Conflict in new DRC Ebola zone exacerbates response

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Protecting vulnerable people in eastern Democratic Republic of the Congo (DRC) from the latest Ebola outbreak is going to be “very complex”, given the huge logistical challenges and ongoing conflict there according to the World Health Organisation (WHO).

“We know there have been around 20 deaths,” Dr Peter Salama, Deputy Director General of Emergency Preparedness and Response, said in Geneva.
“We cannot at this stage confirm if they are all confirmed or probable Ebola cases. We expect the overall case count will rise in coming days to weeks, based on the trajectory of epidemics at this stage in their development.”

Speaking just over a week after the UN agency declared the last Ebola episode over, some 2,500 miles away to the west in DRC’s Equateur province, Salama said WHO was unaware of the public health emergency in North Kivu province at that point.

The outbreak on the western side of the country in June infected dozens and led to 33 deaths, but despite several cases appearing in a major city on the Congo River, was fully contained after a massive international and national response.

The top WHO official said there was “no evidence” to suggest a link between the two outbreaks, although it appears “likely” they share the same deadly Zaire strain.

The death toll from the current Kivu episode is set to rise, he said, adding the alert was raised on July 25 after a woman and members of her immediate family died after exhibiting symptoms consistent with Ebola.
“That event appears to have been a woman admitted to hospital around Beni and on discharge had recovered from the original complaint”, he said. After leaving “she came down with a fever and other symptoms clinically consistent with Ebola. Later on seven direct relatives also contracted the disease.”

Salama explained how longstanding conflict in Eastern DRC – involving more than 100 armed groups in the Kivu area and elsewhere – created an additional level of difficulty in trying to contain the deadly disease.

In the first week of February around Beni attacks displaced more than 2 200, in addition to 1 500 displaced at the end of January. In Djugu Territory to the south of North Kivu, inter-ethnic violence led nearly 30 000 to flee to provincial capital Bunia at the beginning of the year.
“It’s going to be a very complex operation,” he said, adding the vast country is home to the UN’s largest peacekeeping operation, the UN Stabilisation Mission in the DR Congo (MONUSCO).

A million of the province’s eight million inhabitants are displaced and getting access to some in danger of coming into contact with Ebola will require an armed escort in some cases, Salama said.

There is also the additional threat that those fleeing violence may head for nearby Uganda, Tanzania and Burundi, taking the infection with them, Salama said, noting additional surveillance measures are being implemented at crossing points.
“On the scale of difficulty, trying to extinguish a deadly outbreak pathogen in a war zone is as the top of the scale,” he said.

In the most recent Ebola outbreak a key part of the emergency response involved tracing anyone who had come into contact with suspected carriers. WHO staff travelled hundreds of miles on a motorbike to do this vital work, but this is likely to be more difficult in view of the high level of insecurity in the Kivus.



An immediate priority is to confirm whether the latest outbreak involves the Zaire strain, as this can be treated with the same vaccine employed in Equateur.
“It’s good news and it’s bad news. The bad news is this strain of Ebola carries the highest case-fatality-rate of any Ebola strains, 50% and higher, according to previous outbreaks. So, it’s the most deadly variant of Ebola strains we have, that’s the bad news. The good news is we do have – although it’s still an investigational product – a safe and effective vaccine we were able to deploy last time around.”