(Bloomberg) — A rare strain of Ebola with no approved vaccine or treatment may have circulated undetected in conflict-torn northeastern Democratic Republic of Congo for weeks before killing dozens of people.
Laboratory tests by the National Institute for Biomedical Research in Kinshasa have confirmed that the outbreak is caused by the Bundibugyo strain, the World Health Organization said on Friday. The virus has caused only two previous known outbreaks, in Uganda in 2007 and in eastern Congo in 2012.
About 246 suspected cases and 65 deaths were reported mainly in Mongbwalu and Rwampara health zones in Ituri province near the Ugandan border, with other suspected infections in Bunia, the provincial capital, the African Centers for Disease Control and Prevention said. Among the laboratory-positive cases, four deaths were confirmed.
Ebola is among the deadliest infectious diseases in the world, killing about a quarter to nearly 90% of people infected, depending on the type of virus and available medical care. Discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo, the Zaire strain caused a devastating West African epidemic a decade ago and garnered the most research funding, leading to licensed vaccines and treatments.
“Ebola Zaire is the one that’s gotten all the attention, and for very good reasons,” Susan McLellan, director of biocontainment care at the University of Texas Medical Branch, said in an interview. Development of medical countermeasures, including monoclonal antibodies and vaccines, is less advanced for Bundibugyo, she said.
Doctors would likely still consider Gilead Sciences Inc.’s remdesivir. for Bundibugyo infections, McLellan said. Laboratory research has shown that the strain may be more susceptible to antivirals than Ebola Zaire.
Uganda also confirmed a case of Bundibugyo Ebola in a Congolese patient who died in a hospital in Kampala after traveling across the border for treatment.
WHO is deploying additional epidemiologists, laboratory specialists and infection control experts to Ituri while airlifting 5 metric tons of emergency supplies including testing equipment, protective gear and medical supplies, the agency said.
The outbreak is taking place in a remote part of eastern Congo more than 1,700 kilometers (1,100 miles) from Kinshasa, where the response is complicated by insecurity, poor roads, mining-related population movements and frequent cross-border travel.
Mongbwalu lies in one of the nation’s gold mining areas, where tens of thousands of people move between remote mining camps and nearby commercial centers. The region is also plagued by armed groups and weak infrastructure, complicating efforts to supply medical supplies and disease and contact tracing.
“Getting access to Mongbwal is not easy,” said Jimmy Munguirek, Congolese director for advocacy group Resource Matters. “The road is not there.”
There is only one major hospital in the area, Munguirek said, adding that crowded mining settlements and the constant movement of workers could accelerate transmission if the outbreak is not quickly contained.
“These zones are full of people who come from all over to work in artisanal mining,” Munguirek said. Armed groups operating in the area and mistrust of health authorities could also hamper containment efforts, he said. “There is a big risk that things will get worse.”
The scale of the outbreak suggests that the virus may have circulated undetected for several weeks before being identified. The WHO said it first received signals of the suspected outbreak on May 5 and dispatched a team to support the investigation. Initial tests for the more common Zaire strain were negative, further tests later confirmed Bundibugyo on 14 May.
“All of that didn’t happen in the last week,” McLellan said of the suspected infection. “This has been going on for a while.
Patients had fever, weakness, vomiting and, in some cases, bleeding, according to the WHO, which said several cases deteriorated rapidly and died.
Ebola is spread through direct contact with the bodily fluids of infected people or contaminated materials. The risks of transmission can skyrocket in environments where people don’t have reliable access to running water and sanitation, said McLellan, who worked in West Africa during the 2013-2016 Ebola epidemic.
“It takes a very small amount of material,” she said, describing how body fluids can remain on skin or surfaces when handwashing and sanitation are limited.
Still, experts stressed that Ebola does not spread easily through casual contact and that the risk outside the region remains low.
“There is no documented sustained spread of Ebola outside of Africa,” Imperial College London researchers said in an analysis published Friday, noting that exported cases during the West African epidemic were rare and mostly involved health workers.
Congo has extensive experience in responding to Ebola outbreaks, having battled more than a dozen outbreaks over 50 years. The country’s last outbreak, declared in December, was contained within weeks.
The outbreak comes as some global health experts warn that cuts to US foreign aid and public health programs could weaken disease surveillance and emergency response capacity in volatile regions. A study published Thursday in Science found that the sudden withdrawal of USAID funding was linked to increased conflict in parts of Africa heavily dependent on aid.
Acting Director Jay Bhattacharya said Friday that the US Centers for Disease Control and Prevention is “closely monitoring” the outbreak and providing technical support through offices in Congo and Uganda.
“We are absolutely involved,” Bhattacharya told reporters on Friday. “If we have a safe world, if we can address these needs like the Ebola epidemic, we will also have a safer America.”
–With assistance from Janice Kew and Annika Inampudi.
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