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Ebola outbreak in DRC

A World Health Organization (WHO) Ebola vaccination team works in Butembo in the Democratic Republic of the Congo in January 2019.

Outbreak comes just as the worst epidemic in the country’s history is petering out

Nearly 50 staff from the World Health Organisation (WHO) and its partners arrived in Mbandaka in the Democratic Republic of the Congo (DRC) on June 03. Mbandaka is the location of what is feared coulb be the country’s latest Ebola outbreak. T

he head of the World Health Organisation (WHO) Tedros Adhanom Ghebreyesus broke the news to journalists during his regular virtual update on the COVID-19 pandemic. He said the responders carried 3,500 doses of Ebola vaccine and 2,000 cartridges for lab testing.

“This is an important reminder that even as WHO focuses on responding to the COVID-19 pandemic, we continue to monitor and respond to many other health emergencies,” he said.

The Ebola outbreak in Mbandaka, located in Equateur province in northwest DRC – on the opposite side of the country to the worst epidemic in the country’s history that is petering out – was confirmed earlier in the week.

At the point, eight cases had been detected, four of whom have died. “The latest person confirmed with Ebola attended the burial of one of the first cases, but was detected in the town of Bikoro, 150 kilometres away from Mbandaka. This means that two health zones are now affected,” said Tedros.

Mbandaka had suffered a previous Ebola outbreak in May 2018, which was halted in three months.

Meanwhile, the DRC is still fighting an Ebola outbreak in the east that emerged in August 2018, and now appears to be in its final stages.

The WHO has pledged to assist the DRC as it confronts the new Ebola outbreak in the northwest amid the novel coronavirus pandemic and other challenges.

“WHO will continue supporting DRC in tackling Ebola, as well as responding to COVID-19 and the world’s largest measles outbreak”, said Tedros.

The Ebola outbreak in Mbandaka marks the DRC’s eleventh face-off with the deadly disease, which was first discovered in the country in 1976 and is now endemic.

The city also had a short outbreak from May to July 2018 in which 33 people died.

The five latest Ebola victims, who included a 15-year-old girl, died between May 18 and 30 May, the UN Children’s Fund (UNICEF) reported.

Their deaths were only attributed to Ebola following laboratory confirmation.

UNICEF is also working alongside the Government of DRC and all partners in the response to the Ebola epidemic. It is providing essential equipment, deploying community mobilizers, providing water and sanitation services, supporting orphans and other affected children, said Edouard Beigbeder, the agency’s Representative in the country.

“In the ongoing outbreak in Eastern DRC, more children, proportionately, are being affected than in any previous Ebola outbreak, so we must ensure that preventing infection among children is central to the response in Équateur,” said Edouard Beigbeder

New outbreaks expected

The WHO explained that new outbreaks of Ebola are expected in the DRC given the existence of the virus in animal reservoirs in many parts of the country.

The UN agency is already on the ground in Mbandaka supporting response, while contact tracing is underway.

Although the new outbreak represents a challenge, WHO and its partners are up to the task, said Dr. Matshidiso Moeti, the WHO Regional Director for Africa.

Over the past two years, they have worked to strengthen national capacity for Ebola response.

“To reinforce local leadership, WHO plans to send a team to support scaling up the response. Given the proximity of this new outbreak to busy transport routes and vulnerable neighbouring countries we must act quickly,” said Dr. Moeti.

Meanwhile, WHO reported that the Ebola outbreak in eastern DRC is in its final phases.

On May 14, authorities began a 42-day countdown to declare its end.

The outbreak began in August 2018 and has claimed more than 2,000 lives, while more than 1,000 people have survived the disease.

Is Ebola back?

For now, it is unclear whether the confirmed and suspected Ebola cases will remain isolated or whether the DRC will soon face a major Ebola outbreak.

The DRC declared its tenth outbreak of Ebola in 40 years on August 01, 2018. The outbreak is centred in the northeast of the country, in North Kivu and Ituri provinces. Cases have also been reported in South Kivu.

With the number of cases having surpassed 3,000, it is now by far the country’s largest-ever Ebola outbreak. It is also the second-biggest Ebola epidemic ever recorded, behind the West Africa outbreak of 2014-2016.

During the first eight months of the epidemic, until March 2019, more than 1,000 cases of Ebola were reported in the affected region. However, between April and June 2019, this number doubled, with a further 1,000 new cases reported in just those three months.

Between early June 2019 and the beginning of August, the number of new cases notified per week was high, and averaged between 75 and 100 each week; it then started slowly declining for the rest of the year.

In 2020, the number of cases recorded per week has declined dramatically, with just a handful of cases recorded throughout January and February.

However, on 10 April – just three days before the outbreak was expected to be declared over – a new case was recorded in Beni. Six further cases had been recorded in the same area. Although the last Ebola patient was discharged from the Beni ETC on 14 May, the outbreak is not yet officially over and there is a continued need for vigilance, especially in the midst of the current coronavirus COVID-19 pandemic.

At the peak of the outbreak, identifying and monitoring contacts was a significant challenge, with 40 per cent of new Ebola cases having never registered as contacts. Reasons include the movement of people (such as in the case of motorbike taxi drivers), to downright fear in some communities which hinders engagement.

In addition, new Ebola patients were confirmed and isolated with an average delay of five days after showing symptoms, during which time they were both infectious to others and missed the benefit of receiving early treatments with a higher chance of survival.

On 11 June 2019, Uganda announced that three people had been positively diagnosed with Ebola, the first crossborder cases since the outbreak began. After several weeks with no recorded cases, the Ugandan government announced a new case on 29 August; the patient, a young girl, sadly died. On 14 July 2019, the first case of Ebola was confirmed in Goma, the capital of North Kivu, and a city of one million people. The patient, who had travelled from Butembo to Goma, was admitted to the MSF-supported Ebola Treatment Centre in Goma. After confirmation of lab results, the Ministry of Health decided to transfer the patient to Butembo on 15 July, where the patient died the following day. On 30 July, a second person in Goma was diagnosed with Ebola; they died the next day and two more cases were announced. No new cases have since been recorded in either Uganda or in Goma.

The response to the outbreak has been marked by community mistrust towards the response. This is due to a complicated history and to many different reasons, but include community resentment on the focus on Ebola, when many other diseases continue to claim more lives, such as a severe measles outbreak; and community objections and anger over the presence of security forces surrounding the Ebola response.

This mistrust towards the response has led to attacks, including on our Ebola Treatment Centres (ETCs) . The unrest, such as fighting between the army and armed groups in early May 2019, and again in November and December 2019, have at times brought many outbreak response activities to a standstill. The mistrust and violent attacks against the Ebola response show no signs of abating; as recently as early November 2019, a radio journalist, Papy Mumbere Mahamba, was killed in Lwemba, Ituri province, reportedly for his involvement in the response. There were more than 300 attacks on Ebola health workers recorded in 2019, leaving six dead and 70 wounded.

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