As indicated below and per numbers offered by the United Nations the final death toll was 2,280 with a total of 3,470 cases in DRC in almost a two year period. This was made very difficult due to the ongoing military attacks in the region which created a perfect storm for the virus, despite there being a vaccine. rVSV-ZEBOV or Ebola Zaire vaccine live, is a vaccine that prevents Ebola caused by the Zaire ebolavirus. The graph of reported cases reflects cases that were not able to have a laboratory test sample before burial as probable cases. Note Above graph begins in Aug. 2018 at one month intervals, then progresses to two month intervals as the outbreak intensifies at beginning of 2019, then finally has a four month interval until it is declared over (due to a flare up just days prior to the first two 21 day period to call the outbreak over per WHO, which caused a restart of the coutdown)*2018–19<unk>  (total cases-deaths as of 25 June 2020)*x indicates (2) 21 day periods have passed and outbreak is over Democratic Republic of the Congo Map of the Democratic Republic of the Congo; North<unk>  (orange, middle) South<unk>  (dark red, bottom) and Ituri (green, top) On 1 August 2018, the North<unk>  health division notified Congo's health ministry of 26 cases of hemorrhagic fever, including 20 deaths. Four of the six samples that were sent for analysis to the National Institute of Biological Research in Kinshasa came back positive for Ebola and an outbreak was declared on that date. The index case is believed to have been the death and unsafe burial of a 65-year-old woman on 25 July in Mangina, quickly followed by the deaths of seven close family members. This outbreak started just days after the end of the outbreak in Équateur province.On 1 August, just after the Ebola epidemic had been declared, Doctors Without Borders/Médecins Sans Frontières (MSF) arrived in Mangina, the point of origin of the outbreak, to mount a response. On 2 August, Oxfam indicated it would be taking part in the response to this latest outbreak in the DRC. On 4 August, the WHO indicated that the current situation in the DRC, due to several factors, warranted a "high risk assessment" at the national and regional level for public health. By 3 August, the virus had developed in multiple locations; cases were reported in five health zones – Beni, Butembo, Oicha, Musienene and Mabalako – in North<unk>  province as well as Mandima and Mambasa in Ituri Province. However, one month later there had been confirmed cases only in the Mabalako, Mandima, Beni and Oicha health zones. The five suspected cases in the Mambasa Health Zone proved not to be EVD; it was not possible to confirm the one probable case in the Musienene Health Zone and the two probable cases in the Butembo Health Zone. No new cases had been recorded in any of those health zones. WHO chief Tedros Adhanom Ghebreyesu indicated on 15 August that the outbreak then in the DRC might be worse than the West African outbreak of 2013–2016, with the IRC connecting this to the ongoing<unk>  conflict. The<unk>  outbreak was the biggest of the ten recorded outbreaks recorded in the DRC.The first confirmed case in Butembo was announced on 4 September, the same day that it was announced that one of the cases registered at Beni had actually come from the Kalunguta Health Zone. In November, it was reported that the EVD outbreak ran across two provinces and 14 health zones. By 23 December, the EVD outbreak had spread to more health zones, and at that time 18 such areas had been affected. Becoming the 2nd biggest EVD outbreak On 7 August 2018, the DRC Ministry of Public Health indicated that the total count had climbed to almost 90 cases, and the Uganda Ministry of Health issued an alert for extra surveillance as the outbreak was just away from its border. Two days later the total count was nearly 100 cases. On 16 August, the United Kingdom indicated it would help with EVD diagnosis and monitoring in the DRC. On 17 August 2018, the WHO reported that there were around 1,500 "contacts", while noting that certain conflict zones in the DRC that could not be reached might have contained more contacts. Some 954 contacts were successfully followed up on 18 August; however, Mandima Health Zone indicated resistance, so contacts were not followed up there.On 4 September, Butembo, a city with almost one million people and an international airport, recorded its first fatality in the Ebola outbreak. The city of Butembo, in the DRC, has trade links to nearby Uganda. On 24 September, it was reported that all contact tracing and vaccinations would stop for the foreseeable future in Beni due to a deadly attack by rebel groups the day before. On 25 September, Peter Salama of the WHO indicated that insecurity was obstructing efforts to stop the virus and believed a combination of factors could establish conditions for an epidemic. On 18 October, the U.S. Centers for Disease Control and Prevention (CDC) raised its travelers' alert to the DRC from a level 1 to level 2 for all U.S. travelers. On 26 October, the WHO indicated that half of confirmed cases were not showing any fever symptoms, thus making diagnosis more difficult. According to a September 2018 Lancet survey, 25% of respondents in Beni and Butembo believed the Ebola outbreak to be a hoax. These beliefs correlated with decreased likelihood of seeking healthcare or accepting vaccination. On 6 November 2018, the CDC indicated that the current outbreak in the east region of the DRC was potentially non-containable. This would be the first time since 1976 that an outbreak was not able to be curbed. On 13 November, the WHO indicated that the viral outbreak would last at least six months. On 29 December 2018, the DRC Ministry of Public Health announced that there had been "0 new confirmed cases detected because of the paralysis of the activities of the response in Beni, Butembo, Komanda and Mabalako" and no vaccination had occurred for three consecutive days. On 22 January, the total case count approached 1,000 cases, (951 suspected) in the DRC Ministry of Public Health situation report. The graphs below demonstrate the EVD intensity in different locations in the DRC, as well as in the West African epidemic of 2014–15 as a comparison: File:Weekly Ebola cases 18 Mabalako.Mabalako between 16 July and 31 December 2018 File:Weekly Ebola cases 18-19 Beni.Beni between 23 July 2018 and 28 January 2019 File:Weekly Ebola cases 18-19 Butembo und Katwa.Katwa (orange) and Butembo (purple) between 23 July 2018 and 4 February 2019 File:2014 West Africa Ebola Epidemic - New Cases per Week.Western Africa Ebola Epidemic (for comparison with current outbreak). On 16 March 2019, the director of the CDC indicated that the outbreak in the DRC could last another year, additionally suggesting that vaccine supplies could run out. According to the WHO, resistance to vaccination in the Kaniyi Health Zone was ongoing as of March 2019. There was still a belief by some in surrounding areas that the epidemic was a hoax. Democratic Republic of the Congo EVD outbreaks 1976-9 November 2018 (Note: total cases for this date does not reflect 52 suspected cases nor does it reflect the final case numbers)(Uganda has second most EVD cases '00–'01/425West African Ebola virus epidemic '13-'16/ >28,000) Until the outbreak in North<unk>  in 2018, no outbreak had surpassed 320 total cases in the Democratic Republic of the Congo. By 24 February 2019, the epidemic had surpassed 1,000 total cases (1,048). On 10 May 2019, the U.S. Centers for Disease Control and Prevention indicated that the outbreak could eventually surpass the West African epidemic. The 12 May 2019 issue of WHO Weekly Bulletin on Outbreaks and Other Emergencies, indicates that "continued increase in the number of new EVD cases in the Democratic Republic of the Congo is worrying...no end in sight to the difficult security situation". On 25 November 2019, it was reported that violence had broken out in Beni again, to such a degree that some aid agencies had evacuated. According to the same report, around 300 individuals might have been exposed to EVD via an infected individual. Spread to Goma On 14 July 2019, the first case of EVD was confirmed in the capital of North<unk> , Goma, a city with an international airport and a highly mobile population of 2million people located near the DRC's eastern border with Rwanda. This case was a man who had passed through three health checkpoints, with different names on traveller lists. The WHO stated that he died in a treatment centre, whereas according to Reuters he died en route to a treatment centre. This case triggered the decision by the WHO to again reconvene an emergency committee, where the situation was officially declared a Public Health Emergency of International Concern. On
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