On 9 May, a cluster of undiagnosed illness and deaths in a remote location in the north of the Democratic Republic of Congo (DRC) was reported to the World Health Organization (WHO). Several individuals tested positive for Ebola (Zaire subtype) a few days later. As of 19 May, 29 confirmed and suspected cases, including three deaths, had been reported. With the wounds of the West African Ebola outbreak that killed more than 11,000 between 2014 and 2016 still fresh, the rapidly evolving situation in northern DRC is likely to cause unease locally, nationally and internationally.
Here are six things to understand about this new outbreak:
- The potential for international spread is limited. The epicentre of the outbreak is in Likati health zone, 1,400 kilometres from the capital Kinshasa and 350 kilometres from the nearest large urban settlement. There are only 20 kilometres of paved roads in the area and virtually no functional telecommunications. The volume of travel to and from the outbreak area is therefore likely to be small. In addition, because the health of cases deteriorates rapidly, they would likely be unable to travel for the several days it takes to reach populated areas.
- The West African Ebola experience has influenced international perceptions of this outbreak. Despite the outbreak’s limited spread potential, some governments in Europe have requested emergency meetings with technical experts to assess the risk to their own countries, while other countries have advised against unnecessary travel to DRC. The memory of the West African outbreak, rather than the objective risk associated with the current DRC outbreak, is likely to drive such measures. The WHO has not recommended any restrictions to travel or trade in relation to this outbreak.
- The Democratic Republic of Congo has a track record of controlling Ebola. The first reported outbreak of Ebola was reported in the DRC in 1976, approximately 350 kilometres from the epicentre of the current one. In total, the DRC has experienced and successfully controlled eight Ebola outbreaks using the same three-pronged approach: rapid identification and isolation of cases, identification of contacts of cases and monitoring for 21 days, and educating the community to understand the importance of prevention with safe patient transport, safe burial and household decontamination. It is probably the most experienced African country with regards to Ebola control, has provided expert support to the West African outbreak response and will hopefully control this outbreak as it did with the previous ones
- We have learnt lessons from the West African outbreak. This outbreak is the first to occur after the West African tragedy. As such, the response will be subject to intense scrutiny and will be seen as an opportunity to test some of the changes that occurred as a result of the inadequacies of the responses in Liberia, Guinea and Sierra Leone. One of the main criticisms in the West African outbreak was the delay in response. This time, according to the WHO’s Africa regional office, a national investigation team investigated within days and the WHO deployed an expert team within three weeks of the first case becoming unwell. The WHO’s Global Outbreak Alert and Response Network has been activated to provide additional support if required. Within 10 days of the outbreak being reported to the WHO, the first Ebola treatment centre was established, personal protective equipment had been dispatched to health workers and a mobile laboratory was being constructed.
- It may be an opportunity to trial newly developed vaccines. Prior to the West African outbreak, no Ebola vaccine was available despite the virus being known for almost 40 years. The scale of the West African outbreak and the international attention it received led to the acceleration of research into Ebola vaccines and to WHO issuing guidance on how to conduct vaccine trials during public health emergencies. As a result, several vaccines were tested between 2014 and 2016 and one tested in Guinea was shown to be safe and effective. The product is available but has not received regulatory approval yet, and would have to be used through a research protocol. So far, the DRC government has not requested the vaccine and may consider the outbreak to be small enough to be contained using a traditional approach. In any case, using the vaccine would be in addition to, rather than instead of these steps.
- Innovative approaches to detection can help control future outbreaks. The prompt identification of this outbreak has benefited from the fact it occurred in a place experienced with Ebola, at a time where the disease still makes headlines. However in remote areas of countries where the traditional disease surveillance infrastructure is lacking, the risk of missing local health events is high, and occasionally these can turn into global public health disasters. This is what happened in Guinea in 2014. In these settings, we must think of new ways to ensure these events are detected and reported promptly, whether they occur among humans, animals or in the environment.In places where formal disease detection systems do not have sufficient capacity, the community itself is well-placed to detect and report such events. Several initiatives such as the Participatory One Health Disease Detection project in Thailand and the Community-Based Disease Outbreak Detection and Response in East and Southern Africa in Tanzania are empowering the community to become part of the surveillance system by training them to report health events using mobile technology, with promising results.This time, the Ebola outbreak was detected rapidly, allowing outbreak control experts to get ahead of the curve and to hopefully bring it to an end. The global health community must take necessary steps to ensure this is the case every time.
Michael Edelstein is a medical doctor specialised in field epidemiology, with expertise in surveillance systems, outbreak investigations and global health policy, in both routine and emergency contexts. He has worked at national public health agencies (Public Health England, Swedish public health agency) and international organisations (WHO, ECDC) in Europe, Africa and Southeast Asia.