DR Congo Ebola cases grow, deaths top 4,000 as officials struggle to ascertain numbers, trends

Ebola
Health workers helping in Ebola response

UK Department for International Development / Flickr cc

The largest-ever Ebola outbreak in the Democratic Republic of Congo (DRC) has reached 8,300 infections and 4,018 deaths, as a Medicines Sans Frontieres (MSF) staff member is evacuated after testing positive for the virus. 

The staff member was medically evacuated to the Netherlands after testing positive for Ebola on September 29, according to an MSF press release yesterday. Fifty healthcare workers have died of Ebola since the outbreak was declared in May, the Africa Centres for Disease Control and Prevention (Africa CDC) said in a special briefing yesterday. 

There are signs of a downturn in cases: More than 21 days have passed since a new case in 18 health zones, and the 278 infections confirmed near the end of September represent the lowest weekly case count since mid-June. Weekly deaths are now at 192, down from a peak of 364 in mid-August.

But during the briefing, Wessam Mankoula, MBBS, MPH, an epidemiologist with the Africa CDC, said the decline in confirmed cases may also reflect underreporting. 

“This curve doesn’t mean that the outbreak is totally under control, because we need to understand the reason for this falling in the last epi [epidemiologic] week,” he said. “The security situation and some of the community resistance in some of the health zones in Katwa, Beni, Butembo, Nizi, and Nia-Nia has led to the inability of our team to continue with strengthening surveillance activities” in those areas.

Politician murdered, camp torched

In addition to unpaid healthcare workers, armed conflict, and mass population displacement in some areas of the DRC, health officials have had to deal with violence and property destruction. On Sunday, a senior member of the DRC’s ruling party was beaten to death in Nord-Kivu province after he encouraged preventive measures against Ebola infection on a radio show.

The security situation and some of the community resistance in some of the health zones in Katwa, Beni, Butembo, Nizi, and Nia-Nia has led to the inability of our team to continue with strengthening surveillance activities.

Wessam Mankoula, MBBS, MPH

This week, an Ebola-hit camp housing a transit center for infected patients was burned to the ground by soldiers looking for weapons on the outskirts of Bunia in Ituri province, leading 19,000 people in the camp to flee. 

And new infections aren’t declining in all provinces, Mankoula said. While new cases are down 32% in Ituri province, they are climbing in Tshopo and North Kivu, the latter of which has a case-fatality rate of 59.3%, well above the national average of 48.4%.

As of late last week, 6,300 healthcare workers have received the Ervebo Ebola vaccine as part of a clinical trial, and 1,066 others have also received doses. The vaccine has proven efficacy against the more-common Zaire Ebola virus, and its effectiveness is being estimated against the Bundibugyo strain causing the outbreak. There are no vaccines or therapeutics targeting Bundibugyo. 

In addition to testing vaccines, the country is also studying the use of antivirals such as remdesivir for treatment and obeldesivir for post-exposure prophylaxis (prevention), Mankoula said. 

Since the outbreak was declared in May, contact follow-up has reached 78.7% but still represents only 23% of the expected contact volume, which Mankoula described as “a major concern.” 

‘Multiple coordinated actions’ needed

This week MSF published a project update on what is needed to end the outbreak. “Stopping the spread of Ebola disease requires multiple coordinated actions to be carried out at the same time,” the report said. 

“The response must include finding people suspected to have the disease, safely isolating them and transferring them for care, tracing contacts who may have been exposed, preventing infection in health facilities and in communities, and working closely with affected communities to build trust, share information about the disease, and encourage people to seek care early,” it added.

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