Ebola deaths top 1,000 in increasingly dangerous outbreak

Today Mike Ryan, MD, with the World Health Organization (WHO) outlined major response setbacks in trying to contain the ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC)—including more than 100 violent attacks since January—as cases continue to mount and deaths top 1,000.

'Continued intense transmission'

"Every time we have managed to gain control over the virus, we have suffered major security events," Ryan said, as he explained that the situation on the ground in North Kivu and Ituri provinces is the worst it's been in months, marred by community distrust and a growing threat from rebel groups who are using the outbreak to harness political unrest in the region.

"We anticipate a scenario of continued, intense transmission," Ryan said. He is the WHO assistant director-general for emergency preparedness and response.

Ryan said outbreak response efforts this week were back to the high levels seen before the late April attacks on two Ebola treatment centers in Butembo and Katwa. He estimated that health officials are following "1,000 contacts per day, receiving 1,000 alerts, and vaccinating 1,000 people."

But in an update yesterday, the WHO also said that access and activities in parts of Mandima, Masereka, Kalunguta, and Vuhovi remain irregular owing to the presence of armed groups and other security concerns.

Since January, 119 attacks

Since January, Ryan said, there have been 119 separate violent attacks in the region, with 42 of those attacks specifically targeting health facilities. Eighty-five health workers have been injured or killed.

Ryan said security forces yesterday thwarted an attempted attack at an Ebola treatment center in Butembo. No one was injured.

Area violence by militia groups, such as Allied Democratic Forces (ADF) recently caused tens of thousands of Congolese to flee their homes and cross over to Uganda, Oxfam said in a news release today based on a report from Oxfam and 17 other humanitarian groups. The humanitarian situation began on Mar 30, and more than 60,000 people have been displaced throughout April—half of them children.

Tamba Emmanuel Danmbi-saa, Oxfam's humanitarian program manager in the DRC, said, "This is a deeply worrying situation. These people fear going back to their homes and are being forced to live in cramped, unsanitary conditions in an area where Ebola remains a significant threat."

Francis Iwa, executive director of Care for Forced Migrants, said: "Once they enter Uganda, they also are avoiding official immigration procedures and registration as refugees—which means they may not be screened for Ebola and will be unable to access the very services prepared to assist them."

In some cases, refugees are crossing safely into Uganda; in other instances they are being used as human shields by the ADF, the relief groups said. They are calling on DRC authorities to ensure displaced people are able to cross freely and safely into Uganda.

Second vaccine possible

In addition to addressing the insecurity issues facing the response effort, Ryan also fielded questions about the possibility of introducing another vaccine into the DRC, and the role of nosocomial transmission in this outbreak.

The second vaccine, Johnson and Johnson's prime boost Ebola vaccine, would likely be used in communities that have not yet seen any Ebola infections.

"It would lay down [a] barrier to protect from the virus as a tactical approach," Ryan said. Merck's rVSV-ZEBOV, the only vaccine currently in use in the DRC, would still be used, but mainly on close case contacts. As of today, 110,803 people have been vaccinated with rVSV-ZEBOV, including 30,145 in Katwa, 23,397 in Beni, and 13,763 in Butembo, according to the DRC health ministry's daily update.

Ryan said the WHO and DRC officials would launch tomorrow a new health campaign focusing on needle safety. The misuse of needles in suspected malaria patients, who actually have Ebola, may be playing a role in the nosocomial transmission of the virus.

"We are still seeing new cases that are not on any known transmission chains," Ryan said. "These often end up being nosocomial transmissions."

Deaths hit 1,000

According to today's update from the DRC, officials confirmed 19 new cases of Ebola and 14 deaths, half of which took place in the community.

Today's cases raise the outbreak total to 1,529, of which 1,463 are confirmed and 66 are probable. Deaths have now climbed 1,008, and 270 suspected cases still under investigation. Of the 19 new cases, 7 were recorded in Beni, 6 in Katwa, 3 in Mabalako, and 1 each in Musienene, Kalunguta, and Mandima.

The WHO said the current hot spots are Katwa, Butembo, and Mandima. From Apr 10 through 30, a total of 292 confirmed cases were reported, 47% in Katwa, 13% in Butembo, and 11% in Mandima, the WHO added.

"In addition, notable recurring re-introduction events having been documented in previously affected health zones such as Mabalako and Musienene, followed by local amplification and extension to affect new heath area," the WHO said.

The DRC also noted today that the outbreak in Butembo was linked to reintroducing the virus in Kayna, Biena, Masereka, Vuhovi, and Kalunguta.

"While each of these areas had managed to spend more than 21 days without new confirmed cases between February and March 2019, the Ebola epidemic had resumed in these areas after contaminated people from Butembo or Katwa fled the teams of the riposte [response] to take refuge with relatives living in these neighboring areas," the DRC said.

See also

May 3 WHO briefing

May 3 DRC update

May 2 WHO update

May 3 Oxfam news release

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