The Ebola outbreak in North Kivu and Ituri provinces of the Democratic Republic of the Congo (DRC) grew by 9 cases today, according to a daily update from the country’s ministry of health.

There are now 453 cases (220 confirmed and 48 probable), including 268 deaths. Seventy-one people are still under investigation for possible infections.

Concerns about cases around Butembo

Yesterday, Doctors without Borders (MSF), one of the key response organizations working on this outbreak, said that several new cases have been in remote areas surrounding Butembo, one of the largest cities in North Kivu.

“We are very concerned by the epidemiological situation in the Butembo area,” said John Johnson, MSF project coordinator in Butembo, in a press release. Though the number of cases in recent days in Butembo is low, more cases in isolated districts to the east of the city have been appearing.

“We’re expecting this outbreak will last for a while, and we must increase our efforts to get it under control. With the agreement of the authorities, we have made a strategic decision to roll out our activities close to the affected populations and to organize training of key people in the community so that we can reach patients and their relatives,” Johnson said.

MSF said the number of beds at the Ebola treatment center (ETC) in Butembo has doubled in recent weeks, from fewer than 30 when the outbreak began in August to 64. MSF also opened a 48-bed transit center in Beni, the town that’s been the epicenter of the outbreak in the past 2 months.

MSF also said at least 2,000 vaccine recipients have been frontline health workers. According to the DRC ministry of health, 39,845 people have been vaccinated in the country.

Spurt of new cases in Komanda

Today, 6 of the new cases were reported in Komanda in Ituri province, one of the towns north of Butembo.  And three deaths in Komanda were listed as “community deaths,” which means they did not occur in an ETC or hospital.

Such cases raise the risk of transmission, because virus levels are at their highest at the time of death, and people caring for loved ones in community lack the type of personal protective equipment found in healthcare settings.

Officials from the DRC said the outbreak was linked to a confirmed case from Beni who died at an ETC last week. A vaccination team was dispatched to Komanda on Monday and has been vaccinating contacts.

The other three cases reported today were from Beni, Katwa, and Mabalako. Also, the ministry said eight more people died from their infections, lifting the fatality count to 268.

WHO says more US involvement not needed

According to the Associated Press (AP), World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, PhD, told reporters yesterday in Geneva that the WHO could “cover” the Ebola outbreak, in response to two recent editorials in the New England Journal of Medicine and  JAMA Network Open by American public health experts who argue the United States needs to send healthcare workers to the DRC to stop the outbreak.

In September the US State Department under White House orders pulled US Centers for Disease Control and Prevention (CDC) staff and other personnel from the region citing local violence and security concerns. CDC Director Robert Redfield, MD, has gone on record saying he disagrees with the decision. The CDC is currently sharing data and analysis with the WHO.

“We can mobilize from other parts, from those institutions who don’t have very strict security provisions like that,” Tedros told reporters at WHO headquarters, the AP said. “We can cover it.”

See also:

Dec 4 DRC update

Dec 3 MSF press release

Dec 3 AP story