Is Ebola on the Path to Becoming Endemic in the DRC?

Updated: 11/9/18 at 8:25 PM EST

As the North Kivu province Ebola outbreak enters its fourth month, international health officials are worrying if the combination of violence and insecurity in the area will render this outbreak past the point of control.

A total of 319 cases of Ebola infection have been reported in North Kivu as of November 9, 2018; 284 of these cases were confirmed. Another 52 suspected cases are currently under investigation. The region has also seen 198 deaths, 163 of which were in confirmed Ebola patients.

On November 9, 2018, the outbreak has become the largest Ebola outbreak in the history of the Democratic Republic of the Congo (DRC), and the international community is attempting to determine if this outbreak could spread outside the DRC.

On November 5, 2018, Johns Hopkins Center for Health Security hosted a congressional seminar featuring Robert Redfield, MD, director of the US Centers for Disease Control and Prevention (CDC) and Tom Inglesby, MD, director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health. The pair discussed current information on the outbreak as well as the United States’ role in the international response.

Dr. Inglesby, who has spoken to Contagion® about this Ebola outbreak in the past, highlighted several red flags that have appeared in this outbreak, despite the strong responses from the World Health Organization (WHO) and international partners. These red flags include that half of the outbreak cases have occurred in the past month, a total of 28 health care workers have been infected, contact tracing is becoming difficult because of violence in the region, and that community members are dying from Ebola infection before being diagnosed.

The insecurity and violence in the outbreak epicenter and surrounding red zones where rebel groups are active has limited the prevention activities in the area. The government and outbreak control partners have been unable to negotiate a ceasefire between groups to contain the outbreak. As a result, the US State Department’s security assessment has advised against US personnel being on the ground in the response.

Instead, CDC personnel are now providing support to the WHO in Geneva, Switzerland, and Kinshasa, the capital city of the DRC, and in surrounding countries.

According to Dr. Redfield, to prevent the outbreak from spreading to other countries and continents, it is critical that the outbreak be brought under control in North Kivu. This will not be possible without the assistance of international partners. If current efforts fail, Ebola could become endemic in a region for the first time.

“I do think this is one of the challenges we’ll have to see, whether we’re able to contain, control, and end the current outbreak with the current security situation. Or, do we move into the idea that this becomes more of an endemic Ebola outbreak in this region, which we’ve never really confronted,” Dr. Redfield said during the seminar.

In response to the threat of the growing outbreak, the US Food and Drug Administration (FDA) announced on November 9, 2018, that an emergency use authorization has been issued for a rapid, single-use test for the detection of Ebola called DPP Ebola Antigen System. The test can provide rapid diagnostic results in areas where providers do not have access to PCR testing.

Dr. Redfield also reflected on the differences between this current outbreak and the 2014 West African outbreak, remarking that in fighting this outbreak, health workers have access to the Ebola vaccine, and rapid diagnostic tests and experimental therapeutics that were unavailable previously. Additionally, surrounding nations are also preparing for the event that the outbreak spreads.

For example, health officials in Uganda have continuously screened individuals crossing the border from the DRC; however, according to the Ministry of Health, they have now instituted the vaccination of health care workers.

As such, a total of 2100 doses of the Ebola vaccine will be administered to frontline health workers in Uganda under expanded or compassionate use. Targeted vaccination will only include health workers at this time to prepare for the event that a positive case is detected in Uganda.

“It is highly likely that Uganda may import Ebola virus from DRC given the closeness of the current epicenter, the high population movements due to trade, social-cultural connections and easy accessibility of health services in Uganda,” a health official said in the press release.

According to UN Office for the Coordination of Humanitarian Affairs, preventative measures are also being introduced in South Sudan. In Yei, a South Sudanese city bordering the DRC, an isolation area has been established in a hospital and clinicians are being trained about the symptoms of Ebola. Furthermore, surveillance measures have been implemented at an airstrip and health workers are conducting door-to-door education on Ebola prevention; however, violence in this area of South Sudan is also inhibiting health professionals from reaching all citizens.

For the most recent case counts associated with the Tenth Ebola Outbreak in the DRC, check out the Contagion® Outbreak Monitor.