First ur­ban case of Ebola in Congo a ‘game-changer’

Fears that death toll of 23 will now ‘ex­plode’

Irish Independent - - World News - Max Bearak

CONGO has con­firmed a case of Ebola in Mban­daka, a city of 1.2 mil­lion, mark­ing the first ur­ban case in the lat­est out­break of the dis­ease. The World Health Or­gan­i­sa­tion’s lead re­sponse of­fi­cial called the de­vel­op­ment “a game-changer”.

Con­firmed cases of Ebola had pre­vi­ously been lim­ited to a re­mote area more than 160km south of Mban­daka, in the rain­for­est of Congo’s Equa­teur prov­ince. The case in Mban­daka is only the third con­firmed case of the cur­rent out­break; 20 oth­ers are prob­a­ble, and 21 are sus­pected, bring­ing the to­tal po­ten­tial cases to 44. The death toll is now 23.

“This is a ma­jor de­vel­op­ment in the out­break,” said Peter Salama, the WHO’s deputy di­rec­tor-gen­eral of emer­gency pre­pared­ness and re­sponse. “We have ur­ban Ebola, which is a very dif­fer­ent an­i­mal from ru­ral Ebola. The po­ten­tial for an ex­plo­sive in­crease in cases is now there.”

The port city of Mban­daka lies on the east­ern bank of the Congo river, Africa’s sec­ond long­est af­ter the Nile. Tens of mil­lions of peo­ple live along the river, and the cap­i­tals of Congo, Cen­tral African Repub­lic, and the Repub­lic of Congo lie along it and its trib­u­taries.

Ebola is no­to­ri­ously hard to con­tain, though re­cent out­breaks in Congo have been man­aged swiftly by the gov­ern­ment and global health in­sti­tu­tions. This is the ninth Ebola out­break in Congo since the 1970s, and the first since May of last year, when five con­firmed cases re­sulted in four deaths.

An out­break be­tween 2014 and 2016 in west Africa was the worst ever, and killed more than 11,000. There were no cases in the Congo dur­ing that out­break.

The dis­ease causes in­ter­nal bleed­ing and spreads rapidly through con­tact with small amounts of bod­ily fluid. Its early symp­toms are not ob­vi­ous and the worst ef­fects may take weeks to show. Ebola, en­demic in Congo, is of­ten transmitted to hu­mans through eat­ing con­tam­i­nated meat, but can be caught through any close con­tact with an in­fected an­i­mal.

The in­ter­na­tional re­sponse to the cur­rent Congo out­break has been sub­stan­tial, and is ex­pected to grow in size and ur­gency af­ter the an­nounce­ment of a con­firmed ur­ban case. On Wed­nes­day, the WHO de­liv­ered 4,000 in­jec­tions of an ex­per­i­men­tal vac­cine with proven ef­fi­cacy in re­cent tri­als, with more batches ex­pected soon.

The WHO is also de­ploy­ing

30 ex­perts to Mban­daka to “con­duct sur­veil­lance in the city and is work­ing with the Min­istry of Health and part­ners to en­gage with com­mu­ni­ties on preven­tion and treat­ment and the re­port­ing of new cases”.

Per­sis­tent rain and lack of roads has hampered the ef­fort to con­tain the out­break so far.

Cases had pre­vi­ously only been con­firmed in Bikoro, a small town whose health clinic only has “lim­ited func­tion­al­ity,” ac­cord­ing to the WHO. He­li­copter and mo­tor­cy­cle are the only ways to reach Bikoro from Mban­daka, but an airstrip has been rapidly cleared for small planes to land with sup­plies.

Part of the dif­fi­culty in de­ploy­ing the vac­cine is that it must be trans­ported and stored at be­tween -50C and -60C, re­quir­ing pow­er­ful re­frig­er­a­tors. The vac­cine, pro­duced by Merck, is not yet li­censed, but the WHO has cleared it for “com­pas­sion­ate use”.

“The re­mote lo­ca­tion of the out­break hampers both the in­for­ma­tion about the out­break and in­ter­ven­tions to con­trol it,” said Cyrus Shah­par, di­rec­tor of epi­demic preven­tion at Re­solve to Save Lives, a New York-based or­gan­i­sa­tion. (© Wash­ing­ton Post)

‘Ur­ban Ebola is a dif­fer­ent an­i­mal. The po­ten­tial for an ex­plo­sive in­crease in cases is now there’

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