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August 2022 EVD case in DRC linked to 2018-2020 Nord Kivu EVD outbreak - Virological

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  • August 2022 EVD case in DRC linked to 2018-2020 Nord Kivu EVD outbreak - Virological

    August 22 2022


    The new case of Ebola Virus Disease in Beni is genetically linked to the 2018-2020 Nord Kivu/Ituri EVD outbreak and does not represent a new spillover event.**


    On Monday, August 15, 2022, the Institut National de Recherche Biomédicale (INRB) Beni mobile laboratory received an oropharyngeal secretion sample taken from a deceased patient who was being treated at the Beni General Reference Hospital (HGR-Beni). The sample tested positive for Ebola virus (EBOV) using the Cepheid Xpert Ebola assay with ct- values of 32.5 for viral glycoprotein (GP), and 28.2 for viral nucleoprotein (NP). For quality control and confirmation, samples were sent to the Rodolphe Mérieux INRB-Goma Laboratory on Tuesday August 16, 2022, where the analysis confirmed the EVD case.

    The patient was admitted on July 23, 2022 to the Internal Medicine department of the HGR-Beni for cough, headache, polyarthralgia, intense physical asthenia dating back several days and for which she had self-medicated with non-specified drugs. She was HIV-positive on antiretroviral treatment, and she had also presented with tuberculosis for which she was receiving anti-tuberculosis treatment. On August 13, 2022, her health condition deteriorated with the onset of bronchial congestion and kidney failure, which prompted her transfer to the intensive care unit for better care. She died on August 15, 2022. In total her hospitalization lasted 23 days. The body was collected by the family the same day for burial.

    On August 17, 2022, 131 contacts were listed, including 60 front-line healthcare workers and 71 co-patients. Of the 131 pre-listed contacts, 59 of the 60 HCWs are vaccinated. The vaccination status of the index case and 71 co-patients is not yet known.


    Sequencing analysis was conducted at the Rodolphe Mérieux INRB-Goma Laboratory, thanks to genomic support provided by the Africa CDC Pathogen Genomic Initiative.

    The swab sample, BEN1-22, was sequenced in triplicate (A/B/C) at the Pathogen Genomics Sequencing satellite Laboratory in Goma using the Oxford Nanopore Technologies (ONT) sequencing platform. Sequencing libraries were prepared using an amplicon sequencing approach (Mbala-Kingebeni, 2021; Grubaugh et al., 2019; Quick et al. 2017), generating identical genomes with 99.2%, 97% and 97.8% genome coverage, respectively.

    The genome sequence generated from sample BEN1-22 group with other sequences from the Nord Kivu/Ituri Ebola virus disease (EVD) outbreak between 2018 and 2020. The new sequence is most closely related to a cluster of cases occurring in Beni around November/December 2018 and had six additional mutations from this cluster. If the new EVD case was the result of continued human-to-human transmission we would have expected many more mutations to have occurred during this time. Therefore, our initial findings indicate that this case likely represents a new flare-up of the 2018-2020 Nord Kivu/Ituri EVD outbreak, initiated by transmission of Ebola virus from a persistently infected survivor or a survivor who experienced a relapse. This case may be the index case, or there may be previous cases that were not detected. Epidemiological investigations are ongoing to determine the source. ...

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