During the past week, the incidence of new Ebola virus disease (EVD) cases has remained low (Figure 1). From 12 to 18 February, one new confirmed case was reported. The case was reported in Beni Health Zone, North Kivu Province and had an epidemiological link to a confirmed case reported on 5 February. As the case was alerted and transferred to an Ebola Treated Centre four days after symptom onset, there remains a risk that onward transmission to contacts may have occurred, and further cases may be expected from the currently active chain of transmission. Ebola virus may also persist in some survivors’ body fluids for several months, and in a limited number of instances, transmissions from exposure to body fluids of survivors have been documented during this outbreak. The ongoing programme for survivor care helps mitigate the risks of re-introduction events.

To maintain operations and prevent re-emergence of the outbreak, WHO is requesting funding. Under the Strategic Response Plan (SRP 4.1), WHO’s financial need for the Ebola Response from January to June 2020 is US $83 million. Thanks to the generosity of many donors during 2019, WHO has some carry-over funding, which has been applied to maintain operations through February 2020. USD $40 million is currently needed to ensure continuity of response and preparedness activities to bring the case incidence to zero, and continue building strong, resilient health systems.

From 1 January through 9 February 2020, 472 laboratory confirmed cases including 70 deaths (case fatality ratio= 14.8%) have been reported in 26 out of 36 Nigerian states and the Federal Capital Territory.

This week, the case incidence continued to be low in the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (Figure 1). From 5 to 11 February, three new confirmed cases were reported in Beni Health Zone, North Kivu Province. All three cases have epidemiological links to a transmission chain originating in Aloya Health Area, Mabalako Health Zone, with possible nosocomial exposure in Beni. The most recent case reported from Beni Health Zone on 11 February was isolated one day after symptom onset. Early detection of cases reduces the probability of transmission of EVD in the community and significantly improves the clinical outcome for the patients.

In the past 21 days (22 January to 11 February 2020), 12 confirmed cases, including three community deaths, were reported from four health areas within two active health zones in North Kivu Province (Figure 2, Table 1): Beni (n=11) and Mabalako (n=1). It has been 42 days since Katwa Health Zone has reported new cases. The continued reduction of geographic spread of EVD cases and the declining trend in case incidence observed in the past 21 days are encouraging; however, these improvements remain fragile and should not be interpreted as an indication that response efforts can be reduced. Continued vigilance is essential to improve infection prevention and control in health care facilities, as well as ensuring early identification and follow up of cases and contacts.

A 31-year-old male, from the Island of Chuuk (Micronesia), presented to our service with a large fungating shoulder mass. The mass originated 1 year ago as a blister-like lesion at the site of a prior tattoo and slowly expanded to encompass most of the shoulder. The lesion was intermittently painful and without dysesthesia. He lived in Missouri for the past 8 years after emigrating from Guam at age 23. He previously worked in construction and at a chicken processing facility. He denied prior history of incarceration, homelessness, or family contacts with known tuberculosis. He denied local trauma, intravenous drug abuse, breaks in the skin, or new tattoos prior to the start of the rash. Several years prior to the onset of his symptoms, a nonprofessional tattoo artist in Guam created a tattoo on his shoulder. He reported an uncertain amount of weight loss over the prior year with anorexia but denied cough, shortness of breath, or hemoptysis. After the rash started, he traveled back to Guam and reported no other travel.