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Ebola cases due to the Bundibugyo virus outbreak in the Democratic Republic of the Congo (DRC) this week now make this the largest Ebola outbreak, with the highest number of deaths ever recorded in the DRC. The number of cases surpassed 6,250 this week, increasing by 9.4% (+537 cases) compared to the 11.9% increase in cases last week. Deaths increased by 10.8% (+295 deaths) this week, and now total 3,039.

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9-03-26 | Ebola cases have surpassed 6,200, and the total number of deaths is more than 3,000, as experts report this outbreak is on track to surpass the largest Ebola outbreak ever recorded. That outbreak, which occurred in West Africa from 2014-2016, infected more than 28,000 people and killed more than 11,000. The ongoing conflict in the Democratic Republic of the Congo (DRC), healthcare worker strikes, and reported shortages of supplies and available tests make this outbreak more difficult to contain. Over the past week, the number of confirmed cases grew by 9.4% (+537 cases), less than the 11.9% growth recorded the week prior, for a current total of 6,250 cases (as of September 1). The number of deaths – currently at 3,039 – rose by 10.8% (+295 deaths) this week, compared to the 13.4% increase recorded the week before. The current CFR is at 48.6%, meaning nearly half of all the people confirmed to be infected have succumbed to the disease. 

The lack of a vaccine to prevent disease transmission challenges containment of the virus. The World Health Organization (WHO) published an emergency guidance update on the use of the Ervebo vaccine, which is the only vaccine approved for preventing Ebola disease. However, it is approved only to protect against the Zaire species, not the Bundibugyo (BDBV) species, which is causing the current outbreak. The guidance states that the vaccine should only be used in an approved research protocol. As of August 27, healthcare workers in some areas have been given the Ervebo vaccine, but there is no definitive evidence it provides protection against BDBV. The week prior, the WHO announced the immediate release of 70,000 doses of the Ervebo vaccine. Twenty thousand of those doses will be used in a Phase 3 clinical trial to understand whether it is effective in preventing Ebola disease. The remaining doses were allocated to healthcare workers. Two small monoclonal antibody studies also recently yielded positive results, including one that administered an antibody (MBP134) as post-exposure prophylaxis to five family members who had a high-risk exposure. None of the family members developed the disease in the 21 days following. Another study detailed the use of the same antibody, in conjunction with remdesivir, to treat a confirmed case, who later recovered. 

The size of the outbreak is likely drastically underestimated due to insufficient contact tracing, as the outbreak distribution of transmission begins to change. According to the Africa CDC, they are expecting 40-60 contacts per case, and the actual number of cases followed up is well below that. Of the contacts listed, the follow-up rate is 80.9%, below the 95% target. When the Africa CDC takes into consideration the contacts that are listed for follow-up, the rate drops to only 19.2% of expected contacts identified and under follow-up.