altDisease outbreak news: 27 June 2019 - The Ebola virus disease (EVD) outbreak in the North Kivu and Ituri provinces continues at a stable pace this week. Although response operations were temporarily interrupted in Beni following two days of insecurity in the surrounding areas, operations have largely resumed. However, in the town of Musienene, violent threats persist against healthcare workers (HCW) and local security forces providing assistance to the response efforts. Furthermore, response activities in Kambau health area, Manguredjipa health zone were also suspended following security incidents.

Of growing concern this week, are the current hotspots of Mabalako, particularly the Aloya health area, and Mandima (Figure 1), which were the first health zones to report EVD cases in August/September 2018. Sporadic reintroduction events in areas such as Vuhovi, which had not reported any new cases in the past 24 days, further compound the evolving situation. Other areas experiencing a similar resurgence in EVD cases after a period of prolonged absence include Komanda and Masereka.

In the 21 days, between 5 to 25 June 2019, 67 health areas within 19 health zones reported new cases, representing 10% of the 664 health areas within North Kivu and Ituri provinces (Figure 2). During this period, a total of 252 confirmed cases were reported, the majority of which were from the health zones of Mabalako (35%, n=88), Beni (17%, n=43), Mandima (12%, n=30), Butembo (5%, n=13) , Musienene (5%, n=13) , Kalunguta (5%, n=12), and Katwa (5%, n=12). As of 25 June 2019, a total of 2277 EVD cases, including 2183 confirmed and 94 probable cases, were reported (Table 1). A total of 1531 deaths were reported (overall case fatality ratio 67%), including 1437 deaths among confirmed cases. Of the 2277 confirmed and probable cases with known age and sex, 57% (1287) were female, and 29% (663) were children aged less than 18 years. Cases continue to rise among health workers, with the cumulative number infected rising to 129 (6% of total cases).

In Mabalako, a total of 88 confirmed cases, with 61 concentrated in the Aloya health area, have been reported from 5-25 June. Multiple transmissions chains have been identified to be related to family connections, and 15 infections were associated with healthcare facility related infections. Currently, the main challenges present in Mabalako revolve around follow up of registered cases and the low number of alerts reported relative to the number of new EVD cases detected.

In Mandima, as of 25 June, a total of 30 cases have been reported in the past 21 days, with the majority of the cases (22) originating from Biakato Mines, Biakato Mayi, and Alima health areas. Six chains of transmission have been identified over that time period, with new cases being primarily attributed to individuals having contact with an infected family member or other patients in healthcare facilities. Timely investigation of alerts in Mandima to date have been suboptimal due to lack of access and insecurity, with only 73% of alerts being investigated thoroughly within the first 24 hours.

No new EVD cases or deaths have been reported in the Republic of Uganda since the previous EVD Disease Outbreak News publication on 13 June 2019. As of 26 June, 108 potentially exposed contacts have been identified and are under surveillance, including 13 who have completed followed up. Contacts will be visited daily for 21 days until the last contact completes follow-up on 3 July. All contacts remain asymptomatic to date. All 14 suspected cases reported to date have tested negative for EVD. On 26 June, ring vaccination of potential contacts was completed, with a total of 1063 individuals having consented and been successfully vaccinated, including 74 contacts (34 were not eligible for vaccination), 740 contacts of contacts, and 249 healthcare workers.