On 11 June 2019, the Ugandan Ministry of Health (MoH) has confirmed a case of Ebola Virus Disease (EVD) in Kasese district, Uganda. The patient is a 5-year-old child from the Democratic Republic of Congo (DRC) who travelled with his family from Mabalako Health Zone in DRC after attending, on 1 June 2019, the funeral of his grandfather (confirmed EVD case on 2 June 2019). On 10 June 2019, the child and the family entered the country through Bwera border post and sought medical care at Kagando hospital where health workers identified Ebola as a possible cause of illness. The child was transferred to Bwera Ebola Treatment Unit (ETU) for management. The confirmation of Ebola Virus was made on 11 June 2019 at the Uganda Virus Research Institute (UVRI), and the child has deceased in the early hours of 12 June 2019. Two other suspected cases, a 50-year-old female (grandmother of the first case) and 3-year-old male (younger brother of the first case) part of the family members who travelled together with the first confirmed child were also admitted in the same ETU and were confirmed for EVD by UVRI on 12 June 2019. The 50 year-old-female died during the night between 12 and 13 June. 27 other contacts have been identified and are being monitored. Healthcare workers from both health care facilities where the child was treated have been previously vaccinated. All three confirmed cases are imported from DRC and belong to the same family who travelled together from Mabalako Health Zone, an area currently affected by Ebola outbreak in North Kivu, DRC. To date, they remain as a single episode of EVD in Uganda, and the geographical spread in Uganda appears to be limited to one district near DRC border. Further investigations are ongoing both in Uganda and DRC to assess the full extent of the outbreak.

The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) continues to show a decrease in the number of new cases in hotspots such as Katwa, Beni and Kalunguta health zones. However, in other areas such as Mabalako and Butembo, moderate rates of transmission continue. With ongoing EVD transmission within communities in 12 health zones in North Kivu and Ituri provinces, factors such as persistent delays in case detection, approximately a third of cases dying outside of Ebola treatment or transit centres, and high population mobility, pose a high risk of geographical spread both within the DRC and to neighbouring countries. This was highlighted by the recent exportation of cases to Uganda – the first confirmed cases detected outside of North Kivu and Ituri province since the onset of the outbreak over 10 months ago. For more information, please see Disease Outbreak News on EVD in Uganda Weekly decrease in the incidence of new cases have been reported in several health zones; however, increase or a continuation of the outbreak has been observed in others (Figure 1). In the 21 days, between 22 May to 11 June 2019, 62 health areas within 12 health zones reported new cases, representing 9% of the 664 health areas within North Kivu and Ituri provinces (Figure 2). During this period, a total of 212 confirmed cases were reported, the majority of which were from the health zones of Mabalako (33%, n=69), Butembo (18%, n=39), Katwa (14%, n=30) Mandima (11%, n=23) and Beni (9%, n=20). Single confirmed cases were also reported from Rwampara and Komanda health zones this past week following a prolonged period since the last reported case, with both cases acquiring the infection in the aforementioned hotspots.

As the Ebola virus disease (EVD) outbreak surpasses the 2000 case mark, indicators over the past two weeks provide early signs of an easing of the transmission intensity. This follows a period of improved security and therefore access to communities, allowing response teams to operate more freely. A total of 88 confirmed cases were reported each week for the past two epidemiological weeks, down from a peak of 126 cases per week observed in April. Declines in the incidence of new cases have been most apparent in hotspots such as Katwa, Mandima and Beni health zones. Concurrently, improvements in the proportion of cases among contacts registered prior to onset (up from 30% three weeks ago to 55% last week), and a lower proportion of cases resulting from transmission within community health facilities (from 31% during the first week of April 2019 to 9% during the last week of May 2019), are encouraging. Nevertheless, both indicators are below where we would aim to be. The outbreak continues to be contained within 12 active health zones in North Kivu and Ituri provinces. However, substantive rates of transmission continue within affected communities, and further waves of the outbreak may be expected. An increase in the incidence of new cases has been reported from Mabalako Health Zone in recent weeks, and high infection rates continue within Butembo metropolitan. Times between detecting, reporting and admission of cases at Ebola treatment/transit centres (ETCs) remains too long (median 6 days, interquartile range 4–9 days in the past 3 weeks), with about a third (34% in the past 3 weeks) of cases dying outside of ETCs. Collectively these indicators highlight that the risks associated with this outbreak remain very high.