Ebola shifts south to DR Congo's Butembo

Médecins Sans Frontières (MSF) said on 2 October that North Kivu now supplies nearly 40% of new confirmed Ebola cases in DR Congo, up from 24% in late August, with the area around Butembo, a trading city in the province, at the centre⁠¹. In North Kivu 59.7% of confirmed patients have died, according to the World Health Organization (WHO)⁠². MSF says a third of confirmed patients are being treated outside Ebola wards⁠³.

The outbreak, caused by Bundibugyo ebolavirus (a rarer Ebola species with no licensed vaccine or treatment), began in Ituri Province in the north-east. North Kivu logged 567 confirmed cases in the three weeks to 23 September, its highest incidence of the epidemic, though WHO reports a slight decline there since mid-September⁠⁴. Ituri added 868 over the same weeks and has been falling since a mid-August peak. In July North Kivu's isolation beds were already at 134% of capacity while Ituri held spare ones, so more of the new cases now arise in the province with the fewest beds.

Nationally, WHO's Disease Outbreak News bulletin 618 (DON618) counted 7,890 confirmed cases and 3,799 deaths across 63 health zones in seven provinces⁠⁵. That gives a case-fatality ratio (CFR, the share of confirmed patients WHO died) of 48.1%, up from 44.1% in late July. Cases stood above 5,200 on 24 August, so about 90 confirmed infections a day have been added since, against an average of about 52 a day over the outbreak's first hundred days.

On 27 September the health ministry under Samuel-Roger Kamba said the situation "is evolving favourably", citing fewer new cases and deaths, a lower share of positive tests and 78.3% of known contacts followed up⁠⁶. Five days later MSF published its North Kivu figures, and Stephanie Hoffmann, WHO runs MSF's Butembo treatment centre, likened the response to fighting "a megafire, with multiple simultaneous focal points". WHO's bulletin carries both readings: a real national decline, with a warning that the aggregate "conceals substantial variation".

Patients held on general wards can infect the staff and patients around them, as four health-worker deaths at Mongbwalu, a town in Ituri, showed in May. MSF says more than 60% of deaths now happen in the community, against two-thirds in July⁠⁷. Each of those deaths at home is a body washed and buried by relatives, outside any ward a bed count can measure.