Ebola virus disease outbreak in the DRC

Location of the Ebola virus disease outbreak in  Ikoko Impenge near Bikoro, DRC. Click on image to enlarge. Freely downloadable from here or https://doi.org/10.6084/m9.figshare.6233540

UPDATE #1, #2

The World Health Organization has reported that the Democratic Republic of the Congo (f. Zaire) has declared a new outbreak of Ebola virus disease (EVD). The announcement follows laboratory confirmation of the presence of infections by a strain of the genus Ebolavirus, species Zaire ebolavirus.[1,10]

Ebola virus disease in Bikoro

Ebola virus disease outbreak numbers at announcement.

Figure 2. Suspected, probable and confirmed cases and deaths in the DRC EVD outbreak.

Most cases seem to be located at the Ikoko Impenge village health facility located about 30-60 kilometres from the market town of Bikoro.[1,11] The market town is located in Équateur Province, on the shores of Lake Tumba near Lake Tumba (see the adjacent map) and has river access to other villages and the DRC’s western border with Republic of the Congo.

The outbreak has reportedly been ongoing for 5 weeks of viral haemorrhagic fever and includes 21 suspected cases and 17 deaths.[1,3] That makes the proportion of fatal cases 80% but this number is likely to change as the outbreak evolves).

Only 2 of 5 collected samples collected by WHO-dispatched teams have been confirmed (Figure 2) by the Institut National de Recherche Biomédicale (INRB) laboratory in the DRC to date.[1,9]

What to watch

Figure 3. March-April OCHA report from the Great Lakes region, Africa.[12]

This is the 9th recorded outbreak of EVD in the DRC. It follows the announcement of their last outbreak by almost exactly a year.[2] The DRC is expert at containing EVD outbreaks but it will be worth watching the contact tracing. If travel to neighbouring regions has occurred then the chances for a larger outbreak rise.

We’re starting at 5 weeks into this outbreak.[1] We’re in the early days of a collaborative effort to characterise and contain the outbreak, but it will be interesting to read why testing for ebolaviruses took this long. Remote communities and rugged terrain are often to blame here, but even so, 5 weeks seems long.

It is now clear that the rVSV-ZEBOV Merck vaccine, used in the West African epidemic and recently shown to provide lasting protection against Zaire ebolavirus,[16,5,] is being rolled out.

To make matters worse for containment of an EVD outbreak in this region (Figure 3), there is food insecurity, refugees crises and cholera in the DRC and in neighbouring Tanzania, Rwanda and Uganda.[12] You may recall the worlds biggest EVD epidemic in West Africa was confused with cholera early on because of some clinical similarities among early EVD cases including diarrhoea, vomiting, and severe dehydration.[13] 

References…

  1. New Ebola outbreak declared in Democratic Republic of the Congo
    http://www.who.int/news-room/detail/08-05-2018-new-ebola-outbreak-declared-in-democratic-republic-of-the-congo
  2. Ebola returns to the Democratic Republic of the Congo (DRC): Zaire…
    https://virologydownunder.blogspot.com.au/2017/05/ebola-returns-to-democratic-republic-of.html
  3. Ebola outbreak declared in Democratic Republic of Congo
    https://edition.cnn.com/2018/05/08/health/ebola-outbreak-who-bn/index.html
  4. Ebola: DR Congo confirms new outbreak in country’s north-west
    http://www.bbc.com/news/world-africa-44045842
  5. Determinants of antibody persistence across doses and continents after single-dose rVSV-ZEBOV vaccination for Ebola virus disease: an observational cohort study
    https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30165-8/fulltext
  6. Ebola Virus Disease, WHO Africa
    http://www.afro.who.int/health-topics/ebola-virus-disease
  7. Ebola virus disease, WHO
    http://www.who.int/ebola/en/
  8. Disease Outbreak News (DONs)
    http://www.who.int/csr/don/en/
  9. Seventeen deaths reported in Congo as Ebola outbreak confirmed
    https://uk.reuters.com/article/us-health-ebola-congo/seventeen-deaths-reported-in-congo-as-ebola-outbreak-confirmed-idUKKBN1I91VS
  10. DRC: at least 17 people dead in confirmed Ebola outbreak
    https://www.theguardian.com/world/2018/may/08/drc-confirms-two-cases-of-ebola-in-north-western-town
  11. Two cases of Ebola confirmed in Democratic Republic of Congo
    https://www.aljazeera.com/news/2018/05/cases-ebola-confirmed-democratic-republic-congo-180508142327264.html
  12. GREAT LAKES REGION: Humanitarian Snapshot (March – April 2018), OCHA
    https://reliefweb.int/sites/reliefweb.int/files/resources/GLR_humanitarian_snapshot_23%20April%202018.pdf
  13. Origins of the 2014 Ebola epidemic
    http://www.who.int/csr/disease/ebola/one-year-report/virus-origin/en/
  14. Democratic Republic of the Congo Ebola Situation Report #1, 10 May 2018
    https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-situation-report-1-10-may-2018
  15. DRC: 2 Ebola cases confirmed, 17 deaths suspected in 9th outbreak since 1976
    http://www.newtimes.co.rw/africa/drc-2-ebola-cases-confirmed-17-deaths-suspected-9th-outbreak-1976
  16. https://academic.oup.com/jid/article/214/suppl_3/S360/2388110
  17. Efficacy and effectiveness of an rVSV-vectored vaccine in preventing Ebola virus disease: final results from the Guinea ring vaccination, open-label, cluster-randomised trial (Ebola Ça Suffit!)
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32621-6/fulltext

Updates…

  1. Altered spelling of Ikoko Impenge from WHO’s “iIkoko Iponge ; added info on cholera and human travel in and around the DRC
  2. Added links for RT-PCR confirmation of species Zaire ebolavirus

2 thoughts on “Ebola virus disease outbreak in the DRC”

  1. Indeed refugee crises, food insecurity and many public health challenges including cholera and strained health systems could complicate the implementation of interventions to contain the Ebola outbreak in DRC. On the other hand this is not the first outbreak in the region, will the old strategies and experience combined with the vaccine be able to contain and get the disease under control?

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