A | B | C | D | E | F | G | H | CH | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9
 Democratic Republic of the Congo & Uganda; areas affected by the epidemic. | |||||||||||||||||
| Date | 1 August 2018 – 25 June 2020[1] | ||||||||||||||||
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The Kivu Ebola epidemic[note 2] was an outbreak of Ebola virus disease (EVD) mainly in eastern Democratic Republic of the Congo (DRC), and in other parts of Central Africa, from 2018 to 2020.[10] Between 1 August 2018 and 25 June 2020 it resulted in 3,470 reported cases.[11] The Kivu outbreak also affected Ituri Province, whose first case was confirmed on 13 August 2018.[9] In November 2018, the outbreak became the biggest Ebola outbreak in the DRC's history,[12][13][14] and had become the second-largest Ebola outbreak in recorded history worldwide,[11][15] behind only the 2013–2016 Western Africa epidemic.[11][16] In June 2019, the virus reached Uganda, having infected a 5-year-old Congolese boy who entered Uganda with his family,[17] but was contained.[11]
A military conflict in the region that had begun in January 2015 hindered treatment and prevention efforts. The World Health Organization (WHO) described the combination of military conflict and civilian distress as a potential "perfect storm" that could lead to a rapid worsening of the outbreak.[18][19] In May 2019, the WHO reported that since January, 85 health workers had been wounded or killed in 42 attacks on health facilities. In some areas, aid organizations had to stop their work due to violence.[20] Health workers also had to deal with misinformation spread by opposing politicians.[21]
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.[22] In October, the United Nations Security Council stressed that all armed hostility in the DRC should come to a stop to better fight the ongoing EVD outbreak.[23][24][25] A confirmed case in Goma triggered the decision by the WHO to convene an emergency committee for the fourth time,[26][27] 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.[28]
On 15 September 2019, some slowdown of EVD cases was noted by the WHO in DRC.[29] However, contact tracing continued to be less than 100%; at the time, it was at 89%.[29] As of 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).[30] New cases dwindled to zero by 17 February 2020,[31] 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.[32][33][34] On 25 June 2020, the outbreak was declared ended.[1][16]
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.[35] This separate outbreak was declared over as of 18 November following no reported cases for 42 days,[36] and caused 130 cases and 55 deaths.[37]
Epidemiology
As indicated below and per numbers offered by the United Nations the final death toll was 2,280 with a total of 3,470 cases in DRC in almost a two-year period. This was made very difficult due to the ongoing military attacks in the region which created a perfect storm for the virus, despite there being a vaccine.[38] rVSV-ZEBOV or Ebola Zaire vaccine live, is a vaccine that prevents Ebola caused by the Zaire ebolavirus.[39] The graph of reported cases reflects cases that were not able to have a laboratory test sample before burial as probable cases.[40]
*2018–19 Kivu Ebola epidemic (total cases-deaths as of 25 June 2020)[1]
*x indicates (2) 21 day periods have passed and outbreak is over
Democratic Republic of the Congo
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.[41][42] The index case is believed to have been the death and unsafe burial of a 65-year-old woman on 25 July in Mangina, quickly followed by the deaths of seven close family members.[43] This outbreak started just days after the end of the outbreak in Équateur province.[44][45] On 1 August, just after the Ebola 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 latest 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]
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.[49] 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.[50]
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,[51] with the IRC connecting this to the ongoing Kivu conflict.[52] The Kivu outbreak was the biggest of the ten recorded outbreaks recorded in the DRC.[53] 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.[50]
In November, it was reported that the EVD outbreak ran across two provinces and 14 health zones.[40] By 23 December, the EVD outbreak had spread to more health zones, and at that time 18 such areas had been affected.[54]
Becoming the 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,[55] 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.[56] Two days later the total count was nearly 100 cases.[57] On 16 August, the United Kingdom indicated it would help with EVD diagnosis and monitoring in the DRC.[58] 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 contained more contacts.[59] Some 954 contacts were successfully followed up on 18 August; however, Mandima Health Zone indicated resistance, so contacts were not followed up there.[60] 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.[61][50]
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.[62] 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.[63] 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.[64] On 26 October, the WHO indicated that half of confirmed cases were not showing any fever symptoms, thus making diagnosis more difficult.[65]
According to a September 2018 Lancet survey, 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.[66]
On 6 November 2018, the CDC indicated that the current 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.[67] On 13 November, the WHO indicated that the viral outbreak would last at least six months.[68]
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.[69] On 22 January, the total case count approached 1,000 cases, (951 suspected) in the DRC Ministry of Public Health situation report.[70] 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:
-
Mabalako between 16 July and 31 December 2018[71] -
Beni between 23 July 2018 and 28 January 2019[72] -
-
Western Africa Ebola Epidemic (for comparison with current outbreak).[74]
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.[75] According to the WHO, resistance to vaccination in the Kaniyi Health Zone was ongoing as of March 2019.[76] There was still a belief by some in surrounding areas that the epidemic was a hoax.[77]
(Note: total cases for this date does not reflect 52 suspected cases nor does it reflect the final case numbers)[12][78]
(Uganda has second most EVD cases '00–'01/425[79]
West African Ebola virus epidemic '13-'16/ >28,000[80])
Until the outbreak in North Kivu in 2018, no outbreak had surpassed 320 total cases in the Democratic Republic of the Congo. By 24 February 2019, the epidemic had surpassed 1,000 total cases (1,048).[81][82]
On 10 May 2019, the U.S. Centers for Disease Control and Prevention indicated that the outbreak could eventually surpass the West African epidemic.[83]
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".[84] On 25 November 2019, it was reported that 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.[85]
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.[86][87][88][89] This case was a man who had passed through three health checkpoints, with different names on traveller lists.[27] The WHO stated that he died in a treatment centre,[90] whereas according to Reuters he died en route to a treatment centre.[91] This case triggered the decision by the WHO to again reconvene an emergency committee,[26][27] where the situation was officially declared a Public Health Emergency of International Concern.[28]
On 30 July, a second case of EVD was confirmed in the city of Goma, apparently not linked to the first case.[92] Across the border from Goma in the country of Rwanda, Ebola simulation drills were being conducted at health facilities.[93] A third case of EVD was confirmed in Goma on 1 August.[94] On 22 August 2019, Nyiragongo Health Zone, the affected area on the outskirts of Goma, reached 21 days without further cases being confirmed.[95]
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.[96][97] 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.[98]
Uganda
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.[99] 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.[100][101] By 13 June 2019, nine treatment units were in place near the affected border.[102]
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.[103] On 20 September, Uganda indicated it was ready for immediate vaccination, should the Ebola virus be detected in any individual.[104][105]
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.[106][107]
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.[108] Vaccinations started on 7 November, and by 13 June 2019, 4,699 health workers at 165 sites had been vaccinated.[102] Proactive vaccination was also carried out in South Sudan, with 1,471 health workers vaccinated by 7 May 2019.[109]
On 2 January 2019, it was reported that refugee movement from the DRC to Uganda had increased after the presidential elections.[110] On 12 February, it was reported that 13 individuals had been isolated due to their contact with a suspected Ebola case in Uganda;[111] lab results came back negative several hours later.[112]
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 patient had died, while 2 more cases of Ebola infection within the same family were also confirmed.[17][113] On 14 June it was reported that there were 112 contacts since EVD was first detected in Uganda.[114] Ring vaccination of Ugandan contacts was scheduled to start on 15 June.[25] As of 18 June 2019, 275 contacts had been vaccinated per the Uganda Ministry of Health.[115]
On 14 July, an individual entered the country of Uganda from DRC while symptomatic for EVD; a search for contacts in Mpondwe followed.[116] On 24 July, Uganda marked the needed 42 day period without any EVD cases to be declared Ebola-free.[117] 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.[118]
Tanzania
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".[119][120][121] On 27 September, the CDC and U.S. State Department alerted potential travellers to the possibility of unreported EVD cases within Tanzania.[122]
The Tanzanian Health Minister Ummy Mwalimu stated on 3 October 2019 that there was no Ebola outbreak in Tanzania.[123] 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)".[124]
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.[125][126] On 12 January, the individual was released after 21 days without symptoms.[127]
The table which follows indicates confirmed, probable and suspected cases, as well as deaths; the table also indicates the multiple countries where these cases took place, during this outbreak.
| Date | Cases # | Deaths | CFR | Contacts | Sources | |||
|---|---|---|---|---|---|---|---|---|
| Confirmed | Probable | Suspected | Totals | |||||
| 2018-08-01†DRC | 4 | 22 | 0 | 26 | 20 | - | - | [128] |
| 2018-08-03 | 13 | 30 | 33 | 76 | 33 | 76.7%‡ | 879 | [129][130] |
| 2018-08-05 | 16 | 27 | 31 | 74 | 34 | 79%‡ | 966 | [131][132] |
| 2018-08-10 | 25 | 27 | 48 | 100 | 39 | 75%‡ | 953 | [133] |
| 2018-08-12 | 30 | 27 | 58 | 115 | 41 | - | 997 | [134] |
| 2018-08-17 | 64 | 27 | 12 | 103 | 50 | 55.6%‡ | 1,609 | [60] |
| 2018-08-20 | 75 | 27 | 9 | 111 | 59 | - | 2,408 | [135] |
| 2018-08-24 | 83 | 28 | 6 | 117 | 72 | 65%‡ | 3,421 | [136] |
| 2018-08-26 | 83 | 28 | 10 | 121 | 75 | 67.6%‡ | 2,445 | [137] |
| 2018-08-31 | 90 | 30 | 8 | 128 | 78 | 65%‡ | 2,462 | [138] |
| 2018-09-02 | 91 | 31 | 9 | 131 | 82 | - | 2,512 | [139] |
| 2018-09-07 | 100 | 31 | 14 | 145 | 89 | 68%‡ | 2,426 | [140] |
| 2018-09-09 | 101 | 31 | 9 | 141 | 91 | - | 2,265 | [141][142] |
| 2018-09-14 | 106 | 31 | 17 | 154 | 92 | 67.2%‡ | 1,751 | [143] |
| 2018-09-16 | 111 | 31 | 7 | 149 | 97 | - | 2,173 | [144][145] |
| 2018-09-21 | 116 | 31 | n/a | 147 | 99 | 67.3%‡ | 1,641 | [146] |
| 2018-09-23 | 119 | 31 | 9 | 159 | 100 | 67%‡ | 1,836 | [147] |
| 2018-09-28 | 126 | 31 | 23 | 180 | 102 | 65%‡ | 1,410 | [148] |
| 2018-10-02 | 130 | 32 | 17 | 179 | 106 | 65.4%‡ | Zdroj:https://en.wikipedia.org?pojem=2018–19_Kivu_Ebola_epidemic||