Ebola spreads to city

Sec­ond-largest out­break wors­ens amid se­cu­rity con­cerns, wor­ries about vac­cine sup­ply


DAKAR, Sene­gal — The sec­ond­largest Ebola out­break in his­tory has spread to a ma­jor city in east­ern Congo, as health ex­perts worry whether the stock of an ex­per­i­men­tal vac­cine will stand up to the de­mands of an epi­demic with no end in sight.

Butembo, with more than 1 mil­lion res­i­dents, is now re­port­ing cases of the deadly hem­or­rhagic fever. That com­pli­cates Ebola con­tain­ment work al­ready chal­lenged by rebel at­tacks else­where that have made track­ing the virus al­most im­pos­si­ble in some vil­lages.

“We are very con­cerned by the epi­demi­o­log­i­cal sit­u­a­tion in the Butembo area,” said John Johnson, pro­ject co-or­di­na­tor with Medecins Sans Fron­tieres in the city. New cases are in­creas­ing quickly in the east­ern sub­urbs and out­ly­ing, iso­lated dis­tricts, the med­i­cal char­ity said.

The out­break de­clared on Aug. 1 is now sec­ond only to the dev­as­tat­ing West Africa out­break that killed more than 11,300 peo­ple a few years ago. There are cur­rently 471 Ebola cases, of which 423 are con­firmed, in­clud­ing 225 con­firmed deaths, Congo’s health min­istry said late Thurs­day.

With­out the teams that have vac­ci­nated more than 41,000 peo­ple so far, this out­break could have al­ready seen more than 10,000 Ebola cases, the health min­istry said.

This is by far the largest de­ploy­ment of the promis­ing but still ex­per­i­men­tal Ebola vac­cine, which is owned by Merck. The com­pany keeps a stock­pile of 300,000 doses, and pre­par­ing them takes months.

“We are ex­tremely con­cerned about the size of the vac­cine stock­pile,” The World Health Or­ga­ni­za­tion’s emer­gen­cies di­rec­tor, Dr. Peter Salama, told the STAT me­dia out­let this week, say­ing 300,000 doses is not suf­fi­cient as ur­ban Ebola out­breaks be­come more com­mon.

Health work­ers, con­tacts of Ebola vic­tims and their con­tacts have re­ceived the vac­cine in a “ring vac­ci­na­tion” ap­proach, but in some cases all res­i­dents of hard-to-reach com­mu­ni­ties have been of­fered it. The prospect of a mass vac­ci­na­tion in a ma­jor city such as Butembo has raised con­cerns. Salama called the ap­proach “ex­tremely im­prac­ti­cal.”

A WHO spokesman said ship­ments of doses ar­rive al­most ev­ery week to en­sure a suf­fi­cient sup­ply for the ring vac­ci­na­tion. “No in­ter­rup­tions of vac­cine sup­ply have oc­curred to date,” Tarik Jasare­vic said in an email. “Merck is ac­tively work­ing to en­sure suf­fi­cient num­ber of doses con­tinue to be avail­able to meet the po­ten­tial de­mand.”

This Ebola out­break is like no other, with deadly at­tacks by rebel groups forc­ing con­tain­ment work to pause for days at a time. Some wary lo­cals have re­sisted vac­ci­na­tions or safe buri­als of Ebola vic­tims as health work­ers bat­tle mis­in­for­ma­tion in a re­gion that has never en­coun­tered the virus be­fore.

A “fringe pop­u­la­tion” has reg­u­larly de­stroyed med­i­cal equip­ment and at­tacked work­ers, Health Minister Dr. Oly Ilunga Kalenga told re­porters on Wed­nes­day.

The Ebola virus is spread via bod­ily flu­ids of those in­fected, in­clud­ing the dead.

The out­break “re­mains se­ri­ous and un­pre­dictable,” the WHO said in an as­sess­ment re­leased Wed­nes­day. Nine health zones have re­ported new cases in the past week, and some have been un­re­lated to known vic­tims, mean­ing that gaps in track­ing re­main in a re­gion with a dense, highly mo­bile pop­u­la­tion.

Thou­sands of peo­ple have been or­ga­nized by Red Cross so­ci­eties and oth­ers to go house-to-house dis­pelling ru­mours and check­ing on pos­si­ble con­tacts of vic­tims.

Dr. Fa­toumata Nafo-Traore, Africa re­gional di­rec­tor for the In­ter­na­tional Fed­er­a­tion of Red Cross and Red Cres­cent So­ci­eties, joined one aware­ness cam­paign in the out­break’s epi­cen­tre, Beni, this week.

The head of one fam­ily thanked her for the face-to-face con­tact, say­ing he didn’t even have a ra­dio and didn’t un­der­stand what was hap­pen­ing. “Ig­no­rance is the en­emy,” an­other res­i­dent said.

Given the years of con­flict in east­ern Congo, it’s es­sen­tial that house­holds trust why the health work­ers are there, Nafo-Traore said.

While she called the in­se­cu­rity “very wor­ry­ing,” she said that with new tools at hand, in­clud­ing vac­cines, “there is great hope.”


Health work­ers em­brace while putting on their per­sonal pro­tec­tive equip­ment be­fore head­ing into the red zone of a Medecins Sans Fron­tieres sup­ported Ebola treat­ment cen­tre in Bu­nia, Congo, on Nov. 7.

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