Health Workers in South Sudan Will Be Vaccinated as the DRC Ebola Outbreak Spreads. Here's What to Know
Officials are set to begin vaccinating select people in South Sudan against Ebola, as a worsening outbreak in the Democratic Republic of the Congo (DRC) continues to intensify, putting the neighboring country on “high alert.”
The DRC outbreak is still far less sweeping than a West African outbreak that killed 11,000 people between 2014 and 2016, but the WHO has called it the second worst ever. Continuing spread of the disease, and the fact that it has reached a populous city in the DRC’s North Kivu province, has health officials concerned. In September, the WHO declared regional risk associated with Ebola “very high,” though it maintains that global risk remains low. In October, the WHO decided not to declare the outbreak a public health emergency of international concern.
Nonetheless, officials have urged “ongoing vigilance” and protective measures for health workers in the DRC and neighboring countries, including the vaccination of some in South Sudan and Uganda.
Here’s what to know about the Ebola outbreak in the DRC.
How severe is the Ebola outbreak?
The DRC’s current Ebola outbreak, its 10th in 40 years, was officially declared on Aug. 1, shortly after the end of another outbreak in the country that claimed 33 lives. As of Dec. 5, the WHO had recorded 452 confirmed cases of Ebola, as well as 48 suspected cases. Almost 290 deaths have been reported, including 241 confirmed to be the result of Ebola. The most confirmed cases have been reported in the Beni health zone, located in the country’s populous North Kivu Province, and Kalunguta, Beni, Butembo and Katwa “remain the principle hotspots of the outbreak,” according to a recent WHO case report.
Women and children have been disproportionately affected by the outbreak. According to the WHO, women have accounted for about 62% of cases where sex was reported; at least 18 of these women were pregnant, and additional seven were either breastfeeding or had recently given birth. Another cause for concern, according to the WHO, is the high rate of infection among children. Nearly a quarter of cases have been in children younger than 15, including 27 infants not even a year old. Women and children may be exposed to Ebola in health facilities, when attending funerals or through family care, according to the WHO. They may also be more likely to seek medical attention if they do become sick.
Since the beginning of the outbreak, 142 people have been successfully treated for Ebola and released back into their communities.
Is Ebola spreading?
Ebola — a rare and severe virus that causes fatigue, muscle and stomach pain, vomiting, diarrhea and unexplained bleeding — can be quite contagious and is spread through direct contact with infected people or their bodily fluids, according to the Centers for Disease Control and Prevention (CDC). While no cases of the virus have been confirmed outside the DRC, one was confirmed near the Ugandan border in late September, and health officials have deemed the risk of national and regional spread “very high.” The WHO and the Ministry of Health are keeping a close eye on countries that share borders with the DRC, including Uganda, Rwanda and South Sudan.
A number of factors could allow disease transmission to extend beyond the DRC’s borders, raising red flags. In a recent case report, the WHO cited “the volatile security situation, sporadic incidents of community reluctance, refusal or resistance, continued reporting of confirmed cases, and the risk of spread to neighbouring countries” as reasons for concern. Ebola cases have also been reported in Butembo, a North Kivu city with more than 1 million residents, causing health officials to worry about further spread.
One of the primary issues is a long-standing humanitarian crisis in the DRC that has worsened over the past year, forcing millions of people to flee their homes, according to the UN. More than 4 million people in the DRC are considered displaced — including more than a million in North Kivu Province alone — leading to “continuous movement of refugees to neighboring countries,” the WHO says. This movement, along with travel within the DRC, could increase the disease’s chances of spreading, the WHO says. Plus, security concerns and community resistance in North Kivu and Ituri provinces have stifled response and monitoring efforts in these areas, and made it more difficult to carry out “safe and dignified burials” that can curb disease spread.
Several other diseases are also currently circulating in the DRC, including polio, cholera, measles and monkeypox.
What’s being done about the Ebola outbreak?
The WHO continues to closely monitor and respond to affected and at-risk areas. Multiple hospitals in the DRC now have the capacity to confirm diagnoses of Ebola with laboratory testing, and procedures are in place for treating and isolating patients suspected or known to have the virus. (Nonetheless, the WHO says some hospital visitors still show “resistance” to containment procedures, another risk factor for disease transmission.)
Health workers have also been using a new, experimental Ebola vaccine to help stop the virus’ spread, inoculating almost 40,000 people so far. Health workers have been using a vaccine made Merck, which has been shown in field testing to potentially reduce infection rates, and showed some success during the last outbreak in the DRC. Merck has provided thousands of the vaccines to health authorities for emergency use, but it’s still considered experimental since ethical concerns have barred scientists from performing the types of controlled clinical trials usually used to test new drugs.
Vaccination of health and frontline workers in South Sudan will begin on Dec. 19, joining the vaccination of some individuals in Uganda, according to the WHO. More than 2,000 vaccines have been earmarked for use in South Sudan.
About 160 people have also been treated with other experimental drugs, under a WHO policy that allows for the emergency use of investigational therapies. And in a significant step, the WHO announced that the DRC will begin a randomized control trial to test the efficacy of new therapeutics.
The U.S. withdrew its presence in the region in August and has not redeployed anyone in the face of significant security concerns. Some employees from the CDC and the U.S. Agency for International Development are in the DRC capital of Kinshasa, miles away from the heart of the outbreak, the Washington Post reports.
