The Africa Centers for Disease Control (Africa CDC) warned on Thursday that Ebola is still spreading through the Democratic Republic of the Congo (DRC), and while cases have declined in the original outbreak region of Ituri province, more infections are being found in the neighboring provinces of North Kivu and Haut-Uele.
The DRC government said on Thursday there have been a total of 6,843 confirmed cases since the Ebola outbreak was declared in May, with 3,310 deaths.
Over 5,400 of the known cases were reported from Ituri province, but North Kivu has now discovered over 1,000 cases. Africa CDC said new cases in North Kivu have more than doubled over the past three weeks, and some of those cases were reported from two new health zones that have not previously experienced infections.
A 23-year-old man died of Ebola on Thursday in the town of Gwaka, located in the northwestern province of Sud-Ubangi, which had not previously reported any cases. Sud-Ubangi therefore became the seventh province of the DRC to report Ebola infections — and the first in the western part of the country.
According to Sud-Ubangi lawmaker and former health minister Jean-Jacques Mbungani, the victim originated from the province of South Kivu, took a lengthy journey through Rwanda and Uganda over the span of three weeks, and wound up in Ituri, the province where the Ebola outbreak is believed to have originated.
The man then traveled through the provinces of Tshopo and Mongala before arriving in Sud-Ubangi, where he became severely ill and died. His journey included a trip by boat down the Congo River.
The case could present a nightmare for contact tracers, who must determine where the patient contracted Ebola and then find everyone he came into contact with on his travels.
“Thirty-eight people have been identified as having been in contact with the patient and have been placed in quarantine,” the acting governor of South-Ubangi, Jean-Rene Galekwa Vundawe, said on Friday.
Adding to the danger of the situation is that Sud-Ubangi borders on the Central African Republic (CAR). The World Health Organization (WHO) has warned that the outbreak could spread into the CAR and Sudan.
WHO said in its latest Ebola Bundibugyo update on Thursday that there is “evidence of ongoing geographical expansion and sustained increase in cases in some health zones,” and “delayed detection of cases” continues to pose a challenge to containment efforts.
“The outbreak continues to unfold within a complex humanitarian setting characterized by insecurity, armed conflict, and widespread population displacement,” the update noted.
WHO said the dangerous outbreak region in the DRC suffers from “overcrowding, limited water, sanitation and hygiene services, and restricted access to healthcare in mining communities,” while “informal settlements and sites for internally displaced persons further undermine early case detection, infection prevention and control measures.”
The DRC began administering a vaccine called Ervebo to its healthcare workers and frontline responders in August. Ervebo is a single-dose vaccine that was created for the more common Zaire strain of Ebola.
The United Nations sent 70,000 doses of the vaccine to the DRC in the faint hope that it might offer some protection against the Bundibugyo strain. Of those doses, 20,000 were earmarked for frontline health workers while the rest are part of a clinical trial to learn if Ervebo has any effectiveness against Ebola Bundibugyo. The vaccine is not noted for having any severe side effects, so there was little to lose by giving it a try.
“Early laboratory and animal data suggest it may provide some protection. Thus, the clinical trial is expected to provide important new evidence, which is essential for policymakers to inform future use of the Ervebo vaccine,” WHO said in August.
At least five vaccine candidates designed to fight the Bundibugyo strain are currently being tested, most recently including a vaccine from the Minapharm Group, headquartered in Egypt. The Minapharm product was designed by a Berlin-based specialist unit called ProBioGen whose previous vaccines have proven effective against smallpox, monkeypox, and Ebola Zaire.