On May 9th, the World Health Organization (WHO) was notified of undiagnosed illnesses and deaths with hemorrhagic symptoms that were occurring in Likati Health Zone, Bas Uele Province in northern Democratic Republic of the Congo (DRC). Two days later, the DRC Ministry of Health notified WHO of two positive Ebola samples, collected from suspected cases, that had been tested at a national reference laboratory in Kinshasa, 1300 kilometers from the site of the outbreak. According to WHO, as of May 16, 2017, there have been twenty-one suspected cases including three deaths (case fatality rate of 14.3%). Additionally, testing showed that the laboratory samples were of the Zaïre serotype, the same serotype responsible for the large Ebola epidemic that occurred in West Africa from 2014-2016. It has been a little over a year since the WHO declared an end to the Public Health Emergency of International Concern (PHEIC) for this epidemic, which led to the deaths of more than 11,000 people in the countries of Guinea, Sierra Leone and Liberia.
Ebola is no stranger to the healthcare system in the DRC. As a matter of fact, the disease gets its name from the Ebola River, located in the DRC, where the disease was first identified in 1976. Since its initial discovery, there have been seven outbreaks in the DRC (this will be the eighth), the most recent being in 2014, during which there were 66 cases and 49 deaths. The outbreak, which began in late August 2014 and was unrelated to the West African outbreak, was quickly contained and declared over by late November. According to Dr. Yokouidé Allarangar, WHO representative in the DRC, the WHO is working to deploy “health workers and protective kits in the field to strengthen epidemiological surveillance and rapidly control the outbreak.” Contact tracing has begun to identify those who may have been in contact with the cases, and thus far at least 400 close contacts have been identified. Health workers are also working to identify any cultural factors, such as how the affected communities handle and bury their dead, which could potentially increase transmission of the disease. According to the WHO, at least 20% of new Ebola cases are acquired during the burial of Ebola victims, and burial practices used by communities impacted by the 2014-2016 West African epidemic played a large role in the rapid spread of the disease.
In addition to the efforts noted above, according to WHO and Gavi, there have been preparations to make an experimental Ebola vaccine available, although the DRC has not formally requested it as of yet. The vaccine, rVSV-ZEBOV, is being developed by Merck and was shown to be highly protective against Ebola in a clinical trial in Guinea during 2015. As a result, in January 2016, Gavi announced an Advanced Purchase Commitment with Merck, ensuring that 300,000 doses of the Ebola vaccine would be available for use in clinical trials or for emergency use. However, a vaccination campaign could prove difficult given the remote location of Bas Uele province, the need to transport samples back to Kinshasa for testing, and because of storage requirements of the experimental vaccine, which must be kept at -80°C. Additionally, the efficacy of the vaccine for the existing outbreak strain has not yet been established, which could greatly impact its effectiveness in quelling the outbreak.