As the Democratic Republic of the Congo (DRC) continues to battle an outbreak of Ebola in North Kivu--the death toll of which has exceeded the country’s previous outbreak in Bikoro--its neighbors are on the alert for the potential introduction of cases. Though the World Health Organization warned during the Bikoro outbreak of the potential for cross-border spread, no cases were reported outside of DRC. However, health authorities are particularly worried about potential spread from the current outbreak in North Kivu--a populous conflict zone that is home to more than a million displaced persons. In light of these concerns, this post takes a look at the risk of cross-border spread of Ebola and what is being done by one of DRC’s neighbors, Uganda, in response to the potential for the introduction of Ebola.
Ebola Risk Assessment
A rapid risk assessment conducted by the WHO after the declaration of the outbreak in North Kivu on August 1 determined that “the public health risk for this outbreak is high at the regional level.” This assessment took into account the fact that North Kivu is densely populated and shares borders with 4 other DRC provinces and 2 other countries, Uganda and Rwanda. Additionally, the high number of displaced persons have increased the rate of border crossings in and out of neighboring countries. To make matters worse, on August 14 a case was reported outside the province of North Kivu in Ituri province, another area of active conflict.
Ebola Preparedness in Uganda
On August 11, WHO Director-General Tedros Ghebreyesus stopped by the capital of Uganda, where he was briefed by Uganda’s WHO representative on the country’s operational preparedness to respond to an Ebola outbreak. The Director-General was returning from his visit to the DRC.
Five districts in Uganda share a border with the DRC, and, with the help of the WHO, the Uganda Ministry of Health, and other partners, Uganda has taken extensive efforts to decrease the risk of Ebola importation across their border. Some WHO-supported activities in Uganda include the deployment of Preparedness Support Teams; the re-tasking of teams working for polio programs to help support preparedness efforts; the training of rapid response teams to help with surveillance, case investigations, and other activities; the training of risk communicators; and providing viral hemorrhagic fever kits, PPE and other materials. The US CDC, UNICEF, and a number of other partners are also providing support, including staff and supplies. Uganda is also screening all people entering from DRC at both official and unofficial entry points, along with a variety of other surveillance and preparedness activities.
Ebola is no stranger to the country of Uganda. There have been a number of Ebola outbreaks in the country of various sizes, including one in 2000-2001 that had 425 reported cases and 224 deaths (53% case fatality rate). In fact, in late May, it was reported that an Ebola outbreak was occurring in Mubende district. However, the Uganda Ministry of Health quickly quelled the reports of Ebola cases, stating that they were actually cases of Crimean-Congo Hemorrhagic Fever, an endemic, vector-borne disease that has many symptoms similar to Ebola, including vomiting, diarrhea, abdominal pain, and hemorrhaging.
We have written before about the importance of continued vigilance for Ebola outbreaks. Given the risks posed by the current outbreak in DRC, it is paramount that DRC’s neighbors conduct active surveillance for potential Ebola cases and evaluate and strengthen preparedness efforts in the areas at highest risk for Ebola importation. Additionally, it is critical that these efforts continue even after the current DRC outbreak ends, as the emergence of a second outbreak in DRC shortly after containment of the first signifies a likelihood that Ebola outbreaks will continue to emerge in the region.
Photo: This image was taken on the grounds of Kagadi Hospital in the Kibaale District of Uganda, during that nation’s July - August, 2012, Ebola outbreak. Dressed in their green-colored scrubs, and white rubber boots, these were members of the hospital staff, who’d stopped to pose for this quick portrait. Note the somber expressions each staff member displayed, reflecting the seriousness of their plight. According to the World Health Organization (WHO), it was inside the Kibaale District that the 2012, Ugandan Ebola outbreak began.
Photo courtesy of CDC
Outbreak Observatory aims to collect information on challenges and solutions associated with outbreak response and share it broadly to allow others to learn from these experiences in order to improve global outbreak response capabilities.