Cases update

In an update on the Ebola Virus Disease (EVD) outbreak in the Democratic Republic of the Congo (DRC), the World Health Organization (WHO) reports that as of Friday, 11 May 2018, there are a total of 34 cases, with 18 deaths (case fatality rate 52.9%), among which two cases are confirmed, 14 suspected and 18 probable.

Three health workers have been affected, with two suspected cases and a probable case who died. So far, 75 contacts are being monitored by the field teams.

The province of Equateur covers an area of 130 442 km2 and has an estimated population of 2 543 936 people, it has 16 health zones and 284 health centers. However, the affected health area of Bikoro covers 1,075 km2 and has a population of 163, 065 inhabitants. It has three hospitals and 19 health centers, most of which have limited functionality.

Help on the way

This digitally-colorized scanning electron micrograph (SEM) depicts a number of filamentous Ebola virus particles (red) that had budded from the surface of a VERO cell (blue-gray) of the African green monkey kidney epithelial cell line./NIAID
This digitally-colorized scanning electron micrograph (SEM) depicts a number of filamentous Ebola virus particles (red) that had budded from the surface of a VERO cell (blue-gray) of the African green monkey kidney epithelial cell line./NIAID

Peter Salama, who leads the WHO health emergencies programme said that they were preparing for all eventualities, speaking at a press conference in Geneva (see video below).

WHO is working closely with authorities in DRC to scale up operations rapidly and mobilize health partners that have helped in relatively recent Ebola outbreaks in West Africa: Liberia, Guinea and Sierra Leone.

WHO is in discussions with the World Food Programme (WFP) to organize airlifted supplies to the affected area, and to clear ground so that planes can land.

The UN Children’s Fund (UNICEF) has also mobilized doctors, sanitation and hygiene specialists, to help contain the spread of the disease.

WHO now has a team on the ground along with partner Médecins Sans Frontieres (MSF), and will involve an additional team of between 20-40 specialists in epidemiology, logistics, contact-tracing, and vaccination programmes, in the coming days.

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The International Federation of Red Cross and Red Crescent Societies (IFRC) team has deployed to Equateur province in north-western Democratic Republic of Congo (DRC), bringing with them much needed stocks of life-saving equipment and supplies to prevent the further spread of Ebola.

Outbreaks and the role of health promotion

Nearly 40 local Red Cross volunteers on the ground have also been mobilized to support affected communities.

“Our main concerns are that the affected area is difficult to access and that the existing health centres in this isolated area have little or no basic medical supplies,” said Dr Fatoumata Nafo-Traoré, the International Federation of the Red Cross and Red Crescent’s (IFRC) Regional Director for Africa. “We are kickstarting this response by using our stocks from the 2017 Ebola outbreak. This includes essential items like stretchers, chlorine disinfectant, Ebola kits, informational posters and other supplies to support the local communities and health centres.”

WHO Director-General Tedros Ghebreyesus said Friday Ebola vaccines will be shipped as quickly as possible as the agency prepared for a “worst-case scenario.”

UN Emergency Relief Coordinator Mark Lowcock on Friday approved a $2 million expenditure to help UN agencies and partners to fight and contain the outbreak.

“We know that coordinated early response will be critical containing this outbreak,” he said, after signing off on the spending from the UN’s emergency account, known as the Central Emergency Response Fund (CERF).

Neighbor prepares

Uganda officials, who are no stranger to EVD, said there should be screening of those crossing from DR Congo to Uganda but the porous borders with numerous illegal entry points pose a danger to the local communities.

The Acting Hospital Director Arua Regional Referral Hospital, Dr Alex Adaku, said an infection, prevention and emergency response committee has been formed to handle any emergency cases.

Other countries are also taking measures.

DRC map
Democratic Republic of the Congo/CIA

Why so many outbreaks in DRC?

This is the ninth Ebola outbreak in Congo since 1976, when the deadly disease was first identified. Dina Fine Maron with Scientific American looked at this exact question in a recent article:

Ebola experts have various suspicions about why the DRC remains so vulnerable. Most theories involve the country’s large forested areas, and the possibility that infected fruit bats—widely believed to be the primary reservoir animal for the disease—are common in the affected areas. “If you live or work in a forest where bats roost, you may have the bad luck to be in touch with bat guano from an infected animal. Or perhaps you encountered saliva or guano on a piece of fruit which an infected fruit bat was involved with,” says Daniel Bausch, a veteran Ebola responder and director of the U.K. Public Health Rapid Support Team. In certain areas of the DRC—including where Ebola has been reported recently—the disease can now be considered endemic in reservoir animals, he says.

The report continues…

Peter Piot, director of the London School of Hygiene and Tropical Medicine, who was part of the team that originally discovered the virus in 1976, also believes people’s interactions with infected bats may be behind the repeated outbreaks there. “Due to its huge swathes of forest, the DRC is a reservoir for the virus, making the country particularly susceptible to outbreaks of Ebola,” he says. “Occasionally people living in these rural areas will come into contact with infected animals, and the transmission cycle begins.” Some experts also suspect deforestation could be a factor, bringing infected animals and people together in the area when they may cut down trees or butcher infected bats for food. DRC is about the size of Greenland—almost a million square miles—and much of it has long been forested, notes Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.