Ebola outbreak ravaging West Africa: ''totally out of control"

The Ebola superhighway: Why the new outbreak terrifies public health authorities

A new outbreak of the Ebola virus that has killed at least two dozen people has set public health officials scrambling to contain the epidemic as it threatens to spread far beyond the remote jungles of the Congo River Basin — and raises new questions about the World Health Organization’s (WHO) preparations for the next killer virus.

The U.S. government is preparing its most direct response yet to the outbreak that appears to have begun in April, readying staffers from the Centers for Disease Control and Prevention (CDC) to deploy to multiple communities in the Democratic Republic of Congo.

Ministry of Health officials first identified cases of viral hemorrhagic fever when it reached the town of Bikoro earlier this month. On Thursday, officials said a new case had been identified in Mbandaka, a city of 1.2 million.

The new case in Mbandaka has raised the alarm among public health officials because it is the first time the virus has ever landed in a city that sits directly on the Congo River.

In all eight of the previous known Ebola outbreaks in the Democratic Republic of the Congo, the virus has been contained within remote jungle villages or relatively small towns, where isolated populations are less likely to spread the disease.

But the Congo River is effectively the region’s highway system. Barges and boats travel from Kisangani in the east through major cities including Bumba, Mbandaka — and eventually Kinshasa, the capital of the DRC and home to more than 11 million people, as well as Brazzaville, the capital of the Republic of Congo.

“The Congo River connects three national capitals and multiple other large cities,” said Jeremy Konyndyk, who served as head of USAID’s Office of Foreign Disaster Assistance during the 2014-2015 outbreak. “The fact that there are now several cases in an urban center of more than a million people underscores the potential for this outbreak to get out of control.”

If the Ebola virus traveled upriver from Bikoro to Mbandaka, some officials wonder, has it also traveled downstream toward Kinshasa, which offers direct air traffic to cities including Brussels, Paris, Dubai and Lagos, Nigeria?

“We don't know what's happening along the river, because the river is used by a lot of barges,” said Pierre Rollin, one of the world’s leading experts on the Ebola virus at the CDC. “None of the outbreaks have been by the river or in the big towns. So we have a lot of caution before claiming we know what's going on.”

Previous outbreaks have been snuffed out in the Congo, Rollin said, because the area is so remote that humans did not have a chance to travel far enough to transmit the virus before succumbing.

That was not the case four years ago in West Africa, where the virus spread widely across international boundaries. Commercial and cultural travel throughout Guinea, Liberia and Sierra Leone — across borders drawn a century and a half ago by colonizers with little regard for traditional tribal boundaries — is far more common than it is in the Congo.

The present outbreak has raised anew questions about WHO and its capacity to respond to deadly viral threats. In the wake of the West African outbreak ago, when the ill-prepared WHO endured withering criticism for its lackluster response to the initial round of cases, the agency has undergone a remarkable round of self-flagellation, reorganizing to prioritize emergency preparedness and response while cutting bureaucracy.

“We’ve seen WHO activate much more quickly, at much larger scale, and in more effective partnership with players like” Doctors Without Borders, said Konyndyk, who sat on an independent panel that advised WHO on reforming its emergency functions after the West Africa outbreak.

The first WHO investigative team arrived in Bikoro on May 5, about a month after the first suspected cases are likely to have emerged in Ikoko Impenge. A logistics team arrived on May 9, and the United Nations began daily flights carrying supplies and personnel between Kinshasa and Mbandaka on May 13.

Tedros Adhanom Ghebreyesus, the WHO’s director general, visited Bikoro on May 13, in part to show the urgency of the situation.

“A major lesson learnt from the West Africa Ebola outbreak was that WHO needed a flexible fund to rapidly respond to outbreaks and emergencies,” Tarik Jasarevic, a WHO spokesman, said in an email from Geneva. The agency’s new Contingency Fund for Emergencies, already activated in the Congo, has made cash available to responders far more quickly than in the case of West Africa.

Still, some wonder why it took the Congolese Ministry of Health and the WHO a month to spot the virus in the first place.

“We are doing better at response, but not much better at rapid detection, which is important,” said Tom Frieden, the former CDC director who now runs the public health organization Resolve to Save Lives. “This was spreading for a while before [it was] recognized.”

Aiding the response further is a new vaccine, finalized in the last days of the West Africa outbreak. About 4,000 doses of the vaccine are headed to the epicenter of the new outbreak, where they will be used in two ways: First, health care workers, those most vulnerable to exposure, will be vaccinated. Then, those who have come into contact with anyone infected, and the contact’s contacts, will be vaccinated, a practice known as ring vaccination.

“That part should really add another arm to the response. It's not the response by itself, because you still have to do all the rest,” Rollin said.

The Democratic Republic of the Congo is also far more prepared to respond to an Ebola outbreak because the virus is known to be endemic to the region. The first modern outbreak of the Ebola virus occurred in the village of Yambuku, about 370 miles from the site of the present one, back in 1976.

http://thehill.com/policy/healthcar...ay-why-a-new-outbreak-terrifies-public-health

 

New Ebola Outbreak Confirmed In Democratic Republic Of Congo

Four new cases of Ebola have been confirmed in the Democratic Republic of Congo, just a week after the country announced the end of its ninth Ebola outbreak.

Congo’s Ministry of Health was notified Saturday of 26 cases of fever “with hemorrhagic signs” that included 20 deaths in Beni, a city in the northeast province of North Kivu. Of the six samples analyzed for Ebola, four came back positive.

Ebola is considered endemic to Congo because of its equatorial forest ecosystem. Authorities do not believe the new outbreak is connected to the Bikoro outbreak, which infected 54 people and killed 33 and which was just declared over. The two outbreaks are separated by more than 2,500 kilometers (1,553 miles).

The Ministry of Health noted that therapeutic treatments are still in country from the last outbreak, but the species of this Ebola virus has yet to be determined. The Bikoro outbreak was contained using an experimental vaccine, provided by Merck, to target the Ebola Zaire strain. The World Health Organization raised $36 million from a variety of countries and nongovernmental organizations to fight that outbreak, and more than 3,300 people were vaccinated.

North Kivu province, the site of the current outbreak, borders Rwanda and Uganda. Beni has been the site of intense fighting in recent decades, and between 2014 and 2016, more than 800 people were killed in the area, many of them by machete. Allied Democratic Forces, a Ugandan Islamist group, was blamed alongside Congolese army officers for the killings.

The violence and unrest in Beni and the North Kivu province presents a particular challenge for containing an Ebola outbreak, Jeremy Konyndyk, who led parts of the 2014 Ebola response for the Obama administration, told HuffPost in an email. Konyndyk is now a senior policy fellow for the Washington-based Center for Global Development.

“We have been lucky in recent Ebola outbreaks that they have been in relatively safe and stable areas; North Kivu is a different story,” he said, citing the “importance of baseline operational security” in successfully controlling such an situation. To properly trace the spread of an outbreak, he said, disease detectives have to chase down people’s contacts, which can be dangerous with the kind of militia activity seen in this area of Congo.

https://www.huffingtonpost.com/entry/ebola-democratic-republic-congo_us_5b61d252e4b0fd5c73d56d92

 

Ebola spreads to Democratic Republic of Congo conflict zone in scenario health officials have been "dreading"

The Ebola outbreak in the Democratic Republic of Congo has spread to a city surrounded by rebels, creating challenges responders were "dreading," the World Health Organization said Friday.

One probable case and one suspected case have emerged in the city of Oicha in DRC's North Kivu province, WHO's emergency response chief, Peter Salama, told reporters.

While Oicha itself is not under rebel control, Salama said the city is entirely surrounded by territory held by a feared Ugandan insurgent group known as the Allied Democratic Forces (ADF).

https://www.cbsnews.com/news/ebola-...t-zone-in-scenario-health-officials-dreading/

 

CDC director warns that Congo’s Ebola outbreak may not be containable

Centers for Disease Control and Prevention Director Robert Redfield said Monday that the Ebola outbreak in conflict-ridden Congo has become so serious that international public health experts need to consider the possibility that it cannot be brought under control and instead will become entrenched.

If that happened, it would be the first time since the deadly viral disease was first identified in 1976 that an Ebola outbreak led to the persistent presence of the disease. In all previous outbreaks, most of which took place in remote areas, the disease was contained before it spread widely. The current outbreak is entering its fourth month, with nearly 300 cases, including 186 deaths.

If Ebola becomes endemic in substantial areas of North Kivu province, in northeastern Congo, “this will mean that we’ve lost the ability to trace contacts, stop transmission chains and contain the outbreak,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security, which hosted the briefing on Capitol Hill that featured the Ebola discussion with Redfield.

In that scenario, there would be a sustained and unpredictable spread of the deadly virus, with major implications for travel and trade, he said, noting that there are 6 million people in North Kivu. By comparison, the entire population of Liberia, one of the hardest-hit countries during the West Africa Ebola epidemic of 2014-2016, is about 4.8 million.

https://www.washingtonpost.com/amph...-congos-ebola-outbreak-may-not-be-containable/

 

There is an excellent documentary on the Congo and the grey super apes that lurk in the mist protecting their diamond mine.

 

Congo's Ebola epidemic spreads to larger city

Public health officials are sounding new warnings about the spread of the deadly Ebola virus in an eastern province of Congo as cases pop up in a city of more than a million people and as stockpiles of a lifesaving vaccine dwindle.

Congolese Health Minister Oly Ilunga Kalenga said at a news conference Thursday that health workers had seen a dramatic spike in cases in Butembo, a regional trading hub with strong links to neighboring Uganda and Rwanda.

https://thehill.com/policy/healthca...gos-ebola-epidemic-spreads-to-larger-city?amp