Last reviewed: October 2018
Last updated: November  2018

Ebola outbreak in DRC: case numbers exceed 300 as outbreak enters fourth month

The World Health Organization (WHO) announced an Ebola outbreak in the Democratic Republic of the Congo (DRC) in August 2018. This new outbreak in the northeastern provinces comes soon after an outbreak in the western part of the country was declared over. WHO rate the risk of national and regional spread as very high.

As of 6 November 2018, 308 cases (273 confirmed and 35 probable) and 189 deaths have been reported in the North Kivu and Ituri provinces. This includes 28 cases in health care workers. Over 5000 contacts remain under active surveillance.

The affected areas share borders with Rwanda and Uganda. WHO notes that the prolonged humanitarian crisis and deterioration of security in this area may hinder the response to the outbreak. The response is becoming increasingly undermined by security challenges in at-risk areas, particularly Beni.

Ring vaccination in health care workers and contacts of Ebola patients using the rVSV-ZEBOV vaccine has started; 174 vaccination rings have been defined (in addition to 38 rings of health and frontline workers), and 27,360 contacts have been vaccinated including 9106 frontline health care workers and 7256 children.

Experimental treatments (mAb114, remdesivir, ZMapp, favipiravir, and REGN3470-3471-3479) have been approved for use in the current outbreak under the framework of compassionate use/expanded access.

WHO advises against any restriction of travel and trade to the DRC based on the currently available information.

The US Food and Drug Administration has approved a rapid, single-use test for the detection of Zaire ebolavirus . It is the second rapid antigen fingerstick test available under an emergency use authorisation, but is the first that uses a portable battery-operated reader which can provide results outside of laboratories.

Original source of update



History and exam

Key diagnostic factors

  • presence of risk factors
  • exposure to Ebola virus in previous 21 days
  • fever
  • myalgia
  • conjunctival injection

Other diagnostic factors

  • fatigue
  • diarrhoea
  • nausea/vomiting
  • severe headache
  • abdominal pain or heartburn
  • cough, dyspnoea, chest pain
  • sore throat
  • prostration
  • tachypnoea
  • maculopapular rash
  • bleeding
  • hepatomegaly
  • lymphadenopathy
  • hiccups
  • tachycardia
  • hypotension
  • neurological signs

Risk factors

  • living or working in, or arrival from, endemic area in previous 21 days
  • contact with infected body fluids
  • occupational exposure
  • butchering or consumption of meat from infected (or potentially infected) animals
  • bioterrorism

Diagnostic investigations

1st investigations to order

  • reverse transcriptase-polymerase chain reaction (RT-PCR)
  • malaria investigations
Full details

Investigations to consider

  • serum electrolyte levels
  • serum creatinine and urea
  • blood lactate
  • ABG
  • FBC
  • coagulation studies
  • urinalysis
  • LFTs
  • serum amylase level
  • serum blood glucose
  • blood cultures
  • antigen-capture enzyme-linked immunosorbent assay (ELISA)
  • IgM and IgG antibodies
  • chest x-ray
Full details

Emerging tests

  • rapid bedside tests
Full details

Treatment algorithm



Authors VIEW ALL

Senior Lecturer (Honorary Consultant)

Liverpool School of Tropical Medicine and Royal Liverpool University Hospital




NJB is an author of several references cited in this monograph. NJB is partially supported by the National Institute of Health Research Health Protection Unit in Emerging and Zoonotic Infections at the University of Liverpool and Public Health England. He is affiliated with the Liverpool School of Tropical Medicine. Views expressed in this monograph are those of the contributor and do not necessarily represent the official position of the National Health Service, the National Institute for Health Research, the Department of Health, or Public Health England.

Specialist Trainee in Infectious Diseases

Royal Liverpool University Hospital




MF declares that he has no competing interests.

Wellcome Trust/MoD Research Fellow

Liverpool School of Tropical Medicine




TEF is an author of a number of references cited in this monograph. TEF is a consultant to the World Health Organization, and is funded by the UK Surgeon General and the Wellcome Trust.

Clinical Lecturer

University College London

Honorary Clinical Lecturer

London School of Hygiene and Tropical Medicine




CFH declares that she has no competing interests.

Dr Nicholas J. Beeching, Dr Manuel Fenech, Dr Tom E. Fletcher, and Dr Catherine F. Houlihan would like to thank Dr Colin Brown (Infectious Disease Lead, Kings Sierra Leone Partnership) for his helpful comments and insights. CB declares that he has no competing interests.

Peer reviewers VIEW ALL

Wade Hampton Frost Professor of Epidemiology

Professor of Medicine, Microbiology, and Pathology


Division of Infectious Diseases and International Health

University of Virginia




WAP declares that he has no competing interests.

Professor of Medicine and Epidemiology

UT Health Medical School

Medical Director of Epidemiology

Memorial Hermann Texas Medical Center




LO-Z declares that he has no competing interests.

Consultant in Microbiology and Infectious Diseases

Royal Free London NHS Foundation Trust




SM declares that he has no competing interests.

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