An Ebola outbreak in North Kivu province in the Democratic Republic of Congo may be worse than initially realized, health officials say, with dozens of deaths potentially linked to the burgeoning epidemic.
The outbreak in question was first reported earlier in August, one week after a previous epidemic in the country was declared over. That epidemic, which was primarily centered in Equateur province, some 1,500 miles away, killed 33 people and infected dozens more, but was largely contained due to a rapid global response effort and the deployment of a new Ebola Zaire vaccine, V920.
According to the World Health Organization, the DRC Ministry of Health and its regional partners have reported another 36 deaths related to the current outbreak in North Kivu, with a total of 44 Ebola virus disease (EVD) cases suspected. An additional 47 suspected cases are currently undergoing testing to confirm EVD.
“The Ministry of Health, WHO, and partners are working to establish the full extent of this outbreak,” WHO spokespersons stated Saturday. “As of 3 August 2018, a total of 43 Ebola virus disease cases (13 confirmed and 30 probable), including 33 deaths, have been reported. …Three healthcare workers have been affected, of whom one has died.”
Officials on Tuesday updated the number of confirmed cases to 16, with 27 others “probable.” By Friday, WHO officials had updated the death toll to 36, with 44 EVD cases overall.
The North Kivu outbreak is currently confined to five health zones — Mabalako, Beni, Oicha, Musienene, Butembo — and the Mandima health zone in Ituri province.
Unlike the previous epidemic, the North Kivu outbreak also has the potential to transmit more rapidly and with greater aggression, given its location. The affected region is home to more than one million displaced individuals, most of them refugees in their own country, fleeing violence between the government and armed rebel groups, such as Mai Mai fighters and other militants. The region also shares a border with Rwanda and Uganda, and “frequent…border movement” due to trade presents a vehicle through which the virus might spread.
“The prolonged humanitarian crisis and deterioration of the security situation is expected to hinder response to this outbreak,” WHO officials added.
Health officials believe the outbreak may be related to the Ebola Zaire species of the virus, but unrelated to the previous epidemic.
The Ministry of Health appears to be taking no chances this time, with workers already set to deploy the V920 vaccine once more as they did in the last outbreak. During the Equateur outbreak, health workers used a ring vaccination method, inoculating anyone who may have had contact with an infected person, to prevent them from spreading the disease themselves. Health officials working to stop the current epidemic have approximately 3,220 doses of the Merck-manufactured vaccine at their disposal, and have requested more.
“The potential for use of Ebola vaccines, as well as therapeutics for treatment of Ebola virus disease, are being reviewed,” WHO spokespersons said Saturday. “…Contact tracing activities have been initiated. Thus far, 879 contacts have been registered for follow-up.”
For the time being, health workers and rapid response teams from the WHO have begun setting up labs and facilities for diagnosing possible EVD cases. Officials have also established several treatment centers in Mangina, Beni, and Goma.
WHO spokespersons said the current health risk is high at the regional and national level, but low at the international level.
Ebola is a viral hemorrhagic fever found predominantly in nonhuman primates and fruit bats. It can be transferred to humans after contact with an infected animal and through handling tainted bush-meat. The disease is passed between humans through blood or bodily fluids like saliva, sweat, urine, semen, or breast milk, but is not air- or water-borne. Infected persons typically exhibit flu-like symptoms such as fever, muscle pain, weakness, diarrhea, and vomiting, and some may experience sudden hemorrhaging or bruising.
Although the disease has a case fatality rate of 50 percent — meaning it kills roughly half of those it infects — viral disease experts say its ability to live undiagnosed in a host for prolonged amounts of time has upped the threat even further.
A paper published by The Lancet in July revealed hosts may carry the dormant virus for months — if not years — after becoming infected, with no symptoms. The paper’s authors cited a case in Liberia in 2015, in which a mother who had contracted Ebola during an August 2014 outbreak, but was never diagnosed, unintentionally passed the virus to her two sons and husband, after living with the disease symptom-free for a year.
“These findings underscore the need for focused prevention efforts among survivors and sustained capacity to rapidly detect and respond to new Ebola virus disease cases to prevent recurrence of a widespread outbreak,” the authors wrote.
Global health officials appear to be doing just that. “As investigations continue to establish the full extent of this outbreak, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities,” WHO spokespersons wrote Saturday, likely referring to the need for dedicated monitoring efforts in Rwanda and Uganda. “WHO will continue to work with neighbouring countries to ensure health authorities are alerted and prepared to respond.”
This article has been updated to reflect the latest cumulative case count from the WHO, which on Friday raised the death toll in the North Kivu outbreak from 34 to 36, with 44 EVD cases reported overall. It has also been updated to include the fact that health workers have taken steps to begin vaccinated those who had contact with an infected individual.