Kivu Ebola epidemic
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]
This article is about an Ebola virus outbreak in the Democratic Republic of the Congo and Uganda. For the prior Ebola outbreak in DRC, see 2018 Équateur province Ebola outbreak.Date
1 August 2018 – 25 June 2020[1]
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]
![Mabalako between 16 July and 31 December 2018[71]](http://upload.wikimedia.org/wikipedia/commons/thumb/c/cb/Weekly_Ebola_cases_18_Mabalako.svg/225px-Weekly_Ebola_cases_18_Mabalako.svg.png)
![Beni between 23 July 2018 and 28 January 2019[72]](http://upload.wikimedia.org/wikipedia/commons/thumb/0/02/Weekly_Ebola_cases_18-19_Beni.svg/225px-Weekly_Ebola_cases_18-19_Beni.svg.png)
![Katwa (orange) and Butembo (purple) between 23 July 2018 and 4 February 2019[73]](http://upload.wikimedia.org/wikipedia/commons/thumb/2/2d/Weekly_Ebola_cases_18-19_Butembo_und_Katwa.svg/225px-Weekly_Ebola_cases_18-19_Butembo_und_Katwa.svg.png)
![Western Africa Ebola Epidemic (for comparison with current outbreak).[74]](http://upload.wikimedia.org/wikipedia/commons/thumb/1/16/2014_West_Africa_Ebola_Epidemic_-_New_Cases_per_Week.svg/225px-2014_West_Africa_Ebola_Epidemic_-_New_Cases_per_Week.svg.png)
Ebola virus is found in a variety of bodily fluids, such as breast milk, saliva, stool, blood, and semen, rendering it highly contagious due to ease of contact. Although a few transmission methods are known, there is a possibility that many other methods are unknown and must be further researched. Here are some potential routes of transmission:[280][281]
Those infected by EVD generally gain immunity, although it is considered possible that such immunity is only temporary.[282] On 31 October 2019, it was reported that an EVD survivor who had been assisting at a treatment center in Beni had been reinfected with EVD and died; such an incident was unprecedented.[283]
Statistical measures[edit]
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.[360] A March 2019 paper by Tariq et al. suggested that R0 was oscillating around 0.9.[361]
Subsequent outbreaks and other regional health issues[edit]
2020 Équateur province[edit]
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. This area was the site of the 2018 Équateur province Ebola outbreak, which infected 53 people and resulted in 29 deaths. That outbreak was quickly brought under control with the use of the Ebola vaccine.
Genome sequencing suggested that this 2020 outbreak, the 11th outbreak since the virus was first discovered in the country in 1976, was 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 was expected that more people would be identified as surveillance activities increased.[275]
The WHO assisted with the response to this outbreak in part using the structures put in place for the 2018 outbreak. Testing and contact tracing was used and additional medical staff had been sent in.[371] Médecins Sans Frontières was also on hand to give assistance if needed. The outbreak added to an already difficult time for the Congo due to both COVID-19 cases and a large measles outbreak that has caused more than 7,000 deaths as of August 2020.[35]
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.[372] By 15 June the case count had increased to 17 with 11 deaths, with more than 2,500 people having been vaccinated.[373] On 17 October, it had increased to 128 cases and 53 deaths, despite an effective vaccine being available.[374] As of 18 November, the World Health Organization has had no reported cases of Ebola in Équateur province for 42 days; therefore the outbreak is over.[36] In the end there were 130 cases and 55 dead due to the virus.[37]