Alarm grows as Ebola is confirmed in city of 1.2M
Development in latest outbreak raises fears of larger contagion
CNAIROBI, Kenya ongo has confirmed a case of Ebola in Mbandaka, a city of 1.2 million, marking the first urban case in the latest outbreak, which is now the most serious since the epidemic that raged across West Africa between 2014 and 2016.
Ebola is much harder to contain in urban areas, so this development compounds the risk of contagion. The World Health Organization’s lead response official called the new confirmed case “a game changer.”
Previously, confirmed cases had been limited to a remote area more than 100 miles south of Mbandaka, in the rain forest of Congo’s Equateur province. The new, urban case is only the third confirmed case of the current outbreak; 20 others are probable, and 21 are suspected, bringing the total of potential cases to 44. The death toll stands at 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.”
Given the signs of a worsening outbreak, the Centers for Disease Control and Prevention in Atlanta has assembled a team that is ready to deploy to Congo once the WHO finishes assessing its needs and the logistical challenges of transporting experts into the remote outbreak locations.
“Depending on the need, we may be preparing for a longer term,” said CDC epidemiologist Pierre Rollin, an Ebola expert who was in West Africa during the 2014 epidemic. The agency has multiple teams preparing, with each shift in the Congo expected to last four to six weeks.
The densely populated 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, the Central African Republic and Congo Republic lie along it and its tributaries. Health officials are increasingly worried that the virus could be conveyed quickly over long distances by boat between the towns that dot the river’s banks.
Ebola is notoriously hard to contain, though recent outbreaks in Congo have been managed swiftly by the WHO and Congolese health officials, gaining the government there a reputation as one of the continent’s most prepared. Ebola is endemic in Congo, and this is the ninth outbreak of the disease there since the 1970s. Last May, a small outbreak resulted in five confirmed cases and four deaths in a province neighboring Equateur.
The outbreak in West Africa that started in 2014 was the worst ever recorded. It reached epidemic proportions, infecting more than 28,000 and killing more than 11,000. A concurrent but much smaller and unrelated Ebola outbreak took place in Congo in 2014 as well. The WHO was accused of responding slowly in 2014, and the organization has taken pains to ensure it is acting more quickly — and seen as doing so — this time. The organization’s head, Tedros Ghebreyesus, visited the affected area earlier this week.
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. It is often transmitted to humans through the consumption of contaminated meat, but it can also be acquired through any kind of 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, and more batches are expected soon.
Persistent rain and lack of roads has hampered the effort to contain the outbreak. Before Thursday, cases had been confirmed only in Bikoro, a small town whose health clinic 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 minus-60 and minus-80 degrees Fahrenheit, which requires powerful refrigerators. The vaccine, produced by the pharmaceutical giant Merck, is not yet licensed, although the WHO has cleared it for “compassionate use.” Its deployment is being financed by Gavi, the Vaccine Alliance, based in Geneva.
“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 organization. “This is evidenced by the fact that the current outbreak probably started in early April, but it was not officially declared until May 8.”
The only way to stop the outbreak is to seek out all the contacts of the infected person, known as contact tracing, then isolate the infected individuals and provide proper burial for those who die, the CDC’s Rollin said. Much of the transmission during the West Africa epidemic was from unsafe burial practices. The rituals around traditional burial practices are an issue that “always draws a lot of attention and reticence and complication,” he said.