HEALTH
08/03/2018 11:47 am ET Updated Aug 03, 2018

Ebola Keeps Coming Back. This Time's It's In A Conflict Zone.

And its return in the Democratic Republic of Congo points to the concerning rise of the worst kind of outbreaks, experts say.
JUNIOR D. KANNAH via Getty Images

The latest Ebola outbreak in the Democratic Republic of Congo will be extremely difficult to control because it is taking place in an active conflict zone, the World Health Organization’s emergency response chief told HuffPost.

The DRC’s ministry of health believes the outbreak in the northeast province of North Kivu on the border with Uganda, which was announced Tuesday, has infected 26 and killed 20 so far ― although WHO’s Peter Salama expects those numbers to change as testing and case reviews continue. The case that alerted authorities to the outbreak involved the July 25 death of a 65-year-old woman with hemorrhagic fever symptoms. Seven of her family members contracted similar symptoms after her burial and died.

The current national and regional risk is high, Salama said, while global spread risk is low. Complicating matters, the province of North Kivu is home to 1 million displaced people, and 100 armed groups are known to the area ― 20 of which are very active, Salama said.

“On the scale of degrees of difficulty, this is the top of the scale,” he warned. “There aren’t many situations that combine the fear and panic and risk of a high-stress pathogen as dangerous as Ebola with having to work right on the frontlines of a conflict.”

The United Nations has classified North Kivu as U.N. security level four, which is one of its highest levels. But fortunately, in the town of Beni where most of staff will be based, it’s more secure than the surrounding North Kivu, Salama said. The WHO has already deployed 30 staff members to the scene and the Ministry of Health and the Medicins Sans Frontieres NGO are also on site.

“We have to trace people and contacts that are strewn over something like 400 kilometers, and we’re going to face real security challenges,” Salama said.

That’ll require the WHO to travel in armored vehicles and with security, Salama said, and may limit their ability to execute a ring vaccination strategy like the one just applied in the last Ebola outbreak in the country, which ended a little over a week ago.

Initial tests indicate this outbreak is the same Zaire strain of Ebola the country saw earlier this year, but Salama said full confirmation would come in the coming days. Experts initially worried that the Ebola strain in this outbreak would be different, thus limiting the ability to use the same Merck experimental vaccine deployed earlier this year in the DRC ― 3,000 of those doses are still in the country. While there must be a reviewal process to approve any vaccine usage, Salama expects it to move quickly. Minister of Health Oly Ilunga Kalenga told Reuters he expects to deploy vaccine as early as next week.

But deployment has its own difficulties, on top of establishing an effective cold chain, which means the vaccine must be kept under minus 60 degrees Celsius at all times. Salama said that if ring vaccination is impossible due to an inability to effectively trace people who have come into contact with Ebola, then the WHO and others would be forced to vaccinate a designated area. Salama said his largest concern was the WHO would be unable to effectively contact trace and vaccinate due to the security issues. 

The cost of the outbreak should be substantial, Salama warned, citing the added security costs like mandatory radios for each disease detective and armored vehicles. If the transmission stays at a similar level, he said it would be close to the last outbreak’s cost ― about $36 million, covered by fundraising from a variety of countries and NGOs. The WHO has already activated $2 million for the current fight from its emergency response contingency fund.

Salama said the latest Ebola outbreak was an example of the rising risks of the worst kinds of pathogens, citing HuffPost reporting that showed the WHO’s blueprint pathogens ― ones that are most likely to cause a public health emergency and have limited countermeasures ― are happening more frequently.

“Really what we’re seeing is this confluence of high-stress pathogens which we don’t have great many good countermeasures [for, plus] population displacement, population growth, climate change and vector changes, and human encroachment on animal reservoirs all coming together in a way that makes us much more concerned that we’re going to have many, many more outbreaks ― including in urban areas,” he told HuffPost. “And the urban areas point is the critical one here.”

Salama said he fears a single “superspreading” event in an urban area for one of these dangerous outbreaks ― leading to tens of thousands of secondary cases from an unsafe burial, for instance, leading to “massive outbreaks of these diseases with massive mortality potential.”

Dr. Thomas Inglesby, director of the Johns Hopkins Center for Health Security, echoed Salama’s concerns about the increasing risks of such pathogens.

“To see two separate Ebola outbreaks in the same season in the same country is another sign that serious infectious disease outbreaks are the new normal,” he told HuffPost. “We need to build and sustain global and national systems for dealing effectively with them, whether they are in cities, villages or in conflict zones.” 

Dr. Richard Hatchett, CEO of CEPI, the Coalition for Epidemic Preparedness Innovations, stressed the need for better understanding of the geographical range of Ebola ― which is typically spread by infected fruit bats. Salama told HuffPost that Zaire Ebola has never been seen in this part of the DRC, but it’s too early to tell if this is a result of a new migratory pattern for the bats.

However, according to Hatchett, this new outbreak “highlights an important fact about Ebola and emerging infectious disease in general — they are the ultimate opportunists, constantly trying to find ways to break out.”

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