The World Health Organization (WHO) yesterday in its weekly profile of Ebola activity aired growing concern about case spikes in two Democratic Republic of the Congo (DRC) areas—Mabalako and Mandima—that were hit hard when the outbreak began last August.

Meanwhile, the DRC health ministry yesterday reported 7 new cases, and the WHO's online Ebola dashboard says there will likely be 13 more today, which would lift the overall outbreak total to 2,297 cases.

Several recurrence worries

The WHO said new infections over the past week continued at a stable pace, as security incidents continued to plague the response. Operations in Beni have resumed after 2 days of disruptions, but violent threats against health workers continue in Musienene, and security problems in one area of Manguredjipa health zone suspended activities there.

Though the WHO is worried about disease reintroduction in Mabalako, especially in the Aloya health area, and Mandima, it said it is seeing the virus return to other areas, as well. Examples include Vuhovi, which had not reported any new cases in the past 24 days before reintroduction, with similar patterns in Komanda and Masereka.

In Mabalako, 61 of 88 confirmed cases were reported from Aloya in June, with multiple transmission chains related to families and 15 linked to healthcare facilities.

Meanwhile, Mandima has reported 30 cases in the past 3 weeks, most of them in four health areas where six transmission chains have been identified, mainly involving family members and patients in healthcare settings. The WHO said security problems in Mandima are hampering access and investigation of cases.

Breaking 'vicious cycle'

At a media briefing in Geneva today, Ibrahima Soce Fall, MD, PhD, WHO assistant director-general for emergency response, said a resurgence in cases in Beni, where four of the city's health areas have transmission chains, is concerning, because it is not far from Mabalako and Mandima, the latest hot spots. "It is important to break the vicious cycle," he said.

On a positive note, he said health officials have made good progress cutting transmission levels in Butembo and Katwa, hot spots that were rocked by serious disruptions a few months ago. Fall said the key to getting cases down to what is now just sporadic cases is decentralizing the response to target all 33 health areas in that region, focusing on interventions such as safe and dignified burials and household decontamination.

In other response developments, he said health officials are working on the next phase of a United Nations Ebola response scale-up that covers the next 6 months, and details on the plan are expected to be released Jul 8.

New cases, community engagement

The seven new cases reported by the DRC yesterday are from three different locations: Beni (5), Mabalako (1), and Rawmpara (1). Health officials are still investigating 328 suspected cases.

Also, 9 more people died from their Ebola infections, 2 in community settings in Beni and 7 in Ebola treatment centers, boosting the outbreak's fatality count to 1,540.

Yesterday health officials from the health ministry and its outbreak response partners met for a second time with community members in an area of Beni where two response teams were attacked on Jun 23. The talks were geared toward better understanding the community's concerns and toward engaging their support for Ebola response steps.

See also:

Jun 27 WHO statement

Jun 28 WHO media briefing audio file

Jun 27 DRC update

WHO online Ebola dashboard