Urban cases spread worry of ‘explosive’ Ebola disaster

LONDON • An Ebola outbreak in the Democratic Republic of Congo has spread from the countryside to a city of 1.2 million inhabitants, prompting fears of a full-blown health emergency.

A rapid response team, comprising doctors, nurses and other public health experts, is expected to be sent from the U.K. to the region in the next 48 hours by Public Health England as part of an international effort to contain the deadly hemorrhagic disease.

The latest outbreak was first reported 10 days ago in the remote rural area of Bikoro, in the northwest of the country. Now three cases, one of which has been confirmed by laboratory tests, have been reported in Mbandaka, a densely populated city with poor sanitation and thinly spread health care.

The latest official figures suggest at least 44 people have been infected and 23 have died since the outbreak started.

But experts fear many more cases may have gone unreported.

Peter Salama, a senior World Health Organization (WHO) official, said the spread to Mbandaka meant there was now the potential for an “explosive increase” in cases. “This is a major development in the outbreak,” he said. “We have urban Ebola, which is a very different animal from rural Ebola.”

Jose Barahona, Oxfam’s DRC country director, said it was likely the disease had been carried from the countryside down the river Congo to the city by an infected person.

“Boats move up and down the river, carrying people and goods,” he said. “One of the risks is that someone with the virus could easily access one of the boats and start moving up and down.”

The river connects Mbandaka with the capital of DRC, Kinshasa, as well as Brazzaville, the capital of neighbouring Congo-brazzaville.

The authorities always feared the spread of the disease to the city, which is just 128 kilometres from Bikoro.

“If the number increases in Bikoro it’s bad but it’s not a disaster. But if these three cases in Mbandaka become 10 or 12 then we have an urban epidemic,” Barahona said.

This is the ninth outbreak of the disease in DRC since it was first discovered in what was then Zaire. But all previous outbreaks have been contained in rural areas.

Some 514 people who may have been in contact with infected people are being monitored while the WHO is deploying 30 experts to conduct surveillance in the city.

“The arrival of Ebola in an urban area is very concerning and WHO and partners are working together to rapidly scale up the search for all contacts of the confirmed case in the Mbandaka area,” said Matshidiso Moeti, WHO regional director for Africa.

Henry Gray, Medecins Sans Frontieres (MSF) emergency coordinator in DRC, said with the spread of the disease to the city the situation had become “most serious and worrying.”

“We’re certainly not trying to cause any panic in the national or international community,” Salama said. But “urban Ebola can result in an exponential increase in cases in a way that rural Ebola struggles to do.”

MSF teams have set up an isolation zone in the city’s main hospital and are building two Ebola treatment centres in Mbandaka and Bikoro.

The first 4,000 batches of the VSV Ebola vaccine have arrived in the country and the WHO, in partnership with MSF and the Congolese health ministry will soon start a vaccination program .

The largest recorded Ebola outbreak in 2014-16 occurred in West Africa and killed 11,300 people. It proved difficult to control after it spread to the capitals of Guinea, Sierra Leone and Liberia.

Teams from the World Health Organization and all major agencies have been deployed quickly, with significant funding from world governments and agencies.