The current Ebola outbreak in northeastern Democratic Republic of Congo (DRC) likely began in May but wasn’t declared until August 1 after a case was reported in Mangina, North Kivu. As of October 16, the number of Ebola cases has reached 216 (181 confirmed). Of these, 139 people have died (104 of which were confirmed cases), indicating that the outbreak is far from over.
The epidemiological situation is worrisome. So far, health officials in North Kivu and Ituri provinces—including Mandima, Mabalako, Beni, Oicha, Butembo, Kalunguta, Masareka, and Musienene—have reported confirmed or probable cases of Ebola. While the spread of the epidemic appears to be slowing in the the epicenter of Mangina, in the Mabalako health zone, a new confirmed case was recorded on September 23. Doctors Without Borders/Médecins Sans Frontières (MSF) is particularly concerned by the scattered pattern of the outbreak and the fact it has now spread to Butembo, a city of about one million people. Worryingly, the number of cases in the city of Beni also increased considerably in October, and a new case was recorded in Tchomia on September 20, near the Ugandan border.
While more than 1,842 contacts have been identified and more than 1,704 are being followed up by the Congolese Ministry of Health (MoH), epidemiological teams are still working to identify all active chains of transmission.
What’s different about this outbreak?
While this outbreak of Ebola is the tenth to occur in DRC, the fact that it is occurring in a densely populated area marked by conflict and regular population movement complicates efforts to educate people about the disease, identify and track deaths and active chains of transmission, and trace contacts of those infected. In any Ebola response, community outreach and health promotion activities are essential to gain the trust of the community and curb the spread of the disease.
Further complicating matters, North Kivu shares a border with Uganda to the east. This area sees a lot of trade, and some communities straddle the border. It is quite common for people to cross into Uganda to visit relatives or trade goods, raising risks of transmission across the border and the spread of the virus throughout the region.
How are MSF and other actors responding?
At the request of the MoH, MSF is part of the task force coordinating the response to the outbreak and is focusing on the traditional “six pillars” of Ebola response: isolation and proper care for the sick, surveillance, health promotion, contact tracing, safe burials, and the protection of the regular health care system. MSF currently has more than 330 staff members working in Ebola projects in North Kivu and Ituri.
Within a week of the declaration of the outbreak MSF improved an isolation unit for suspected and confirmed cases in the Mangina Health Center, located at the epicenter of the outbreak, where patients were isolated and cared for while an Ebola Treatment Center (ETC) was built (the ETC opened on August 14). MSF currently works in collaboration with the MoH in ETCs in Mangina, Butembo, and Tchomia and, as of September 22, we had treated 74 patients confirmed to have Ebola and admitted 195 for testing for the virus in Mangina and Butembo.
MSF teams in Uganda have also mobilized to prepare for the possibility of the outbreak crossing the border, opening an isolation tent in Bwera, a small town directly across the border from Beni and Butembo. Teams have also added an isolation tent at MSF’s regular project in Hoima, Uganda.
Which vaccines and treatments are being offered?
Soon after the outbreak was declared, the World Health Organization and MoH began providing the Ebola vaccine to people who had come into contact with those infected. Soon after, MSF began offering vaccinations to front line health workers, people involved in burials, and religious figures, all of whom run a higher risk of contracting Ebola. So far, 13,750 people have been vaccinated. This vaccine, rVSVDG-ZEBOV, works against the Zaire Ebola virus, the deadliest species and the same one that affected West Africa in the 2014–2016 epidemic and the Equator province of western DRC earlier this year.
As the outbreak continues to spread, MSF is bringing novel medical approaches to bear to prevent new infections and improve survival chances for those who have contracted Ebola. For example, MSF has started testing blood samples of suspected cases in laboratories within the ETCs themselves, rather than in an outside lab, allowing teams to react faster to the changing medical conditions of patients.
Additionally, for the first time during an Ebola outbreak, five developmental drugs (Favipiravir, Remdesivir (GS5734), REGN3470-3471-3479, ZMapp, and mAb114) have been approved for use under Monitored Emergency Use of Unregistered and Investigational Interventions (MEURI) protocol (with informed consent of the patient or a family member if they are too young or too sick to consent). The presence of on-site testing capability means people who test positive for the virus can be offered these new treatments within 24 hours of case confirmation.