Ebola death in city of one million prompts fears of urban spread

Health workers carry out the body of a patient with suspected Ebola in the village of Mangina
Health workers carry out the body of a patient with suspected Ebola in the village of Mangina Credit: John Wessels/AFP

There are fears that the current outbreak of Ebola in Democratic Republic of Congo could spread further after reports of three cases of the disease, including one death, in a city of around a million people. 

The mother of a known Ebola patient travelled to the city of Butembo where she fell ill. According to reports she was admitted to hospital where isolation procedures were put in place but she later died.

There are two other suspected cases of the highly infectious disease in the city but these have not yet been confirmed, according to the latest information from the World Health Organization (WHO).

Peter Salama, WHO's deputy director-general for emergency preparedness and response, tweeted that that the case was detected quickly and a response was in place.

But he added: "Bad [news] is [the case] increases risk of further spread, and having Ebola in an urban centre makes ending the outbreak much harder."

The outbreak of Ebola has been ongoing since the beginning of August in the north east of the country, where a number of militant groups operate and security is poor.  As of September 5 there have been 127 cases - 96 of which have been laboratory confirmed - including 87 deaths. 

The Nord-Kivu and Ituri provinces of DRC, where the outbreak is occuring, are among the country's most densely populated areas with a combined population of around 11 million. The area borders both Rwanda and Uganda and, because of the poor security situation, there is a constant flow of refugees out of the country.

The current outbreak of the disease - the second known outbreak in the country this year - first occurred in the village of Mangina and then spread to the neighbouring town of Beni. The outbreak appears to be under control in Mangina but there are still new cases in Beni - the number of cases has increased from eight on August 23 to 19 on September 2.

A case of the disease has also been reported in a town on the border with Uganda and the Ugandan government is sending a team to Beni to learn about the containment strategy. People from DRC often go over the border to seek healthcare which has heightened fears of further spread. 

The WHO has mounted a so-called "ring" vaccination campaign to vaccinate the contacts and contacts of contacts with the disease. This is only the second time the experimental rVSV-Zebov vaccine has been deployed during an active outbreak. 

As of September 3, 38 vaccination rings have been defined, as well as five rings of health workers and other frontline workers. To date, 6134 people have been vaccinated, of which 1395 are health workers and 1642 are children. 

More than 80 per cent of cases and deaths so far have been in or within a 20 to 30 kilometre radius of the village of Mangina – in areas accessible to international and local health workers.

There have also been three cases of the disease in Oicha, a town almost entirely surrounded by ADF Islamist militia and which can only be reached with an armed military escort. 

"It is the first time we have a confirmed case and contacts in an area of high insecurity. It is really the problem we were anticipating and at the same time dreading," Dr Salama told a press conference last month.

Although the WHO has a system of alerts in place in the region to try and pick up any cases of the disease as quickly as possible, it did not rule out that cases in "red zones" such as Oicha could be missed. 

WHO director-general Dr Tedros Adhanom Ghebreyesus warned of the severity of the outbreak given the security challenge in North Kivu. 

“This is a very dangerous outbreak,” he said. “What makes the outbreak in eastern DRC or northern Kivu more dangerous is there is a security challenge – there is active conflict in that area.”

Some 100 armed groups are active in North Kivu, which has seen over 120 violent incidents since January. Lack of access to the zones of active conflict makes finding, isolating and treating potential cases very difficult for both local and international responders.

This is the first time that there has been an outbreak of Ebola in this area of DRC - there have been 9 previous outbreaks of the disease in the country after it was first discovered in what was then known as Zaire in 1976.  

Health workers and others have encountered hostility from local people with some accusing foreign aid workers of infecting local people.  

As part of the effort to fight the current outbreak, five experimental drugs to treat patients have also been approved under "compassionate use" grounds.

Two of these – mAb114, which was developed by the United States National Institutes of Health using the antibodies of an Ebola survivor from 1995 and remdesivir, developed by pharmaceutical company, Gilead have been used so far in the current outbreak. 

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