The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo, continues to prove challenging to contain as ongoing security incidents and pockets of community mistrust hamper response efforts. Following our last report on 5 February 2019, 31 additional cases have been reported, including 24 confirmed and seven probable EVD cases. The 7 additional probable cases include cases dying in November and December 2018 in Katwa Health Zone with a history consistent with EVD but without the opportunity to be tested, and reported following a retrospective re-classification of cases. Three healthcare workers were among the newly confirmed cases, bringing the cumulative number of confirmed and probable cases among healthcare workers to 68 (8% of the total number of cases), with 21 deaths.
From the beginning of the outbreak to 10 February 2019, a total of 816 EVD cases, including 755 confirmed and 61 probable cases (Table 1), were reported from 18 Health zones in the North Kivu and Ituri provinces (Figure 1). A total of 513 deaths were reported (overall case fatality ratio 63%), including 452 deaths among confirmed cases. Of confirmed and probable cases with reported gender, 58% (465/815) were female.
Thirteen of the 18 affected health zones have ongoing active transmission (Figure 1), reporting at least one confirmed case in the last 21 days (21 January to 10 February 2019). Over this period, a total of 104 confirmed cases were reported from Katwa (65), Butembo (10), Beni (7), Kyondo (4), Manguredjipa (4), Oicha (3), Vuhovi (3), Biena (2), Kalunguta (2), Mabalako (1), Kayna (1), Masereka (1), and Mutwanga (1)1 . The major urban centres of Katwa and Butembo remain notable areas were most cases were reported, with 75/104 (72%) of cases reported in the last three weeks. Trends in case incidence reflect an increase in the number of cases since the start of this year and continuation of the outbreak across a geographically widely dispersed area (Figure 1, Figure 2 and Figure 3).
The Ministry of Health (MoH), WHO and partners continue to monitor and investigate all alerts in affected areas, in other provinces in the Democratic Republic of the Congo and in neighbouring countries. To date, all reported alerts outside the outbreak affected areas have been investigated or laboratory tested to rule out EVD.