The virus causing a major Ebola outbreak in the Democratic Republic of the Congo could be mutating, health officials said, as confirmed cases passed 4,000. Africa’s public health watchdog said the time for incremental action was over and announced plans to scale up every part of the response, including going “door to door” to find patients.
The outbreak, caused by the Bundibugyo strain of the virus, was first reported on 15 May, although there are suspicions the disease could have been spreading since January. There have been recorded as of 4 August, according to the DRC’s national public health institute. Speaking on Thursday, Dr Jean Kaseya, director general of the Africa Centres for Disease Control and Prevention (Africa CDC), told a press briefing cases had topped 4,000.
The outbreak is now the second-largest Ebola outbreak on record. There are eight times more cases, and six times more deaths, than were recorded 11 weeks into the West Africa Ebola outbreak in 2014-18, which infected more than 28,000 people and killed at least 11,000.
Kaseya said he had spoken to the director general of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, and they planned studies “to check if there is no additional issue, or maybe if the virus is not mutating. Because the of this Bundibugyo outbreak is unprecedented.”
More than two-thirds of Ebola deaths are happening in the community rather than in treatment centres. In a treatment centre run by MSF in Bunia, the capital of Ituri province, 90% of admitted patients do not appear on authorities’ lists of contacts of known cases. Both factors indicate high levels of untracked transmission.
Kaseya said contact tracing in the DRC was insufficient, with only 10 contacts identified for every Ebola patient, when about 40 would be the expected number.
Ebola is a viral haemorrhagic fever that can cause vomiting, diarrhoea, organ damage and internal bleeding. The outbreak is centred on the conflict-affected mining province of Ituri, but has spread to Nord-Kivu, Sud-Kivu, Haut-Uele and Tshopo. There were 20 cases recorded in neighbouring Uganda before it .
How are response teams changing their strategy?
Response teams plan to shift “from contact tracing to active case search”, which would mean community health workers “moving from door to door” asking households if they had anyone sick with Ebola symptoms. Dr Wessam Mankoula, acting head of emergency preparedness and response at Africa CDC, said the new approach was needed because the outbreak was expanding and contact tracing alone was not enough.
“I think the time for incremental action is over and we’re starting now the phase for scaling up.”
Kaseya promised a “village-centered response” that would involve communities, more use of digital tools and greater action in the camps for people who have been internally displaced by conflict in affected provinces.
Earlier coverage noted on 30 July that the World Health Organization said the Ebola outbreak in the DRC was the country’s biggest ever, with 3,605 confirmed cases and 1,587 deaths.
What other treatments and vaccines are being considered?
Officials said they planned to begin using antiviral remdesivir on a compassionate use basis to treat patients. They also plan to start testing whether Ervebo, a vaccine licensed for use against a different strain of Ebola, should be offered in the affected province after receiving data suggesting that Bundibugyo caused less serious disease and “zero death” among people who had received that jab.
“Seeing the expansion of this outbreak, only the public health measure will not be enough to quickly control or stop this outbreak,”
said Dr Placide Mbala Kingebeni, Africa CDC director of research, clinical trials and innovation.
What is happening beyond the main outbreak area?
DRC authorities said they were investigating a suspected Ebola death on a boat heading to the capital, Kinshasa, from the north-east of the country, and that the other passengers on board would be quarantined and tested. The development raised concern about further spread outside the provinces already affected.
Unicef warned that essential healthcare was being disrupted by the outbreak, as fear of infection and service disruptions kept families away from clinics. In the outbreak’s centre, the mining town of Mongbwalu, the proportion of children receiving their first measles dose has fallen 69%.
Why do officials think the outbreak may be harder to control?
Officials said more than two-thirds of Ebola deaths are occurring in the community, not in treatment centres, and that many patients are not being tracked as known contacts. In Bunia, 90% of admitted patients at the MSF treatment centre did not appear on authorities’ contact lists, while contact tracing in the DRC has identified only 10 contacts per Ebola patient instead of the expected 40.
The outbreak remains centred in Ituri, a conflict-affected mining province, but has spread to Nord-Kivu, Sud-Kivu, Haut-Uele and Tshopo. There were 20 cases recorded in neighbouring Uganda before it .
Health officials said the combination of conflict, population movement, weak contact tracing and limited case finding meant the response now needed to reach households directly and involve communities more closely.
Key Facts
- The outbreak was first reported on 15 May and is linked to the Bundibugyo strain.
- Confirmed cases passed 4,000, according to Africa CDC on Thursday.
- The DRC outbreak is now the second-largest Ebola outbreak on record.
- Authorities are considering remdesivir and possible use of Ervebo in the affected province.
- Unicef says essential healthcare services, including measles vaccination, are being disrupted.
