The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo, continues to present challenges in response, as security incidents and community resistance to response measures persist. Since our last report on 16 January 2019, 41 additional confirmed EVD cases and 31 deaths have been reported.

From the beginning of the outbreak to 21 January 2019, a total of 699 EVD cases, including 650 confirmed and 49 probable cases, were reported from 18 health zones in the provinces of North Kivu and Ituri. Thirteen of these health zones have ongoing active transmission, reporting at least one confirmed case in the last 21 days (1 – 21 January 2019). Over this period, a total of 94 confirmed and probable cases were reported, with 56% (53/94) reported from Katwa Health Zone alone. Overall, the majority of the cases occurred in urban centres and towns including Katwa (53), Butembo (12), Oicha (6), Kayna (4), Kyondo (3), Vuhovi (3), Beni (2), Biena (2), Kalunguta (2), Komanda (2), Mabalako (2), Musienene (2), and Manguredjipa (1). Trends in case incidence reflect the continuation of the outbreak across a geographically widely dispersed area with a decline in the number of cases in Beni and increase of reported cases, especially in Katwa.

As of 21 January 2019, a total of 433 deaths were reported, including 384 deaths among confirmed cases. The case fatality ratio among confirmed cases is 59% (384/650). Women are disproportionately affected, accounting for 62% of total reported cases. Cases among pregnant women and children <1 year of age continue to be reported with a total of 29 pregnant and 18 breastfeeding women among the reported cases thus far. The total number of cases among children ><1 year of age is 6% (43/680) and among children ><5 years is 15% (105/680).>

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 alerts outside the outbreak affected areas have been ruled out for EVD.
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