Health workers in the Democratic Republic of Congo are struggling to contain a rapidly growing Ebola outbreak in the country’s North Kivu and Ituri provinces.
The World Health Organization (WHO) announced Thursday that the outbreak, which was first reported in early August, had so far killed approximately 159 people (124 of those deaths were confirmed Ebola Virus Disease, or EVD cases, 35 considered “probable”). In total, 247 EVD cases have been reported so far, with 212 confirmed and dozens of others probable.
It is the second wide-scale Ebola outbreak the country has seen in less than a year. The first major outbreak was initially reported in May, and killed 33 people by the time it was contained in late July.
The grim outlook in this recent outbreak has been made worse by ongoing civil conflict in the region, as well as a high refugee population which is particularly vulnerable to the disease.
“Security incidents over the past week, ranging from clashes between rebel and government forces resulting in civilian deaths to response vehicles being pelted with stones, continued to cause community distress and severely impede response activities […],” WHO officials said Thursday. “These incidents are occurring amidst intense EVD transmission in communities in the city of Beni.”
More troubling is the fact that at least 17 of the 27 new EVD cases identified over the past week had no established contact with any other infected individuals. Dr. Mike Ryan, assistant director-general of the WHO’s emergency preparedness and response program, told STAT News the unmapped chains of transmission pose a particular threat to the containment process.
“There is underground community transmission in Beni. It may not be at a very intense level. But it is enough to continue and drive transmission in this town. And we need to stop it,” he said. “We need to pull the roots of this thing out of this city.”
As ThinkProgress previously reported, the North Kivu region is home to approximately 1 million internally displaced individuals. Most are refugees fleeing violence between government forces and armed rebel groups, such as Mai-Mai fighters and the Democratic Forces for the Liberation of Rwanda (FDLR). Population density, poor living conditions, and scant medical supplies contributed to the disease’s rapid spread, and health officials worry that it may spill over into neighboring Uganda, Rwanda, or South Sudan.
All three countries share heavily traveled transportation links and the possibility of refugees fleeing to nearby countries presents a real possibility that the disease may be carried outside DRC borders unbeknownst to health officials.
“Risk of the outbreak spreading to other provinces in the Democratic Republic of the Congo, as well as to neighbouring countries, remains very high with ongoing transmission in communities in North Kivu,” WHO officials stated. “Enhanced efforts are needed to ensure areas beyond the main affected health zones are prepared and operationally ready to rapidly detect, investigate and respond to any such exportations of the virus.”
Speaking to STAT, Ryan added that fears generated by the ongoing conflict in the region undoubtedly made any containment efforts that much more difficult.
“Beni is going to be a grind. There’s no other way to look at it,” he said. “This is rooting out an entrenched virus in an urban environment, in a traumatized population where there is clear compromises to security.”
Health workers have deployed and administered the new Ebola Zaire vaccine, V920, to 22,288 people so far, including several thousand children. Officials are using a ring vaccination method, tracking down anyone who may have had contact with an infected individual; 122 vaccination rings have been identified since the start of the outbreak.
Officials credited the early containment of the country’s previous outbreak to a swift vaccination process.
Ebola is a viral hemorrhagic fever found in nonhuman primates and fruit bats. It is typically transmitted to humans after contact with an infected animal or handling of tainted bush-meat.
The disease is passed between humans through blood or bodily fluids, such as breast milk, blood, saliva, urine, or semen, or through contaminated needles or syringes. It is not air- or water-borne.
Symptoms of EVD include fever, weakness, muscle pain, diarrhea, or vomiting, and, in the most severe cases, sudden bruising or hemorrhaging. It has an average case fatality rate (CFR) of around 50 percent.