Ebola virus behind massive outbreak in DRC could be mutating, officials say

Africa’s public health watchdog said the time for incremental action was over as they announced plans to scale up every aspect of the response and go “door to door” looking for patients.

The Ebola outbreak, caused by the Bundibugyo strain of the virus, was first reported on 15 May, although there are suspicions the disease could have been spreading since January.

There have been 3,973 cases and 1,801 deaths recorded as of 4 August, according to the DRC’s national public health institute. Speaking on Thursday, Dr Jean Kaseya, director general of the Africa Centres for Disease Control and Prevention (Africa CDC), told a press briefing cases had topped 4,000.

The outbreak is now the second-largest Ebola outbreak on record. There are eight times more cases, and six times more deaths than were recorded 11 weeks into the West Africa Ebola outbreak in 2014-18, which infected more than 28,000 people and killed at least 11,000.

Kaseya said he had spoken to the director general of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, and they planned studies “to check if there is no additional issue, or maybe if the virus is not mutating. Because the level of severity of this Bundibugyo outbreak is unprecedented.”

More than two-thirds of Ebola deaths are happening in the community rather than in treatment centres. In a treatment centre run by MSF in Bunia, the capital of Ituri province, 90% of admitted patients do not appear on authorities’ lists of contacts of known cases. Both factors indicate high levels of untracked transmission.

Kaseya said contact tracing in the DRC was insufficient, with only 10 contacts identified for every Ebola patient, when about 40 would be the expected number.

Ebola is a viral haemorrhagic fever that can cause vomiting, diarrhoea, organ damage and internal bleeding. The outbreak is centred on the conflict-affected mining province of Ituri, but has spread to Nord-Kivu, Sud-Kivu, Haut-Uele and Tshopo. There were 20 cases recorded in neighbouring Uganda before it brought its outbreak under control.

Dr Wessam Mankoula, acting head of emergency preparedness and response at Africa CDC, said response teams planned a shift “from contact tracing to active case search”, which would mean community health workers “moving from door to door” asking households if they had anyone sick with Ebola symptoms.

He added: “I think the time for incremental action is over and we’re starting now the phase for scaling up.”

Kaseya promised a “village-centered response” that would involve communities, more use of digital tools and greater action in the camps for people who have been internally displaced by conflict in affected provinces.

Officials also said they planned to begin using antiviral remdesivir on a compassionate use basis to treat patients. They will also start testing whether Ervebo, a vaccine licensed for use against a different strain of Ebola, should be offered in the affected province, after receiving data suggesting that Bundibugyo caused less serious disease and “zero death” among people who had received that jab.

“Seeing the expansion of this outbreak, only the public health measure will not be enough to quickly control or stop this outbreak,” said Dr Placide Mbala Kingebeni, Africa CDC director of research, clinical trials and innovation.

DRC authorities said they were investigating a suspected Ebola death on a boat heading to the capital, Kinshasa, from the north-east of the country, and that the other passengers on board would be quarantined and tested.

Unicef warned that essential healthcare was being disrupted by the outbreak as fear of infection and service disruptions kept families away from clinics. In the outbreak’s centre, the mining town of Mongbwalu, the proportion of children receiving their first measles dose has fallen 69%.