Africa CDC cautions against premature optimism over DRC Ebola outbreak

The Democratic Republic of the Congo's Ebola outbreak remains active in 45 health zones despite a recent decline in reported cases, with the Africa Centres for Disease Control and Prevention warning on Thursday that insecurity and community resistance may be concealing continued transmission.

The country had recorded 8,224 confirmed cases, including 3,982 deaths, as of Sept 29, with an overall case fatality rate of 48 percent, according to the latest report by Africa CDC.

Speaking at an online press briefing, Wessam Mankoula, head of the Continental Incident Management Support Team at Africa CDC, said the outbreak had expanded from three health zones in mid-May to 63 health zones across seven provinces.

Although the epidemic curve had largely plateaued over the previous four to five weeks, reported cases declined in the latest week, prompting concerns that surveillance disruptions could be obscuring the true scale of transmission.

"Falling in this curve doesn't mean that the outbreak is totally under control," Mankoula said.

He said insecurity and resistance from some communities had hampered surveillance and response activities, potentially preventing health teams from identifying and reporting infections in affected areas.

Despite the continued spread, Africa CDC reported progress in some areas. Seven of the 63 affected health zones had gone more than 42 days without reporting cases, while another 11 had recorded no cases for between 21 and 42 days. However, 45 health zones remained in active transmission, reporting cases within the previous three weeks.

The outbreak has also spread to areas bordering Uganda, Burundi, Rwanda, South Sudan, the Central African Republic, and the Republic of the Congo, underscoring the importance of cross-border coordination and preparedness, Mankoula said.

The agency reported differing trends across affected provinces. In Ituri, the outbreak's long time epicenter, reported cases declined by about 32 percent over the latest three-week period compared with the preceding three weeks, while North Kivu recorded an increase of approximately 4 percent.

Contact tracing remains a major weakness in the response. Mankoula said an average of about 14 contacts were being identified per confirmed case, far below the expected level of around 60. Although some reports put contact follow-up at approximately 78 percent, the proportion falls to about 23 percent when calculated against the estimated number of contacts requiring monitoring.

Nearly 80 percent of new cases are being detected outside known contact lists, complicating efforts to identify transmission chains and contain the outbreak.

"This is also one of the reasons...we cannot confidently say the outbreak is under control at this stage," Mankoula said.

The outbreak has also affected healthcare workers, with 254 infections recorded among medical personnel, including 50 deaths, he said.

Mankoula stressed that secure access to affected communities and public trust were essential to containing the outbreak, calling for stronger community engagement and improved access for response teams.

The United Nations has also warned that escalating violence in eastern DRC is further hampering the Ebola response.