Democratic Republic of Congo (DRC) declared their tenth outbreak of Ebola in 40 years on 1 August 2018. The outbreak is centred in the northeast province of North Kivu. With the number of cases surpassing 300, it is now the country’s largest-ever Ebola outbreak. The World Health Organization (WHO) counts, as of 20 November 2018, a total of 386 cases in the country – 339 of those confirmed, and 219 of those cases resulting in deaths.
The Congolese Ministry of Health (MoH) and WHO declared the outbreak following a joint investigation, examining six cases of haemorrhagic fever, four of which were confirmed positive. The national laboratory (INRB) confirmed on 7 August that the current outbreak is of the Zaire Ebola virus variation, the most deadly strain and the same one that affected West Africa during the 2014-2016 outbreak. Ebola is spread human-to-human through direct contact via bodily fluids, and victims remain infectious for as long as their blood contains the virus.
On 6 August 2018, Médecins Sans Frontières (MSF) opened an isolation unit in Mangina, a town of 40,000 people in North Kivu’s Beni territory. By 14 August 2018 the 30-bed Ebola Treatment Centre (ETC) had expanded to 68 beds. The virus continued to spread during August and September, with both Ituri and North Kivu provinces now impacted, the majority of cases in North Kivu.
By October 2018 the epicentre had moved from Mangina to Beni, a city of 420,000 people, and the administrative centre of the Beni territory. North Kivu borders Uganda to the east and Rwanda to the southeast, while Ituri borders South Sudan in the north. Neighbouring states of the DRC are at risk of the virus spreading across the border.
With the epidemic so close to the Ugandan border, there is an increased risk of a spill over. The government of Uganda has started a vaccination campaign, targeting 3,000 front line workers as a preventive measure. The South Sudanese government have also announced the enhancement of its Ebola-related capacities, and some Rwanda Red Cross staff have attended a safe and dignified burial training in preparation.
Epidemiological teams are working to identify all active chains of transmission. This is not a simple task as local communities in the affected areas are highly mobile and move from village to village for work and family reasons, as well as to seek healthcare. Persons have been known to visit more than one health centre before being identified as potential carriers of the disease.
It is common for people to cross the border to visit relatives or trade goods at the market on each side of the DRC-Uganda border. Conflict in the region has put a strain on the work of ETCs, placing further stress on the humanitarian response and control of the outbreak.
New therapeutic treatments are offered to patients with confirmed Ebola infection under the MEURI protocol– Monitored Emergency Use of Unregistered Interventions. A team of clinicians makes the choice on an ad-hoc basis between five potential drugs. The treatments are given only with the informed consent of the patient (or a family member if they are too young or too sick to consent) and are provided in addition to supportive care, which includes oral and IV hydration, and treatment of other illnesses such as malaria. As they have not been tested, the efficacy of these drugs is uncertain. MoH and MSF ethical committees have approved their use on the basis of enhancing survival chances.
Aid workers and medical personnel remain on the ground, ready to assist DRC authorities and neighbouring states. It is uncertain at this point whether Uganda, Rwanda, or South Sudan will be affected with Ebola epidemics of their own. Communication with local communities and community leaders remains of the utmost importance in order to increase the adoption of preventative measures and strengthen outbreak response operations.
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Image courtesy of MONOSCU Photos via Flickr