The World Health Organization has declared an Ebola outbreak in the Democratic Republic of Congo an international health emergency as suspected deaths rise to 91, with no vaccine available for the deadly strain spreading through the country’s northeast.
The outbreak, centred in Ituri province near the borders with Uganda and South Sudan, has recorded around 350 suspected cases since April, according to Congolese Health Minister Samuel-Roger Kamba. More than 60% of those affected are women, with most patients aged between 20 and 39.
The WHO declared the outbreak a “public health emergency of international concern” on Sunday, the second-highest alert level under international health regulations.
Bundibugyo strain presents new challenge
The current outbreak is caused by the Bundibugyo strain of Ebola, for which no vaccine or specific treatment exists. This marks a significant departure from recent outbreaks in the region, which involved the Zaire strain for which effective vaccines are available.
Virologist Jean-Jacques Muyembe, who co-discovered Ebola in 1976, warned that the outbreak could spread rapidly due to the densely populated nature of Ituri province.
“It’s an outbreak that will spread very rapidly, all the more so because it has broken out in a densely populated province,” Muyembe told AFP.
The Bundibugyo strain has previously caused two outbreaks, in Uganda in 2007 and in the DRC in 2012, with mortality rates between 30% and 50%. Few samples from the current outbreak have been laboratory tested, with reports based mainly on suspected cases.
Virus crosses borders
The disease has already spread beyond Ituri province. A case has been confirmed in Goma, the major eastern city under control of the Rwanda-backed M23 rebel group since early last year. The city serves as capital of North Kivu province, which neighbours Ituri.
Uganda has reported one confirmed case and one death, both involving Congolese nationals who travelled from the DRC. No local outbreak cluster has been identified in Uganda.
Laboratory tests have confirmed the link to Ebola in all three cases outside Ituri province. The Africa Centres for Disease Control and Prevention has warned of a high risk of spread to eastern African countries bordering the DRC.
Challenges in outbreak response
Ituri province’s gold-rich terrain sees intense daily population movement linked to mining activities. Violence by several armed groups in parts of the province makes access difficult for health workers and security personnel.
The first identified case was a nurse who attended a health centre in Bunia, the capital of Ituri province, on 24 April. However, the epicentre lies about 90 kilometres away in the Mongbwalu health zone.
The WHO was alerted to a high-mortality disease on 5 May after four healthcare workers died within four days in the Mongbwalu area.
Detection has been complicated by symptoms that initially resemble flu or malaria. The Congolese health ministry said communities initially believed the illness to be “mystical” or caused by “witchcraft”, leading patients to seek help at prayer centres rather than health facilities.
Historical context
Ebola has killed more than 15 000 people in Africa over the past 50 years. The deadliest outbreak in the DRC claimed nearly 2 300 lives from 3 500 cases between 2018 and 2020.
The previous outbreak before the current one killed 45 people between September and December last year.
This marks the 17th Ebola outbreak in the central African nation, which has a population of more than 100 million. If all suspected cases are confirmed, the current outbreak would rank as the seventh largest ever recorded across all Ebola strains, and the second largest for the non-Zaire strain.
Control measures rely on adherence to protective protocols and rapid case detection to limit contact, in the absence of vaccines or specific treatments for the Bundibugyo strain.
Epidemiological investigations continue to establish the outbreak’s origin.
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