.002 |pmid=25655197 |url=https://www.journalofhospitalinfection.com/article/S0195-6701(15)00046-8/pdf |access-date=25 August 2018}}</ref><ref>{{cite journal |title=Ebola haemorrhagic fever in Zaire, 1976 |journal=Bulletin of the World Health Organization |date=1978 |volume=56 |issue=2 |pages=271–293 |pmc=2395567 |author1=Report of an International Commission |pmid=307456 }}</ref> On 1 August 2018, the tenth Ebola outbreak was declared in the DRC, only a few days after [[w:2018 Équateur province Democratic Republic of the Congo Ebola virus outbreak|a prior outbreak]] in the same country had been declared over on 24 July.<ref name=again1/><ref name=again2/> |
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WHO chief Tedros Adhanom Ghebreyesu indicated on 15 August that the outbreak then in the DRC might be worse than the [[w:West African Ebola virus epidemic|West African outbreak]] of 2013–2016,<ref>{{cite news |last1=Schlein |first1=Lisa |title=West Africa: Ebola Outbreak Potentially More Dangerous Than West African Epidemic |url=https://allafrica.com/stories/201808150166.html |newspaper=Voice of America (Washington, DC) |access-date=16 August 2018 |date=15 August 2018}}</ref> with the [[w:International Rescue Committee|IRC]] connecting this to the ongoing [[w:Kivu conflict|Kivu conflict]].<ref>{{cite web |first1=Morgan |last1=Winsor |title=Congo's latest Ebola outbreak could become 'worst ever' in East Africa, IRC warns |url=https://abcnews.go.com/International/congos-latest-ebola-outbreak-worst-east-africa-irc/story?id=57482984 |website=ABC News |access-date=30 August 2018 |date=29 August 2018}}</ref> The Kivu outbreak was the biggest of the ten recorded outbreaks recorded in the DRC.<ref name="currently">{{cite web|title=Current Ebola outbreak is worst in Congo's history: Ministry|url=https://www.standardmedia.co.ke/article/2001302241/current-ebola-outbreak-is-worst-in-congo-s-history-ministry|access-date=10 November 2018|website=The Standard}}</ref> |
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{{cot|'''Table 2 {{!}}''' Timeline of Ebola outbreaks in the [[w:Democratic Republic of the Congo|Democratic Republic of the Congo]] (formerly [[w:Zaire|Zaire]]) since 1976 [click to expand]|bg=#F0F2F5|border=0px}} |
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{{Timeline of Ebola outbreaks in the Democratic Republic of the Congo}} |
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{{cob}} |
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Learning from other responses, such as in the [[w:List of Ebola outbreaks|2000 outbreak in Uganda]], the WHO established its [[w:Global Outbreak Alert and Response Network|Global Outbreak Alert and Response Network]], and other public health measures were instituted in areas at high risk. Field laboratories were established to confirm cases, instead of shipping samples to [[w:South Africa|South Africa]].<ref>{{Cite journal | pmid=15630468 | doi=10.1371/journal.pmed.0010059 | title=Containing the Threat—Don't Forget Ebola | year=2004 | last1=Cohen | first1=Jonathan | journal=PLOS Medicine | volume=1 | pages=e59 | issue=3 | pmc=539049}}</ref> Additionally, the outbreak was closely monitored by the CDC Special Pathogens Branch.<ref>{{cite web | url=https://www.cdc.gov/ncidod/dvrd/spb/mnpages/whoweare.htm | title=Mission Statement | date=31 October 2007 | publisher=National Center for Infectious Diseases & Centers for Disease Control and Prevention | access-date=3 May 2019 | archive-url=https://web.archive.org/web/20160304092940/http://www.cdc.gov/ncidod/dvrd/spb/mnpages/whoweare.htm | archive-date=4 March 2016 | url-status=dead }}</ref>{{CSS image crop |
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|Image = Ebola-and-Marburg-Hemorrhagic-Fevers-Neglected-TropicalDiseases-pntd.0001546.g001.jpg |
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|bSize = 900 |
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|cWidth = 800 |
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|cHeight = 250 |
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|oTop = 40 |
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|oLeft = 60 |
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|Location = center |
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|Description = Ebola (and Marburg virus depicted as green squares) outbreaks on the African continent, both from the ''Filoviridae'' family<ref name="2alltime">{{cite web |title=Ebola Virus Disease Distribution Map: Cases of Ebola Virus Disease in Africa Since 1976 |url=https://www.cdc.gov/vhf/ebola/history/distribution-map.html |publisher=[[Centers for Disease Control and Prevention]] (CDC) |access-date=10 October 2018 |date=22 May 2018}}</ref><ref>{{cite web |title=Chronology of Marburg Hemorrhagic Fever Outbreaks |url=https://www.cdc.gov/vhf/marburg/resources/outbreak-table.html |publisher=[[Centers for Disease Control and Prevention]] (CDC) |access-date=10 October 2018 }}</ref>{{attrib|McNeil A., Rollin P.|cc by sa}} |
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}} |
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==Statistical measures== |
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One way to measure the outbreak is via the [[w:basic reproduction number|basic reproduction number]], ''R''<sub>0</sub>, a statistical measure of the average number of people expected to be infected by one person with a disease. If the basic reproduction number is less than 1, the infection dies out; if it is greater than 1, the infection continues to spread—with exponential growth in the number of cases.<ref>{{cite web|title=Basic Reproductive Rate (Ro)|url=http://practice.sph.umich.edu/micphp/epicentral/basic_reproduc_rate.php|publisher=University of Michigan|access-date=16 September 2014|archive-url=https://web.archive.org/web/20141104222957/http://practice.sph.umich.edu/micphp/epicentral/basic_reproduc_rate.php|archive-date=4 November 2014|url-status=dead|df=dmy-all}}</ref> A March 2019 paper by Tariq ''et al.'' suggested that ''R''<sub>0</sub> was oscillating around 0.9.<ref>{{cite journal |last1=Tariq |first1=A. |last2=Roosa |first2=K. |last3=Mizumoto |first3=K. |last4=Chowell |first4=G. |title=Assessing reporting delays and the effective reproduction number: The Ebola epidemic in DRC, May 2018 – January 2019 |journal=Epidemics |date=March 2019 |volume=26 |pages=128–133 |doi=10.1016/j.epidem.2019.01.003 |pmid=30880169 |display-authors=3 |doi-access=free }}</ref> |
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==Response== |
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During the Ebola outbreak in Democratic Republic of the Congo, a number of organizations helped in different capacities: |
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[[w:Caritas Internationalis|CARITAS]] DRC, [[w:CARE International|CARE International]], Cooperazione Internationale (COOPE), Catholic Organization for Relief and Development Aid (CORDAID/PAP-DRC), [[w:International Rescue Committee|International Rescue Committee]] (IRC), [[w:Médecins Sans Frontières|Médecins Sans Frontières]] (MSF), [[w:Oxfam|Oxfam]], [[w:International Federation of Red Cross and Red Crescent Societies|International Federation of Red Cross and Red Crescent Societies]] (IFRC), [[w:International Committee of the Red Cross|International Committee of the Red Cross]] (ICRC), and [[w:Samaritan's Purse|Samaritan's Purse]].<ref name=response /> |
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===WHO=== |
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On 12 April 2019, the WHO Emergency Committee was reconvened by the WHO Director-General after an increase in the rate of new cases, and determined that the outbreak still failed to meet the criteria for a [[w:Public Health Emergency of International Concern|Public Health Emergency of International Concern]] (PHEIC).<ref name=PHEIC_12_April_2019>{{cite web |url=https://www.who.int/news-room/detail/12-04-2019-statement-on-the-meeting-of-the-international-health-regulations-(2005)-emergency-committee-for-ebola-virus-disease-in-the-democratic-republic-of-the-congo-on-12th-april-2019 |title=Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 12th April 2019 |publisher=World Health Organization |date=12 April 2019 |access-date=12 April 2019 }}</ref><ref>{{cite web |url=https://www.who.int/dg/speeches/detail/ihr-emergency-committee-on-ebola-virus-disease-in-the-democratic-republic-of-congo-north-kivu |title=IHR Emergency Committee on Ebola virus disease in the Democratic Republic of Congo, North Kivu |author=Tedros Adhanom Ghebreyesus |publisher=World Health Organization |date=12 April 2019 |access-date=13 April 2019 }}</ref> |
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Following the confirmation of Ebola crossing into Uganda, a third review by the WHO on 14 June 2019<ref name=NYTimes14June2019/> concluded that while the outbreak was a health emergency in the DRC and the region, it did not meet all three criteria required for a PHEIC.<ref name="WHO14June2019">{{Cite web|url=https://www.who.int/news-room/detail/14-06-2019-statement-on-the-meeting-of-the-international-health-regulations-(2005)-emergency-committee-for-ebola-virus-disease-in-the-democratic-republic-of-the-congo|title=Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 14 June 2019|publisher=World Health Organization (WHO)|access-date=14 June 2019}}</ref> Following a case in Goma, the reconvening of a fourth review was announced on 15 July 2019.<ref name="CIDRAP15July2019"/> The WHO officially declared the situation a PHEIC on 17 July 2019,<ref name=Goldberg17July2019/> and as of 12 February 2020, it continues to be a PHEIC,<ref>{{cite web |url=https://www.who.int/news-room/detail/12-02-2020-statement-on-the-meeting-of-the-international-health-regulations-(2005)-emergency-committee-for-ebola-virus-disease-in-the-democratic-republic-of-the-congo-on-12-february-2020 |title=Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 12 February 2020 |publisher=World Health Organization |date=12 February 2020 |access-date=14 February 2020}}</ref> one of only six declared in its history.<ref>{{cite web |title=Archived: WHO Timeline - COVID-19 |url=https://www.who.int/news-room/detail/27-04-2020-who-timeline---covid-19 |website=www.who.int |access-date=12 July 2020 }}</ref> |
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===World Bank=== |
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The [[w:World Bank|World Bank]] was criticised when its [[w:Pandemic Emergency Financing Facility|Pandemic Emergency Financing Facility]], intended to support countries affected by pandemic diseases, had only paid out $31 million of a potential total of $425 million by August 2019 while generating substantial returns for investors. The conditions used to decide when the fund should pay out to disease-affected countries were criticised as too stringent.<ref name="nature19">{{cite journal|doi=10.1038/d41586-019-02415-9|pmid=31409936|bibcode=2019Natur.572..285J|journal=Nature|volume=572|page=285|title=Pandemic bonds: designed to fail in Ebola|first1=Olga|last1=Jonas|issue=7769|date=13 August 2019|doi-access=free}}</ref> |
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===International governments=== |
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Financial support has been contributed by the governments of the US and the UK, among others. The UK [[w:Department for International Development|DfID]] minister, [[w:Rory Stewart|Rory Stewart]], visited the area in July 2019, and called for other western countries, including [[w:Canada|Canada]], [[w:France|France]] and [[w:Germany|Germany]], to donate more financial aid. He identified a funding deficit of $100–300{{nbsp}}million to continue responding to the outbreak until December. He urged WHO to classify the situation as a PHEIC, to facilitate the release of international aid.<ref name=Landale_BBC>{{cite news |url=https://www.bbc.co.uk/news/world-africa-48908993 |title=Fear and mistrust stalk battle to halt spread of Ebola |author=James Landale |publisher=BBC News Online |date=9 July 2019 |access-date=9 July 2019 |author-link=James Landale }}</ref><ref name=Wintour9July2019>{{Cite news|url=https://www.theguardian.com/world/2019/jul/07/declare-ebola-outbreak-in-drc-an-emergency-says-uks-rory-stewart|title=Declare Ebola outbreak in DRC an emergency, says UK's Rory Stewart|last1=Wintour|first1=Patrick|date=7 July 2019|work=The Guardian|access-date=10 July 2019|issn=0261-3077}}</ref> |
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==2020 Équateur Province outbreak and other regional health issues== |
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On 1 June 2020, the Congolese health ministry announced a new DRC outbreak of Ebola in [[w:Mbandaka|Mbandaka]], [[w:Équateur Province|Équateur Province]], a region along the Congo River. Genome sequencing suggests that this outbreak, the 11th outbreak since the virus was first discovered in the country in 1976, is unrelated to the one in North Kivu Province or the previous outbreak in the same area in 2018. It was reported that six cases had been identified with four fatalities. It is expected that more people will be identified as surveillance activities increase.<ref>{{cite web |title=Ebola virus disease case in Equateur Province, DRC is a new spillover |url=https://virological.org/t/ebola-virus-disease-case-in-equateur-province-drc-is-a-new-spillover/504 |website=Virological.org |access-date=June 8, 2020}}</ref> |
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The Équateur Province was the site of [[w:2018 Équateur province Ebola outbreak|a small Ebola outbreak in 2018]], which infected 53 people and resulted in 29 deaths. That outbreak was quickly brought under control with the use of the Ebola vaccine. The WHO is assisting with the response to this outbreak in part using the structures put in place for the 2018 outbreak. Testing and contact tracing is underway and additional medical staff has been sent in.<ref>{{cite web |title=New Ebola outbreak detected in northwest Democratic Republic of the Congo; WHO surge team supporting the response |url=https://www.who.int/news-room/detail/01-06-2020-new-ebola-outbreak-detected-in-northwest-democratic-republic-of-the-congo-who-surge-team-supporting-the-response#:~:text=New%20Ebola%20outbreak%20detected%20in%20northwest%20Democratic%20Republic%20of%20the,surge%20team%20supporting%20the%20response&text=The%20Government%20of%20the%20Democratic,%2C%20Mbandaka%2C%20in%20%C3%89quateur%20province. |website=World Health Organization |access-date=June 7, 2020}}</ref> [[w:Médecins Sans Frontières|Médecins Sans Frontières]] was also present to give assistance if needed. The outbreak adds to an already difficult time for the Congo due to both [[w:Coronavirus disease 2019|COVID-19]] cases (whose worldwide total at the time was over 75 million cases<ref>{{cite web |title=COVID-19 CORONAVIRUS PANDEMIC |url=https://www.worldometers.info/coronavirus/ |website=worldometers.info/coronavirus/ |access-date=20 September 2020}}</ref>) and a [[w:2019–2020 measles outbreak in the Democratic Republic of the Congo|large measles outbreak]] that had caused almost 7000 deaths since 2019.<ref name="msf.org"/> |
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By 8 June, a total of 12 cases had been identified in and around Mbandaka and 6 deaths due to the virus. The WHO said 300 people in Mbandaka and the surrounding Équateur province had been vaccinated.<ref>{{cite web |title=Up to 12 Infected in Congo's New Ebola Outbreak: WHO |url=https://www.usnews.com/news/world/articles/2020-06-08/up-to-12-infected-in-congos-new-ebola-outbreak-who |website=USNews |publisher=USNews |access-date=8 June 2020}}</ref> By 15 June the case count had increased to 17 with 11 deaths, with more than 2,500 people having been vaccinated.<ref>{{cite web |title=17 infected, 11 dead in new Ebola outbreak in DR Congo |url=https://www.aljazeera.com/news/2020/06/17-infected-11-dead-ebola-outbreak-dr-congo-200615112609457.html |website=www.aljazeera.com |access-date=15 June 2020}}</ref> On 17 October, it had increased to 128 cases and 53 deaths, despite an effective vaccine being available.<ref>{{cite web |title=DR Congo's latest Ebola outbreak 'under control' |url=https://medicalxpress.com/news/2020-10-dr-congo-latest-ebola-outbreak.html |website=medicalxpress.com |access-date=19 October 2020 |language=en}}</ref> As of November 18, the World Health Organization has had no reported cases of Ebola in Équateur province for 42 days; therefore the outbreak was declared over.<ref>{{Cite web|date=2020-11-18|title=For the first time since 2018, there is no active Ebola outbreak in the DRC|url=http://cd.usembassy.gov/for-the-first-time-since-2018-there-is-no-active-ebola-outbreak-in-the-drc/|access-date=2020-11-18|website=U.S. Embassy in the Democratic Republic of the Congo|language=en-US}}</ref> In the end there were 130 cases and 55 dead due to the virus.<ref>{{cite web |title=UNICEF welcomes end of Ebola outbreak in the Equateur Province of the DRC |url=https://www.unicef.org/press-releases/unicef-welcomes-end-ebola-outbreak-equateur-province-drc |website=www.unicef.org |access-date=18 November 2020 |language=en}}</ref> |
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== Additional information == |
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=== Acknowledgements === |
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Would like to acknowledge all who contributed to this paper |
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=== Conflict of interest === |
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There are no conflicts of interest |
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=== Ethics statement === |
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No ethics issues exist that the author(s) are aware of. |
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==Notes== |
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{{reflist|group=note}} |
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==References== |
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{{reflist}} |
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==Further reading== |
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{{refbegin|30em}} |
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* {{cite web |title=FDA approves an Ebola vaccine, long in development, for the first time |url=https://www.statnews.com/2019/12/19/fda-approves-an-ebola-vaccine-long-in-development-for-the-first-time/ |website=STAT |access-date=22 December 2019 |date=20 December 2019}} |
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* {{cite journal |last1=Dokubo |first1=Emily Kainne |last2=Wendland |first2=Annika |last3=Mate |first3=Suzanne E |last4=Ladner |first4=Jason T |last5=Hamblion |first5=Esther L |last6=Raftery |first6=Philomena |last7=Blackley |first7=David J |last8=Laney |first8=A Scott |last9=Mahmoud |first9=Nuha |last10=Wayne-Davies |first10=Gloria |last11=Hensley |first11=Lisa |last12=Stavale |first12=Eric |last13=Fakoli |first13=Lawrence |last14=Gregory |first14=Christopher |last15=Chen |first15=Tai-Ho |last16=Koryon |first16=Augustine |last17=Roth Allen |first17=Denise |last18=Mann |first18=Jennifer |last19=Hickey |first19=Andrew |last20=Saindon |first20=John |last21=Badini |first21=Mehboob |last22=Baller |first22=April |last23=Clement |first23=Peter |last24=Bolay |first24=Fatorma |last25=Wapoe |first25=Yatta |last26=Wiley |first26=Michael R |last27=Logue |first27=James |last28=Dighero-Kemp |first28=Bonnie |last29=Higgs |first29=Elizabeth |last30=Gasasira |first30=Alex |last31=Williams |first31=Desmond E |last32=Dahn |first32=Bernice |last33=Kateh |first33=Francis |last34=Nyenswah |first34=Tolbert |last35=Palacios |first35=Gustavo |last36=Fallah |first36=Mosoka P |title=Persistence of Ebola virus after the end of widespread transmission in Liberia: an outbreak report |journal=The Lancet Infectious Diseases |date=September 2018 |volume=18 |issue=9 |pages=1015–1024 |doi=10.1016/S1473-3099(18)30417-1 |pmid=30049622 |display-authors=3 }} |
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{{refend}} |
Revision as of 18:16, 28 January 2022
The Kivu Ebola epidemic[note 1] began on 1 August 2018, when four cases of Ebola virus disease (EVD) were confirmed in the eastern region of Kivu in the Democratic Republic of the Congo (DRC).[2][3][4] The disease affected the DRC, Uganda, and is suspected to have also affected Tanzania, though the Ministry of Health their never shared information with WHO.[5] The outbreak was declared ended on 25 June 2020, with a total of 3,470 cases and 2,280 deaths.[6][7]
Other locations in the DRC affected included the Ituri Province, whose first case was confirmed on 13 August, 2018.[1] In November 2018, it became the biggest Ebola outbreak in the DRC's history,[8][9][10] and by November, it had become the second-largest Ebola outbreak in recorded history,[11][12] behind only the 2013–2016 Western Africa epidemic. On 3 May 2019, nine months into the outbreak, the DRC death toll surpassed 1,000.[13][14] In June 2019, the virus reached Uganda, having infected a 5-year-old Congolese boy who entered with his family,[15] but was contained.
Since January 2015, the affected province and general area have been experiencing a military conflict, which hindered treatment and prevention efforts. The World Health Organization (WHO) has described the combination of military conflict and civilian distress as a potential "perfect storm" that could lead to a rapid worsening of the situation.[16][17] In May 2019, the WHO reported that since January of that year there had been 42 attacks on health facilities and 85 health workers had been wounded or killed. In some areas, aid organizations have had to stop their work due to violence.[18] Health workers also had to deal with misinformation spread by opposing politicians.[19]
Due to the deteriorating security situation in North Kivu and surrounding areas, the WHO raised the risk assessment at the national and regional level from "high" to "very high" in September 2018.[20] In October, the United Nations Security Council stressed that all armed hostility in the DRC should come to a stop to better address the ongoing outbreak.[21][22][23] A confirmed case in Goma triggered the decision by the WHO to convene an emergency committee for the fourth time,[24][25] and on 17 July 2019, the WHO announced a Public Health Emergency of International Concern (PHEIC), the highest level of alarm the WHO can sound.[26]
On 15 September 2019, some slowdown of cases was noted in the DRC.[27] However, contact tracing continued to be less than 100%; at the time, it was at 89%.[27] In mid-October the transmission of the virus had significantly reduced; by then it was confined to the Mandima region near where the outbreak began, and was only affecting 27 health zones in the DRC (down from a peak of 207).[28] New cases decreased to zero by 17 February 2020,[29] but after 52 days without a case, surveillance and response teams on the ground confirmed three new cases of Ebola in Beni health zone in mid-April.[30][31][32]
As a new and separate outbreak, the Congolese health ministry reported on 1 June 2020 that there were cases of Ebola in Équateur Province in north-western DRC, described as the eleventh Ebola outbreak since records began.[33] Five people died in Mbandaka during the second half of May.[34] This outbreak had increased within the province to 50 cases and 20 deaths by 14 July.[35]}}
Epidemiology
The final death toll was 2,280 with a total of 3,470 cases in DRC in almost a two year period. Managing the outbreak was made very difficult due to the ongoing military attacks in the region, despite there being a vaccine.[36] rVSV-ZEBOV or Ebola Zaire vaccine live, is a vaccine that prevents Ebola caused by the Zaire ebolavirus.[37] The graph of reported cases marks those not able to have a laboratory test sample before burial as probable cases.[38]
![Kivu Ebola epidemic](http://upload.wikimedia.org/wikipedia/commons/thumb/c/c9/Kivu_Ebola_epidemic.jpg/850px-Kivu_Ebola_epidemic.jpg)
*2018–19 Kivu Ebola epidemic (total cases-deaths as of 25 June 2020)[7]
*x indicates (2) 21 day periods have passed and outbreak is over
Democratic Republic of the Congo
![](http://upload.wikimedia.org/wikipedia/en/thumb/7/74/DRC_cases_south_and_north_kivu_%2C_ituri.jpg/290px-DRC_cases_south_and_north_kivu_%2C_ituri.jpg)
On 1 August 2018, the North Kivu health division notified Congo's health ministry of 26 cases of hemorrhagic fever, including 20 deaths. Four of the six samples that were sent for analysis to the National Institute of Biological Research in Kinshasa came back positive for Ebola and an outbreak was declared on that date.[39][40] The index case is believed to have been the death and unsafe burial of a 65-year-old woman on 25 July in the town of Mangina; soon afterwards seven members of her immediate family died.[41] This outbreak started just days after the end of the outbreak in Équateur province.[42][43]
By 3 August, the virus had developed in multiple locations; cases were reported in five health zones – Beni, Butembo, Oicha, Musienene and Mabalako – in North Kivu province as well as Mandima and Mambasa in Ituri Province.[44] However, one month later there had been confirmed cases only in the Mabalako, Mandima, Beni and Oicha health zones. The five suspected cases in the Mambasa Health Zone proved not to be EVD; it was not possible to confirm the one probable case in the Musienene Health Zone and the two probable cases in the Butembo Health Zone. No new cases had been recorded in any of those health zones. The first confirmed case in Butembo was announced on 4 September, the same day that it was announced that one of the cases registered at Beni had actually come from the Kalunguta Health Zone.[45]
On 1 August, just after the epidemic had been declared, Doctors Without Borders/Médecins Sans Frontières (MSF) arrived in Mangina, the point of origin of the outbreak, to mount a response.[46] On 2 August, Oxfam indicated it would be taking part in the response to this outbreak in the DRC.[47] On 4 August, the WHO indicated that the current situation in the DRC, due to several factors, warranted a "high risk assessment" at the national and regional level for public health.[48]
In November, it was reported that the EVD outbreak ran across two provinces (and 14 health zones). Table 1. Timeline of reported cases reflects cases that were not able to have a laboratory test sample prior to burial as probable cases.[49] By 23 December, the EVD outbreak had spread to more health zones, and at that time 18 such areas had been affected.[50]
Becoming 2nd biggest EVD outbreak
On 7 August 2018, the DRC Ministry of Public Health indicated that the total count had climbed to almost 90 cases,[51] and the Uganda Ministry of Health issued an alert for extra surveillance as the outbreak was just 100 kilometres (62 mi) away from its border.[52] Two days later the total count was nearly 100 cases.[53] On 16 August, the United Kingdom indicated it would help with EVD diagnosis and monitoring in the DRC.[54] On 17 August 2018, the WHO reported that there were around 1,500 "contacts", while noting that certain conflict zones in the DRC that could not be reached might have more contacts.[55] Some 954 contacts were successfully followed up on 18 August; however, Mandima Health Zone indicated resistance, so contacts were not followed up there.[56]
On 4 September, Butembo, a city with almost one million people and an international airport, recorded its first fatality in the Ebola outbreak. The city of Butembo, in the DRC, has trade links to nearby Uganda.[57][45]
On 24 September, it was reported that all contact tracing and vaccinations would stop for the foreseeable future in Beni due to a deadly attack by rebel groups the day before.[58] On 25 September, Peter Salama of the WHO indicated that insecurity was obstructing efforts to stop the virus and believed a combination of factors could establish conditions for an epidemic.[59] On 18 October, the U.S. Centers for Disease Control and Prevention (CDC) raised its travelers' alert to the DRC from a level 1 to level 2 for all U.S. travelers.[60] On 26 October, the WHO indicated that half of confirmed cases were not showing any fever symptom, thus making diagnosis more difficult.[61]
Per a September 2018 survey in the Lancet, 25% of respondents in Beni and Butembo believed the Ebola outbreak to be a hoax. These beliefs correlated with decreased likelihood of seeking healthcare or accepting vaccination.[62]
On 6 November 2018, the CDC indicated that the outbreak in the east region of the DRC was potentially non-containable. This would be the first time since 1976 that an outbreak was not able to be curbed.[63] On 13 November, the WHO indicated that the viral outbreak would last at least six months.[64]
On 29 December 2018, the DRC Ministry of Public Health announced that there had been "0 new confirmed cases detected because of the paralysis of the activities of the response in Beni, Butembo, Komanda and Mabalako" and no vaccination had occurred for three consecutive days.[65] On 22 January, the total case count began to approach 1,000 cases, (951 suspected) in the DRC Ministry of Public Health situation report.[66] The graphs below demonstrate the EVD intensity in different locations in the DRC, as well as in the West African epidemic of 2014–15 as a comparison: {{FIG}} template missing ID and not present in Wikidata. On 16 March 2019, the director of the CDC indicated that the outbreak in the DRC could last another year, additionally suggesting that vaccine supplies could run out.[67] According to the WHO, resistance to vaccination in the Kaniyi Health Zone was ongoing as of March 2019.[68] There was still a belief by some in surrounding areas that the epidemic was a hoax.[69]
On 25 November 2019, violence had broken out in Beni again, to such a degree that some aid agencies had evacuated. According to the same report, around 300 individuals might have been exposed to EVD via an infected individual.[70]
![](http://upload.wikimedia.org/wikipedia/commons/thumb/e/e8/Bar_graph_of_Democratic_Republic_of_the_Congo_outbreaks_1976-present.jpg/400px-Bar_graph_of_Democratic_Republic_of_the_Congo_outbreaks_1976-present.jpg)
(Note: total cases for this date does not reflect 52 suspected cases nor does it reflect the final case numbers)[8][71]
(Uganda has second most EVD cases '00–'01/425[72]
West African Ebola virus epidemic '13-'16/ >28,000[73])[attribution needed]
Until the outbreak in North Kivu in 2018, no outbreak had surpassed 319 total cases in the Democratic Republic of the Congo. By 24 February 2019, the epidemic had surpassed 1,000 total cases (1,048),[74][75] and a year later, it had surpassed 3,000.
On 10 May 2019, the U.S. Centers for Disease Control and Prevention indicated that the outbreak could eventually surpass the West African epidemic.[76]
The 12 May 2019 issue of WHO Weekly Bulletin on Outbreaks and Other Emergencies, indicates that "continued increase in the number of new EVD cases in the Democratic Republic of the Congo is worrying...no end in sight to the difficult security situation".[77]
Spread to Goma
On 14 July 2019, the first case of EVD was confirmed in the capital of North Kivu, Goma, a city with an international airport and a highly mobile population of 2 million people located near the DRC's eastern border with Rwanda.[78][79][80][81] This case was a man who had passed through three health checkpoints, with different names on traveller lists.[25] The WHO stated that he died in a treatment centre,[82] whereas according to Reuters he died en route to a treatment centre.[83] This case triggered the decision by the WHO to again reconvene an emergency committee,[24][25] where the situation was officially declared a Public Health Emergency of International Concern.[26]
On 30 July, a second case of EVD was confirmed in the city of Goma, apparently not linked to the first case.[84] Across the border from Goma in the country of Rwanda, Ebola simulation drills were being conducted at health facilities.[85] A third case of EVD was confirmed in Goma on 1 August.[86] On 22 August 2019, Nyiragongo Health Zone, the affected area on the outskirts of Goma, reached 21 days without further cases being confirmed.[87]
Spread to South Kivu Province
On 16 August 2019, it was reported that the Ebola virus disease had spread to a third province – South Kivu – via two new cases who had travelled from Beni, North Kivu.[88][89] By 22 August the number of cases in Mwenga had risen to four, including one person at a health facility visited by the first case.[90]
Uganda
![](http://upload.wikimedia.org/wikipedia/commons/thumb/7/70/Uganda_Distrikt_Kasese.svg/220px-Uganda_Distrikt_Kasese.svg.png)
In August 2018 a UN agency indicated that active screening was deployed to ensure that those leaving the DRC into Uganda were not infected with Ebola.[91] The government of Uganda opened two Ebola treatment centers at the border with the DRC, though there had not yet been any confirmed cases in the country of Uganda.[92][93] By 13 June 2019, nine treatment centers were in place near the affected border.[94]
According to the International Red Cross, a "most likely scenario" entailed an asymptomatic case entering the country of Uganda undetected among the numerous refugees then coming from the DRC.[95] On 20 September, Uganda indicated it was ready for immediate vaccination, should the Ebola virus be detected in any individual.[96][97]
On 21 September, officials of the DRC indicated a confirmed case of EVD at Lake Albert, an entry point into Uganda, though no cases were then confirmed within Ugandan territory.[98][99]
On 2 November, it was reported that the Ugandan government would start vaccinating health workers along the border with the DRC as a proactive measure against the virus.[100] Vaccinations started on 7 November, and by 13 June 2019, 4,699 health workers at 165 sites had been vaccinated.[94] Proactive vaccination was also carried out in South Sudan, with 1,471 health workers vaccinated by 7 May 2019.[101]
On 2 January 2019, it was reported that refugee movement from the DRC to Uganda had increased after the presidential elections.[102] On 12 February, it was reported that 13 individuals had been isolated due to their contact with a suspected Ebola case in Uganda;[103] lab results came back negative several hours later.[104]
On 11 June 2019, the WHO reported that the virus had spread to Uganda. A 5-year-old Congolese boy entered Uganda on the previous Sunday with his family to seek medical care. On 12 June, the WHO reported that the 5-year-old had died, while 2 more cases of Ebola infection within the same family were confirmed.[15][105] On 14 June it was reported that there were 112 contacts since EVD was first detected in Uganda.[106] Ring vaccination of Ugandan contacts was scheduled to start on 15 June.[23] As of 18 June 2019, 275 contacts had been vaccinated per the Uganda Ministry of Health.[107]
On 14 July, an individual entered the country of Uganda from DRC while symptomatic for EVD; a search for contacts in Mpondwe followed.[108] On 24 July, Uganda marked the needed 42 day period without any EVD cases to be declared Ebola-free.[109] On 29 August, a 9-year-old Congolese girl became the fourth individual in Uganda to test positive for EVD when she crossed from the DRC into the district of Kasese.[110]
Tansania
![](http://upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Tanzania_relief_location_map.svg/220px-Tanzania_relief_location_map.svg.png)
In regards to possible EVD cases in Tanzania, the WHO stated on 21 September 2019 that "to date, the clinical details and the results of the investigation, including laboratory tests performed for differential diagnosis of these patients, have not been shared with WHO. The insufficient information received by WHO does not allow for a formulation of a hypotheses regarding the possible cause of the illness".[111][112][113] On 27 September, the CDC and U.S. State Department alerted potential travellers to the possibility of unreported EVD cases within Tanzania.[114]
The Tanzanian Health Minister Ummy Mwalimu stated on 3 October 2019 that there was no Ebola outbreak in Tanzania.[115] The WHO were provided with a preparedness update on 18 October which outlined a range of actions, and included commentary that since the outbreak commenced, there had been "29 alerts of Ebola suspect cases reported, 17 samples tested and were negative for Ebola (including 2 in September 2019)".[116]
Countries with medically evacuated individuals
On 29 December, an American physician who was exposed to the Ebola virus (and who was non-symptomatic) was evacuated, and taken to the University of Nebraska Medical Center.[117][118] On 12 January, the individual was released after 21 days without symptoms.[119] The table which follows indicates confirmed, probable and suspected cases, as well as deaths; the table also indicates the countries where these cases took place.
Table 1 | Timeline of reported cases[71] [click to expand]
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Outbreak and military conflict
![](http://upload.wikimedia.org/wikipedia/commons/thumb/c/cb/Goma_-_North_Kivu_%2821070159821%29.jpg/220px-Goma_-_North_Kivu_%2821070159821%29.jpg)
At the time of the epidemic, there were about 70 armed military groups, among them the Alliance of Patriots for a Free and Sovereign Congo and the Mai-Mayi Nduma défense du Congo-Rénové, in North Kivu. The armed fighting displaced thousands of individuals[230] and seriously affected the response to the outbreak.[231][232] According to the WHO, health care workers are to be accompanied by military personnel for protection and ring vaccination may not be possible.[233] On 11 August 2018, it was reported that seven individuals were killed in Mayi-Moya due to a militant group, about 24 miles from the city of Beni where there were several EVD cases.[234][235][236]
On 24 August 2018, it was reported that a physician infected with Ebola had been in contact with some 97 individuals in an inaccessible military area, who hence could not be diagnosed.[237][238] In September, it was reported that 2 peacekeepers were attacked and wounded by rebel groups in Beni,[239] and 14 individuals were killed in a military attack.[240] In September 2018, the WHO's Deputy Director-General for Emergency Preparedness and Response described the combination of military conflict and civilian distress as a potential "perfect storm" that could lead to a rapid worsening of the outbreak.[16][17]
On 20 October 2018, an armed rebel group in the DRC killed some 13 civilians and took 12 children as hostages in Beni, which was then experiencing one of the worst outbreaks.[241][242] On 11 November, six people were killed in an attack by an armed rebel group in Beni; as a consequence vaccinations were suspended there.[243][244] Yet another attack reported on 17 November, in Beni by an armed rebel group forced the cessation of EVD containment efforts and WHO staff to evacuate to another DRC city for the time being.[245] Beni continues to be the site of attacks by militant groups as 18 civilians were killed on 6 December.[246] On 22 December it was reported that elections for the President of the DRC would go forward despite the EVD outbreak, including in the Ebola-stricken area of Beni.[247] Four days later, on 26 December, the DRC government reversed itself to indicate those Ebola-stricken areas, such as Beni, would not vote for several months;[248] as a consequence election protesters ransacked an Ebola assessment center in Beni.[249][250][251] Post election tensions continued when it was reported that the DRC government had cut off internet connectivity for the population, as the vote results were yet to be released.[252]
On 29 December 2018, Oxfam said it would suspend its work due to the ongoing violence in the DRC;[253] on the same day, the International Rescue Committee suspended their Ebola support efforts as well.[254] On 18 January, the African Union indicated that presidential election results announcements should be suspended in the DRC.[255]
Virology
![](http://upload.wikimedia.org/wikipedia/commons/thumb/9/96/Rousettus_aegyptiacus_1.jpg/220px-Rousettus_aegyptiacus_1.jpg)
![](http://upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Genomic_epidemiology_of_the_2018-19_Ebola_epidemic.jpg/600px-Genomic_epidemiology_of_the_2018-19_Ebola_epidemic.jpg)
The outbreak was caused by the Zaire ebolavirus species. This is the same strain that was involved in the early 2018 outbreak in western DRC.[260]
Zaire ebolavirus strain is the most lethal of the six known strains (including the newly discovered Bombali strain);[261] it is fatal in up to 90% of cases.[262] Both Ebola and Marburg virus are part of the Filoviridae family.[263]
The filovirus genome contains seven genes, including VP40.[264] The natural reservoir of the virus is thought to be the African fruit bat,[265] which is used in many parts of Africa as bushmeat.[266]
Viral mechanism
A significant part of the EVD infection is based on immune suppression along with systemic inflammation, leading to multiple organ failure.[267] Systemic inflammation and fever may damage many types of body tissues but the consequences are especially profound in the liver, where Ebola wipes out cells required to produce coagulation factors. In the gastrointestinal tract damaged cells lead to diarrhea putting people at risk of dehydration. And in the adrenal gland the virus harming the cells that make steroids which regulates blood pressure, resulting in circulatory failure.[268]
Genetic epidemiology
This is a medical field which tries to understand how genetic factors and the environment interact in this case while the outbreak was going through the population of the Democratic Republic of the Congo and the neighboring country of Uganda.[269][101] The WHO declared a Public Health Emergency of International Concern when the virus reached Goma with its first case.[270] Genomic surveillance and Ebola virus evolution have been facilitated due to Ebola virus disease genetic epidemiology.[271]
The graph that follows is an indication of the genetic epidemiology of the virus until October 2019, when the outbreak decline began.
Transmission
Ebola virus is found in a variety of bodily fluids including: blood, saliva, stool, semen, and breast milk. The virus is extremely infectious following contact with any of these bodily fluids. Some potential routes of transmission include:[272][273]
- Bodily fluids: The most common way of transmitting in humans is through contact with infected bodily fluids.
- Droplets: Droplet transmission occurs when contact is made with virus-containing droplets.
- Fomites: Occurs when an individual comes in contact with a pathogen-contaminated surface.
Those infected by EVD generally gain immunity, although it is possible that such immunity is only temporary.[274] In October 2019, a survivor who had been assisting at a treatment center in Beni was reinfected with EVD and died; which was unprecedented.[275]
Containment and control
Even with the advances made in vaccine technology and treatment options during previous Ebola outbreaks, effective control of the North Kivu Epidemic continued to rely heavily on traditional public health efforts including the timely identification and isolation of cases, control measures in hospital settings, identification and follow-up of contacts, community engagement, and safe burials. Data from the West African Ebola Outbreak showed that response strategies which achieved 60% efficacy for sanitary burial, case isolation, and contact-tracing combined, could have greatly reduced the daily number of Ebola cases and ended the outbreak after only 6 months;[276] therefore, the most effective outbreak response should include non-pharmaceutical containment and control strategies in addition to new preventive and therapeutic measures.
Surveillance and contact tracing
Contact tracing is defined as the identification and follow-up of persons who may have been in contact with a person infected with Ebola. All close contacts should be monitored for 21 days following their last known exposure to the case and be isolated if they become ill. The volume of contacts and the duration of monitoring presented challenges in Ebola surveillance as it requires careful record-keeping by properly trained and equipped staff.[277] To strengthen surveillance activities, the DRC Ministry of Health began disseminating standardized Ebola case definitions, developed reporting tools, and communication strategies, and began distribution of daily situation reports.[257] Rapid response teams were deployed to affected health zones to strengthen Ebola case management and infection prevention and control in health care facilities and treatment centers.[257] Similar to the West African Ebola Outbreak, less than 10% of cases presented with bleeding.[278]
Disease surveillance in North Kivu and Ituri was complicated by two major obstacles: 1) the outbreaks of sporadic violence against those responding and the affected communities and 2) suspicion of the response in parts of some affected communities. Poor record keeping by local health facilities also made it difficult or impossible to identify and trace contacts that might have been exposed to the disease while they were undergoing treatment for other illness at health centers. Additionally, the high degree of mobility of affected populations, combined with occasional mistrust of the response has meant that contacts that had been identified sometimes were lost to follow-up for extended periods.[279] Initially, it was estimated that 30-50% of contacts may not have originally been registered by contact tracing teams;[280] improvements to the security situation and improved acceptance by affected communities had led to improvement in most surveillance metrics which was central to controlling the outbreak.
Community engagement and awareness
Surveys among the affected population in North Kivu and Ituri showed both general mistrust with the Ebola response, partly related to years of mistrust of any governmental or external action, and specific opposition to the response because of conflicts with local cultural practices.[281] Some of the cultural practices which complicated the response included eating bush meat, regular gatherings at family or village events, and traditional funeral practices, which were events that were particularly high risk for transmission.[281] Additionally, people from the affected region reported that their perception of security and trust in the government, as well as humanitarian workers, declined over the course of the outbreak, complicating an already complex response.[282]
Misinformation
Combating misinformation was a key element in overcoming Ebola in North Kivu. One study using surveys found that low institutional trust coupled with a belief in misinformation about Ebola were inversely associated with preventive behaviors in individuals, including Ebola vaccine acceptance.[283] Belief in misinformation regarding Ebola was widespread, with 25% of respondents reporting that they did not believe the Ebola outbreak was real. Some of the rumors that were being circulated included statements that the outbreak did not exist, it was fabricated by the authorities for financial gains, or was fabricated to destabilize the region.[283] Approximately 68% of respondents reported that they did not trust the local authorities to represent their interest, and community trust in the Ebola response was often further undermined by misinformation spread by local politicians.[283]
Delay in seeking treatment
Early in the epidemic there were several delays in people seeking care for Ebola because the initial cases were misdiagnosed. Ebola symptoms were similar to symptoms of more common infectious diseases such as malaria, flu, and typhoid fever so people would wait until their situation deteriorated, usually after failure to respond to anti-malarial or antibiotic regimens, before going to the hospitals;[284] during this delay in care seeking, the relatives and close contacts of were being exposed.
Burials
The IFRC has called funerals "super-spreading events" as burial traditions include kissing and generally touching bodies. Safe burial teams formed by health workers were subject to suspicion.[285]
Travel restrictions and border closings
On 26 July 2019, Saudi Arabia stopping providing visas to people from the DRC after the WHO declared it an international emergency due to EVD.[286] On 1 August 2019, Rwanda closed its border with the DRC after multiple cases in the city of Goma, which borders the country in the upper Northwestern region.[287]
To minimize the risk of the spread to neighboring countries, screening points which consisted of temperature and symptom monitoring were established at many border crossings. Over 2 million screenings were undertaken during the outbreak which is believed to have contributed to the containment of the epidemic within DRC.[288]
Treatment
In August 2018, the WHO evaluated the benefits and risks of several medications, including remdesivir, ZMapp, REGN-EB3 (REGN3470-3471-3479), mAb114 and favipiravir.[289] The mAb114 (which is a monoclonal antibody) was deployed for the first time to treat individuals during this EVD outbreak.[290]
In November 2018, the DRC gave approval to start randomized clinical trials for EVD treatment.[291] On 12 August 2019, two medications were found to improve the rate of survival: REGN-EB3, a cocktail of three monoclonal Ebola antibodies, and mAb114. When used shortly after infection they were found to have a 90% survival rate. ZMapp and remdesivir were subsequently discontinued.[292][293][294][295]
In October 2020, the U.S. Food and Drug Administration (FDA) approved w:atoltivimab/maftivimab/odesivimab (Inmazeb, formerly REGN-EB3) with an indication for the treatment of infection caused by Zaire ebolavirus.[296]
Vaccination
![](http://upload.wikimedia.org/wikipedia/commons/thumb/5/53/Ebola_Geimpfte_311218_englisch.png/220px-Ebola_Geimpfte_311218_englisch.png)
On 8 August 2018, the process of vaccination began with rVSV-ZEBOV Ebola vaccine.[298] While several studies have shown the vaccine to be safe and protective against the virus, additional research is was needed before it could be licensed. Consequently, the WHO reported that it was being used under a ring vaccination strategy under "compassionate use" to protect persons at highest risk of Ebola, i.e. contacts of those infected, contacts of those contacts, and front-line medical personnel.[299] As of 15 September, almost a quarter of a million individuals had been vaccinated in the outbreak.[27]
On 20 September 2019 a second vaccine by w:Johnson & Johnson was introduced in the EVD epidemic in the DRC.[300]
In November 2019, the World Health Organization prequalified an Ebola vaccine, rVSV-ZEBOV, for the first time.[301] As of 22 February 2020, a total of 297,275 people had been vaccinated since the start of the outbreak.[302]
Vaccination has helped to contain the epidemic, though military attacks and community resistance have complicated distribution.[303]
Pregnant and breastfeeding
Based on a lack of evidence about the safety of the vaccine during pregnancy, the DRC ministry of health and the WHO decided to cease vaccinating women who are pregnant or breastfeeding. Some authorities criticized this decision as "utterly indefensible" from an ethical perspective. They note that as caregivers of the sick, pregnant and breastfeeding women are more likely to contract Ebola. They also note that since it is known that almost 100% of pregnant women who contract Ebola will die, a lack of safety data in this population should not be a deciding factor.[304] As of June 2019, pregnant and breastfeeding women were also being vaccinated.[305]
Vaccine stockpile
The DRC Ministry of Public Health reported on 16 August 2018 that 316 individuals had been vaccinated.[306] On 24 August, the DRC indicated it had vaccinated 2,957 individuals, including 1,422 in Mabalako against the Ebola virus.[307] By late October, more than 20,000 individuals had been vaccinated.[308] In December, Peter Salama, who is Deputy Director-General of Emergency Preparedness and Response for WHO, reported that the current 300,000 vaccine stockpile might not be enough to contain the EVD outbreak, especially since it takes several months to make more of the Zaire EVD vaccine (rVSV-ZEBOV).[309][310] On 11 December, Beni only had 4,290 doses of vaccine in stock.[161]
As of August 2019, w:Merck & Co, the producers of the vaccine in use, reported a stockpile sufficient for 500,000 individuals, with more in production.[311]
Effectiveness
In April 2019, the WHO published the preliminary results, in association with the DRC's Institut National pour la Recherche Biomedicale, into the effectiveness of the ring vaccination program, including data from 93,965 at-risk people who had been vaccinated. WHO stated that the rVSV-ZEBOV-GP vaccine had been 97.5% effective at stopping Ebola transmission.[312][313] The vaccine had also reduced mortality among those who were infected after vaccination. The ring vaccination strategy was effective at reducing EVD in contacts of contacts (tertiary cases), with only two such cases being reported.[313]
Treatment centres
In August 2018, the Mangina Ebola Treatment Center was reported to be operational.[314][315] A fourth Ebola Treatment Center (after those in Mangina, Beni and Butembo) was inaugurated in September in Makeke in the Mandima Health Zone of Ituri Province.[316] Makeke is less than five kilometers from Mangina along a well-traveled local road; the site had been proposed in August when it appeared that a second Ebola Treatment Center would be needed in the area, and space was insufficient in Mangina itself to accommodate one.[317] By mid-September, however, there had been only two additional cases in the Mandima Health Zone, and only sporadic cases were being reported in the Mabalako Health Zone.[318]
In February 2019, attacks at treatment centers had been carried out in Butembo and Katwa. The motives behind the attacks were unclear. Due to the violence, international aid organizations stopped their work in the two communities.[319][320] In April, an epidemiologist from WHO was killed and two health workers injured in a militia attack on Butembo University Hospital in Katwa.[321] In May, WHO's health emergencies chief said insecurity had become a "major impediment" to controlling the outbreak. He reported that since January there had been 42 attacks on health facilities and 85 health workers had been wounded or killed. "Every time we have managed to regain control over the virus and contain its spread, we have suffered major, major security events. We are anticipating a scenario of continued intense transmission".[18]
Healthcare workers
Health workers must wear personal protection equipment during treatment of those affected by the virus.[322] On 3 September 2018, WHO stated that 16 health workers had contracted the virus.[131] On 10 December, the WHO reported that the current DRC outbreak had led to 49 healthcare workers contracting the Ebola virus, and 15 had died.[160] As of 30 April 2019, there have been 92 health care workers in the DRC infected with EVD, of which 33 had died.[323] With false rumors being spread by word-of-mouth and social media, residents remain mistrustful and fearful of health care workers. In January 2020, it was reported that there had been nearly 400 attacks on medical workers since the outbreak began in 2018.[324]
Post-Ebola virus syndrome
In terms of prognosis, aside from the possible effects of post-Ebola syndrome,[325] there was also the reality of survivors returning to communities where they might be shunned due to the fear many have towards the Ebola virus,[326][327] hence psychosocial assistance was often needed.[328] Many survivors of EVD face serious side effects, including but not limited to:[329][330]
History
![](http://upload.wikimedia.org/wikipedia/commons/thumb/0/07/Ebola_Virus_-_Electron_Micrograph.tiff/lossy-page1-150px-Ebola_Virus_-_Electron_Micrograph.tiff.jpg)
The Ebola virus disease outbreak in Zaire (Yambuku) started in late 1976, and was the second outbreak ever after the earlier one in Sudan the same year.[331][332] On 1 August 2018, the tenth Ebola outbreak was declared in the DRC, only a few days after a prior outbreak in the same country had been declared over on 24 July.[42][43]
WHO chief Tedros Adhanom Ghebreyesu indicated on 15 August that the outbreak then in the DRC might be worse than the West African outbreak of 2013–2016,[333] with the IRC connecting this to the ongoing Kivu conflict.[334] The Kivu outbreak was the biggest of the ten recorded outbreaks recorded in the DRC.[335]
Table 2 | Timeline of Ebola outbreaks in the Democratic Republic of the Congo (formerly Zaire) since 1976 [click to expand]
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Learning from other responses, such as in the 2000 outbreak in Uganda, the WHO established its Global Outbreak Alert and Response Network, and other public health measures were instituted in areas at high risk. Field laboratories were established to confirm cases, instead of shipping samples to South Africa.[350] Additionally, the outbreak was closely monitored by the CDC Special Pathogens Branch.[351]
Statistical measures
One way to measure the outbreak is via the basic reproduction number, R0, a statistical measure of the average number of people expected to be infected by one person with a disease. If the basic reproduction number is less than 1, the infection dies out; if it is greater than 1, the infection continues to spread—with exponential growth in the number of cases.[353] A March 2019 paper by Tariq et al. suggested that R0 was oscillating around 0.9.[354]
Response
During the Ebola outbreak in Democratic Republic of the Congo, a number of organizations helped in different capacities: CARITAS DRC, CARE International, Cooperazione Internationale (COOPE), Catholic Organization for Relief and Development Aid (CORDAID/PAP-DRC), International Rescue Committee (IRC), Médecins Sans Frontières (MSF), Oxfam, International Federation of Red Cross and Red Crescent Societies (IFRC), International Committee of the Red Cross (ICRC), and Samaritan's Purse.[133]
WHO
On 12 April 2019, the WHO Emergency Committee was reconvened by the WHO Director-General after an increase in the rate of new cases, and determined that the outbreak still failed to meet the criteria for a Public Health Emergency of International Concern (PHEIC).[355][356]
Following the confirmation of Ebola crossing into Uganda, a third review by the WHO on 14 June 2019[22] concluded that while the outbreak was a health emergency in the DRC and the region, it did not meet all three criteria required for a PHEIC.[23] Following a case in Goma, the reconvening of a fourth review was announced on 15 July 2019.[25] The WHO officially declared the situation a PHEIC on 17 July 2019,[26] and as of 12 February 2020, it continues to be a PHEIC,[357] one of only six declared in its history.[358]
World Bank
The World Bank was criticised when its Pandemic Emergency Financing Facility, intended to support countries affected by pandemic diseases, had only paid out $31 million of a potential total of $425 million by August 2019 while generating substantial returns for investors. The conditions used to decide when the fund should pay out to disease-affected countries were criticised as too stringent.[359]
International governments
Financial support has been contributed by the governments of the US and the UK, among others. The UK DfID minister, Rory Stewart, visited the area in July 2019, and called for other western countries, including Canada, France and Germany, to donate more financial aid. He identified a funding deficit of $100–300 million to continue responding to the outbreak until December. He urged WHO to classify the situation as a PHEIC, to facilitate the release of international aid.[360][361]
2020 Équateur Province outbreak and other regional health issues
On 1 June 2020, the Congolese health ministry announced a new DRC outbreak of Ebola in Mbandaka, Équateur Province, a region along the Congo River. Genome sequencing suggests that this outbreak, the 11th outbreak since the virus was first discovered in the country in 1976, is unrelated to the one in North Kivu Province or the previous outbreak in the same area in 2018. It was reported that six cases had been identified with four fatalities. It is expected that more people will be identified as surveillance activities increase.[362]
The Équateur Province was the site of a small Ebola outbreak in 2018, which infected 53 people and resulted in 29 deaths. That outbreak was quickly brought under control with the use of the Ebola vaccine. The WHO is assisting with the response to this outbreak in part using the structures put in place for the 2018 outbreak. Testing and contact tracing is underway and additional medical staff has been sent in.[363] Médecins Sans Frontières was also present to give assistance if needed. The outbreak adds to an already difficult time for the Congo due to both COVID-19 cases (whose worldwide total at the time was over 75 million cases[364]) and a large measles outbreak that had caused almost 7000 deaths since 2019.[33]
By 8 June, a total of 12 cases had been identified in and around Mbandaka and 6 deaths due to the virus. The WHO said 300 people in Mbandaka and the surrounding Équateur province had been vaccinated.[365] By 15 June the case count had increased to 17 with 11 deaths, with more than 2,500 people having been vaccinated.[366] On 17 October, it had increased to 128 cases and 53 deaths, despite an effective vaccine being available.[367] As of November 18, the World Health Organization has had no reported cases of Ebola in Équateur province for 42 days; therefore the outbreak was declared over.[368] In the end there were 130 cases and 55 dead due to the virus.[369]
Zusätzliche Informationen
Acknowledgements
Would like to acknowledge all who contributed to this paper
Conflict of interest
There are no conflicts of interest
Ethics statement
No ethics issues exist that the author(s) are aware of.
Notes
- ^ Ituri province was added to N. Kivu province, in terms of viral infection, when the first case of EVD was confirmed on 13 August.[1]
- ^ ...in the Congolese statistics cases of Mabalako. Uganda's index case and 7 other family members were classified in Mabalako, the health zone where they started to develop symptoms. Of these 8 confirmed cases of the same family, 5 remained in the DRC and 3 had crossed the border. [...] The 2 deaths of Bwera are the 5-year-old boy and the 50-year-old grandmother who were classified...[197] As of 25 June 2020[update]
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{{cite news}}
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A perfect storm of active conflict limiting our ability to access civilians, distress by segments of the community already traumatized by decades of conflict and of murder, driven by a fear of a terrifying disease
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Further reading
- "FDA approves an Ebola vaccine, long in development, for the first time". STAT. 20 December 2019. Retrieved 22 December 2019.
- Dokubo, Emily Kainne; Wendland, Annika; Mate, Suzanne E; et al. (September 2018). "Persistence of Ebola virus after the end of widespread transmission in Liberia: an outbreak report". The Lancet Infectious Diseases. 18 (9): 1015–1024. doi:10.1016/S1473-3099(18)30417-1. PMID 30049622.
- Nanclares, Carolina; Kapetshi, Jimmy; Lionetto, Fanshen; et al. (September 2016). "Ebola Virus Disease, Democratic Republic of the Congo, 2014". Emerging Infectious Diseases. 22 (9): 1579–1586. doi:10.3201/eid2209.160354. PMC 4994351. PMID 27533284.
- Claude, Kasereka Masumbuko; Underschultz, Jack; Hawkes, Michael T (October 2018). "Ebola virus epidemic in war-torn eastern DR Congo". The Lancet. 392 (10156): 1399–1401. doi:10.1016/S0140-6736(18)32419-X. PMID 30297137.
- "Experimental Ebola vaccines elicit year-long immune response/NIH reports final data from large clinical trial in West Africa". National Institutes of Health (NIH). NIH.gov. 11 October 2017.
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