A number of Americans who are in the Democratic Republic of the Congo are believed to have had exposure to suspected cases in the country’s latest Ebola outbreak, with several deemed to have had high-risk exposures, sources have told STAT. At least one of these individuals may have developed symptoms.
One source said that there are not yet test results for any of the individuals, but the U.S. government is reportedly trying to arrange to transport them out of the DRC to somewhere they can be safely quarantined, and cared for, if they prove to have been infected. It’s not clear if that would be in the United States; there is some discussion of perhaps taking the individuals to an American military base in Germany, a source said.
The sources spoke on condition of anonymity, because they had not been authorized to discuss the situation publicly.
Already, the outbreak’s suspected case count is at least 246 cases, with 80 deaths, including at least four health workers.
The Centers for Disease Control and Prevention held a hastily called news conference on Sunday to discuss the outbreak, which the World Health Organization has declared a public health emergency of international concern (PHEIC). But when specifically asked whether any Americans have been exposed to Ebola, and whether the government is planning on extricating them from the DRC, the CDC’s incident manager, Satish Pillai, did not answer the questions.
Neither the State Department nor the Department of Health and Human Services have responded to repeated requests from STAT for information about the situation.
“We don’t discuss or comment on individual dispositions,” Pillai said. “It is a highly dynamic situation, and at this point, what I would say is, we continue to assess [and] we will continue to keep you posted as we learn more.”
Pillai said the CDC is assessing the needs on the ground and is working to deploy experts to help with the response.
Despite the lack of official answers, STAT has been told that the U.S. government has been reaching out to the health care institutions that have high-containment treatment facilities able to quarantine people who have had high-risk exposures to Ebola, and isolation beds where they can be cared for, if they become ill.
One of the sources who spoke to STAT said the situation is fluid, with numbers changing daily. But what is clear, the individual said, is that there is an effort afoot to get some Americans out of the DRC quickly.
These efforts are likely made more difficult by the fact that one of the facilities that can quarantine people suspected of being infected with a high-consequence pathogen like Ebola and care for them if they are infected is currently housing Americans who were passengers on the MV Hondius, the cruise ship on which there was a recent hantavirus outbreak.
The Ebola outbreak was declared a PHEIC overnight Sunday Geneva time, by WHO Director-General Tedros Adhanom Ghebreyesus. Tedros declared the PHEIC without yet having convened an expert panel to advise him on the situation — an unprecedented move that speaks to the gravity of the unfolding situation.
Confirmation that an Ebola outbreak is underway in northeastern DRC only came Friday from DRC’s National Public Health Institute.
Daniel Jernigan, who led the CDC’s National Center for Emerging and Zoonotic Infectious Diseases until he quit last summer in protest over the firing of former CDC Director Susan Monarez, said the current signs point to an outbreak that may take quite some time to bring under control. It is unusual for Ebola outbreaks to be this large when they are first declared, a fact that suggests tracing all the chains of transmission will be a daunting task.
“There is a lot that we don’t know here, and it has happened very quickly, and the numbers suggest that it’s not going away anytime soon,” Jernigan said.
The WHO said Sunday that the first known suspected case, a health worker, developed symptoms on April 24. A health care worker is unlikely to be the first case in an outbreak; the more probable scenario is that someone infected — either by a bat or by another infected person — brought the virus into a health care setting while seeking care. Either way, the outbreak had been smoldering for some time before the cause of the rising tide of illness was deemed to be caused by Ebola.
Two infected people from DRC traveled — independently of one another — to Kampala, the capital of neighboring Uganda, where one died. At present, there is no indication of ongoing transmission in Uganda, the WHO said.
An Ebola species called Bundibugyo is responsible for the outbreak. This marks only the third detected Bundibugyo outbreak on record; the previous two were in 2007 and 2012.
Historically, Bundibugyo has been perceived as much less of a risk than the Zaire and Sudan ebolaviruses, because of the infrequency of the outbreaks and because it is believed the case fatality rate for this virus is lower than for Zaire and Sudan ebolaviruses. There is no licensed vaccine to target it, and it is unlikely there would be sufficient doses of an experimental Bundibugyo vaccine to deploy in the outbreak.
The outbreak appears to have started in Ituri province in northeastern DRC, near the border with Uganda, South Sudan, and Rwanda. The area was the site of the second-largest Ebola outbreak in history, which ran from 2018 to 2020, involving 3,470 cases and 2,287 deaths. (That outbreak was caused by Zaire ebolavirus.) This part of the DRC has also been engulfed in a longstanding conflict, which complicated the earlier response and will certainly do so again now. As was seen in the 2018-2020 outbreak, people in this region regularly move around the area; cross-border transmission of the virus was common in the earlier outbreak.