What is Ebola and why is stopping the latest outbreak so difficult?
EPA
The current Ebola outbreak in the Democratic Republic of Congo is now the deadliest of the 17 the country has faced as it continues to spread. United Nations experts have described it as the fastest growing outbreak on record in terms of new infections.
Getting the spread of the deadly virus under control is challenging because it involves a rare species of Ebola for which there is no vaccine – though some are being tested – and the epicentre is in an area affected by conflict.
What is Ebola and what are the symptoms?
Ebola is a rare but deadly disease caused by a virus.
Ebola viruses normally infect animals, typically fruit bats, but outbreaks among humans can sometimes start when people eat or handle infected animals.
It takes two to 21 days for symptoms to appear. They come on suddenly and start like the flu or malaria, with fever, headache and tiredness.
As the disease progresses, vomiting and diarrhoea develop and it can lead to organ failure. Some, but not all, patients develop internal and external bleeding.
The virus spreads from one person to another by contact with infected bodily fluids such as blood or vomit.
Ebola outbreaks used to be small and contained to remote rural areas. However, urbanisation is pushing larger populations closer to these natural reservoirs of Ebola and increasing the risk of transmission.
Why is this Ebola outbreak different and is there a vaccine?
This outbreak is caused by the rare Bundibugyo species of Ebola, which had not been seen for over a decade.
Named after a district in Uganda where it was first detected, Bundibugyo has only caused two previous outbreaks – in 2007 and 2012.
One study showed that it killed about a third of those infected, far less than the more common Zaire (66.6%) and Sudan (48.5%) species. About 48% of those known to have been infected in the current outbreak have died.
Initial blood tests for Ebola in the affected areas were negative as they were designed to identify the more common form of the disease.
In July, the UK’s medicines regulator, the MHRA, said it had given permission for the first human trials of a vaccine for Bundibugyo to go ahead.
It was created by a team from the University of Oxford based on the same technology used in the Oxford-AstraZeneca Covid vaccine.
It took scientists just eight weeks to develop the new jab after plugging in genetic code from the Bundibugyo species of Ebola.
The vaccineis being tested on 50 volunteers from Oxford aged 18 to 55 to see whether it triggers the correct antibody response without causing significant side effects.
Three other groups are also developing different vaccines for Bundibugyo although they have not yet entered clinical trials.
While treatments are available for other species of the Ebola virus, no drugs have been specifically approved to treat those infected with Bundibugyo.
DR Congo is currently preparing to roll out the Ervebo vaccine – which helps protect against the Zaïre species of Ebola – as part of a trial to see if it is effective against the Bundibugyo species.
The World Health Organization (WHO) is also sponsoring a separate clinical trial in the country to see whether two existing antiviral therapies can improve survival rates.
The two drugs selected as the most promising are an experimental monoclonal antibody called MBP134 and remdesivir, an injection into a vein, which is also used to treat Covid.
A further complication is that the outbreak is taking place in a conflict zone, with a quarter of million people displaced from their homes and people moving across porous bordersinto neighbouring countries.
How did the current Ebola outbreak start?
The first known case was a nurse who developed symptoms on 24 April, which means the virus had been spreading undetected for weeks.
The nurse died in Bunia, the capital of eastern DR Congo’s Ituri province, according to Congolese Health Minister Samuel Roger Kamba.
The victim’s body was repatriated to Mongbwalu.
Kamba said one of the reasons the virus spread so quickly was the number of people exposed to the body during the funeral ceremony.
But researchers believe that it may have been spreading since February but it was initially misdiagnosed as malaria or typhoid.
How many Ebola cases have been reported and where are they?
On 23 August, officials said there had been 5,514 confirmed cases and 2,642 confirmed deaths from the virus in DR Congo.
There have also been 1,200 recoveries from Ebola so far, including four nurses whose discharge from hospital was celebrated at a special ceremony.
Ituri province is the epicentre of this outbreak and accounts for the vast majority of confirmed infections.
Cases have also been confirmed in North Kivu (714) and South Kivu (3), provinces partly controlled by the rebel AFC-M23 alliance. These discoveries signalled the outbreak’s spread from its epicentre.
The last patient being treated for Ebola in neighbouring Uganda was discharged from hospital on 16 July. Up to that point, the country had recorded 20 confirmed cases – with most having travelled from DR Congo – and two deaths.
Uganda has since announced it is Ebola-free, going against the protocol of waiting 42 days – until 27 August – from when the last patient recovers to declare an outbreak over.
What is being done in DR Congo to tackle the current Ebola outbreak?
Mass gatherings have been banned in the six provinces with confirmed cases – Ituri, North Kivu, South Kivu, Tshopo, Haut-Uele and Bas-Uele.
The capital city, Kinshasa – which has no confirmed cases and is located some 1,800 km (1,100) miles from the outbreak – has also been ordered to ban mass gatherings.
The government has now established four laboratories in Ituri – in Bunia, Mongbwalu, Beni and Aru – which can test blood samples for Bundibugyo and deliver results within 24 hours, removing earlier delays.
Surveillance systems, contact tracing and the treatment infrastructure, with dedicated centres in several affected towns, have also been expanded, according to the health minister.
The WHO has dedicated $3.9m (£2.9m) to tackling the outbreak, while Africa CDC has announced a $319m budget.
A toll-free number, 151, has been provided for reporting symptoms and people are being reminded to:
- avoid contact with bodies of people who died with symptoms, or with dead animals
- not eat raw meat, as undercooked food may transmit the virus
- practise social distancing.
How have the rebels responded to the latest Ebola outbreak?
The AFC-M23 group has created an Ebola response team in an effort to prevent transmissions in the areas it controls.
In late June, the rebel authorities had declared their zones Ebola-free, but introduced new restrictions in August, following two travellers testing positive in North Kivu.
Shared taxis and passenger boats between government-held and rebel-held areas of the province, have been suspended, highlighting the hostilities between the two sides.
The region’s Ebola response co-ordinator Dr Freddy Kaniki, told the BBC in July that while UN agencies such as the WHO and Unicef – for children – had been helping, there has been no co-ordination with the Congolese government.
What are Rwanda and other countries doing about the Ebola outbreak?
Rwanda closed its borders with DR Congo earlier on in the outbreak. According to Congolese media, authorities began to reopen parts of the border late in June following a lull in local infections.
Uganda hastemporarily suspended flights, buses and all other public transport crossing the border with DR Congo.
Several other African countries have tightened border screenings and bolstered health facilities.
The US has extended travel restrictions on its citizens who have been to DR Congo. Anyone who wants to return home must spend 21 days in a third country before being allowed into America.
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