The response to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo has seen significant improvements over the past weeks, including strong performances by field teams conducting vaccinations, and improved community engagement and risk communication in priority areas. However, as new cases continue to emerge from Beni and appear closer to security ‘red zones’, it is clear that risks remain and that strong response measures need to be prioritized. The virus’ spread is partly due to security conditions that severely impact frontline and health workers, at times forcing the suspension of response activities and increasing the risk that the virus may spread to neighbouring provinces and countries. The MoH, WHO and partners continue to rapidly adapt to these challenging circumstances, scaling up all pillars of the response: surveillance, contact tracing, community engagement, laboratory testing, infection prevention and control, safe and dignified burials, vaccination, and therapeutics. Due to the challenges faced in Democratic Republic of the Congo, the 1st Meeting of the 2018 International Health Regulations (IHR) Emergency Committee for Ebola Viral Disease in the Democratic Republic of the Congo took place on 17 October. Due primarily to the strength and tempo of current response operations, it was the view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not been met. The Committee further concluded that the current outbreak has several characteristics of particular concern: the risk of more rapid spread given EVD presence in urban environments; that there are several outbreaks in remote and hard to reach areas; and that health care staff have been infected. Risk of international spread also remains very high due to the outbreak’s proximity to significant regional traffic. Logistical challenges due to poor infrastructure continue to affect surveillance, case detection and confirmation, contact tracing, and access to vaccines and therapeutics.

On 31 May 2018, the State Ministry of Health (SMOH) of the Red Sea State in Sudan reported four suspected cases of chikungunya fever from Swakin locality, in Red Sea State. Among the signs and symptoms were sudden onset of fever, headache, joint pain and swelling, muscle pain and/or inability to walk. The first suspected case of chikungunya in the neighboring Kassala State was reported on 8 August 2018, in a male travelling from the Red Sea State. Since then cases have been reported in three localities of the State (Kassala, West Kassala and Rural Kassala). On 10 August, among 24 collected blood samples, 22 samples tested positive for chikungunya by PCR and ELISA at the National Public Health Laboratory (NPHL) in Khartoum. On 9 September, an additional 100 samples were collected and pooled in batches of ten: 50% of pools tested positive for mixed chikungunya and dengue viruses, and all pools were positive for chikungunya virus.

The response to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is becoming increasingly undermined by security challenges in at-risk areas, particularly Beni. These incidents severely impact both civilians and frontline workers, forcing suspension of EVD response activities and increasing the risk that the virus will continue to spread. WHO continues to distinguish between the incidents of conflict between rebel and government forces, and pockets of community push-back on the response. A recent increase in the incidence of new cases (Figure 1) is the result of the multitude of challenges faced by response teams. This also reflects improved active surveillance and reporting from the community. Since the last Disease Outbreak News (data as of 2 October), 29 new confirmed EVD cases were reported: 23 from Beni, four from Butembo, one from Mabalako, and one from Masereka Health Zones in North Kivu Province. Fifteen of these confirmed cases have been linked to known cases or were linked retrospectively through case to transmission chains within the respective communities, while fourteen recently reported cases remain under investigation.