The Ebola outbreak in the Democratic Republic of the Congo has spread to a sixth province, Bas-Uele, after a man who had travelled from Isiro in Haut-Uele province died in the provincial capital Buta, according to Jean Kaseya, director general of Africa CDC. The death toll has surpassed 2,100 from more than 4,500 recorded cases, and WHO Director-General Tedros Adhanom Ghebreyesus said on Wednesday that the outbreak is on track to eclipse the 2014–2016 West African crisis, the deadliest on record.
DRC Ebola outbreak reaches sixth province as death toll tops 2,100 and study identifies new animal-to-human transmission
The Ebola outbreak in the Democratic Republic of the Congo has spread to a sixth province, Bas-Uele, after a man who had travelled from Isiro in Haut-Uele province died in the provincial capital Buta, according to Jean Kaseya, director general of Africa CDC. The death toll has surpassed 2,100 from more than 4,500 recorded cases, and WHO Director-General Tedros Adhanom Ghebreyesus said on Wednesday that the outbreak is on track to eclipse the 2014–2016 West African crisis, the deadliest on record.
The current outbreak involves the rare Bundibugyo strain of the Ebola virus, for which no approved vaccines or treatments exist, according to both sources. The 2014–2016 outbreak involved a different strain, Zaire ebolavirus, and the vaccine developed in response to that crisis does not work against the Bundibugyo strain.
A study published this week in the medical journal Nature Medicine, involving researchers from the DRC, Uganda, Belgium and other countries, analysed the genetic make-up of virus samples from 22 patients in the DRC and Uganda. The researchers found the outbreak strain was genetically distinct from Bundibugyo viruses seen in outbreaks in 2007 and 2012, and concluded it originated from a new animal-to-human transmission event rather than from continued circulation or re-emergence of a previous human outbreak. The animal source has not been specified.
Infectious diseases physician Krutika Kuppalli explained that the finding of a new zoonotic spillover does not mean a new form of Ebola has emerged or that animals are now transmitting the virus differently. 'After that initial spillover, the outbreak has been driven predominantly by human-to-human transmission,' she said, according to Al Jazeera. She also noted that the animal origin of the virus does not change required treatment, as management is based on the virus causing the illness and the patient's clinical condition.
Kaja Abbas, associate professor of infectious disease epidemiology and dynamics at the London School of Hygiene and Tropical Medicine and Nagasaki University, told Al Jazeera that it is the human-to-human transmission dynamics of the Bundibugyo virus that make the outbreak dangerous, beyond the initial zoonotic spillover.
WHO's director for health emergency alert and response operations, Dr Abdirahman Mahamud, said the agency's moderate projection has the outbreak peaking within six months, while under a more severe scenario it could last nine to twelve months, according to Al Jazeera.
The outbreak was formally declared on 15 May, though WHO says genetic sequencing shows the virus had been circulating since February. Health authorities have said between 60 and 70 percent of new cases are recorded outside contacts being monitored. WHO Regional Director for Africa Dr Mohamed Yakub Janabi said this week, according to The Guardian: 'We are chasing the virus; the virus is ahead of us.'
The death toll has been reached almost three times faster than during the 2014–2016 West African outbreak, according to The Guardian. Al Jazeera describes the current outbreak as the fastest-moving on record.
The outbreak is taking place amid strikes by some unpaid health workers, threats from rebel groups, community distrust, and misinformation asserting that Ebola is not real, according to The Guardian. Health workers at the Nizi treatment centre in Ituri province went on strike, leading to its temporary closure, after reporting they had not been paid for three months. Clinical trials of two possible treatments for this type of Ebola began last month in Ituri, according to The Guardian.
Al Jazeera also reported that the outbreak in Uganda was linked to the outbreak in the DRC, according to the Nature Medicine study.
Where sources differ
- The total death toll figure differs slightly between sources: The Guardian reports more than 2,100 deaths from more than 4,500 cases, while Al Jazeera reports more than 2,000 deaths from 4,449 cases. The difference likely reflects different reporting timestamps.
- The 2014–2016 West African death toll is given as 'more than 11,000' by The Guardian and 'at least 11,300' by Al Jazeera, with Al Jazeera also citing 28,600 reported cases for that outbreak; The Guardian does not provide a case figure for that outbreak.
- The specific animal reservoir from which the Bundibugyo virus spilled over into humans has not been identified.
- The full scale of the outbreak remains uncertain, as health authorities acknowledge that 60–70 percent of new cases are recorded outside monitored contacts.
- Details about the progress or preliminary results of the clinical trials of two possible treatments begun last month in Ituri are not provided.
- The sources do not specify what international funding or logistical support, if any, is being provided to address the health worker pay dispute.
- No response or comment from DRC government officials regarding the spread to Bas-Uele or the health worker strikes is included in either source.
- The nature, scale, and impact of the Uganda-linked cases mentioned in the Nature Medicine study are not detailed.
- The sources do not state whether the WHO has formally declared a public health emergency of international concern in connection with this outbreak.
- The Guardian — original — by Rachel Savage
- Al Jazeera English — by Priyanka Shankar
Read the original at The Guardian