The outbreak of Ebola in the Democratic Republic of Congo (DRC) may be “a much larger outbreak than what is currently being detected and reported, with significant local and regional risk of spread”, the World Health Organization (WHO) warned on Sunday. 

The WHO declared the outbreak a public health emergency of international concern (PHEIC) on Saturday, confirming that it involves the Ebola species, Bundibugyo virus disease (BVD). There is no vaccine or treatment for BVD, and a high case fatality rate of 30-50%.

By Saturday, there were 336 suspected cases and 87 deaths, 13 of which had been confirmed as BVD, according to the Africa Centres for Disease Control and Prevention.

Very high risk of spread in DRC

Africa CDC warned that the risk of spread within the DRC was “very high” as a “four-week detection delay” had enabled “extensive uncontrolled community transmission”.

It also said the risk for East Africa is “high”. The outbreak is likely to have originated in the Mongbwalu health zone of DRC’s Ituri province, a high-traffic mining area on the borders of South Sudan and Uganda, which “increases the risk of regional exportation and cross-border transmission”, according to the WHO.

Two laboratory-confirmed cases (including one death) with no apparent link to each other were reported in Kampala in Uganda, late last week, involving two people travelling from the DRC.

Meanwhile, insecurity and conflict in the DRC are “restricting surveillance and rapid response operations”, Africa CDC noted.

While there are no approved vaccines or therapeutics, Africa CDC said its research team is studying the candidate vaccine, Ervebo, and potential treatments including “DP134, Remdesivir, Opaldesivir (oral form), and monoclonal antibodies”.

It also warned that while national and regional stocks of personal protective equipment (PPE) are “sufficient to cover existing demand patterns”, if transmission increases, countries will need to import new PPE and the lead time for this is six to eight weeks.

Why ‘public health emergency’?

“Response measures include deployment of rapid response teams, delivery of medical supplies, strengthened surveillance, laboratory confirmation, infection prevention and control assessments, the set-up of safe treatment centres, and community engagement,” the WHO said in a statement issued on Sunday.

WHO Director-General Dr Tedros Adhanom Ghebreyesus said that the outbreak meets the criteria of the definition of PHEIC in terms of the International Health Regulations as it is “extraordinary”, constitutes a public health risk to other countries and “requires international coordination and cooperation to understand the extent of the outbreak, to coordinate surveillance, prevention and response efforts, to scale up and strengthen operations and ensure ability to implement control measures.”

The “extraordinary” nature of the outbreak includes “unusual clusters of community deaths with symptoms compatible BVD”, and the high positivity rate of the initial samples collected (eight positive out of 13 samples).

The WHO is in the process of convening an emergency committee under the provisions of the IHR, “as soon as possible” to advise affected countries on how to respond to the outbreak.