An Ebola outbreak spreading across eastern Democratic Republic of the Congo has surpassed 6,000 confirmed cases, extending what is already the largest Ebola outbreak ever recorded in the country as health authorities struggle to contain transmission amid armed conflict, population displacement and shortages of medical resources.
As of Aug. 31, Congo had recorded 6,041 confirmed cases and 2,911 deaths, according to government figures reported by Reuters. More than 1,360 people have recovered. The new figures represent an increase of 247 confirmed cases and 125 deaths since Aug. 26.
The World Health Organization’s latest detailed outbreak assessment, published Aug. 28, said the virus had reached 60 health zones across six provinces, up from 54 health zones two weeks earlier. The six affected provinces are Bas-Uélé, Haut-Uélé, Ituri, North Kivu, South Kivu and Tshopo.
The WHO continues to classify the outbreak as a Public Health Emergency of International Concern and has assessed the risk within Congo as “very high,” citing sustained transmission, geographic expansion, infections among health workers, insecurity and weaknesses in the health response.
The epidemic is caused by Bundibugyo virus, a less common type of Ebola virus for which there is currently no licensed vaccine or specific approved treatment.
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Outbreak continues to outpace containment efforts
Congolese authorities officially declared the outbreak on May 15, although health officials believe the virus may have been circulating for months before it was recognized.
The pace of growth has been striking. According to the WHO’s Aug. 1 outbreak report, Congo had recorded 3,605 confirmed cases and 1,587 deaths as of July 30. By Aug. 12, the WHO reported 4,665 cases and 2,184 deaths. The total reached 5,794 cases and 2,786 deaths by Aug. 26 before crossing 6,000 cases five days later.
Ituri province remains the epicenter, while North Kivu and Haut-Uélé are also major areas of concern. Six additional health zones were added between the WHO’s Aug. 14 and Aug. 28 reports, demonstrating that the outbreak was continuing to expand geographically even as health authorities intensified surveillance and contact tracing.
Despite some progress in testing and identifying contacts, health officials say transmission remains intense.
“Transmission remains very active,” Dr. Marie Roseline Belizaire, the WHO’s emergency preparedness director for Africa, said during a regional meeting, according to Reuters. “We have slowed the acceleration, but we have not yet bent this curve.”
Belizaire said contact tracing and testing had improved and that analysis of the Bundibugyo virus had not shown signs of mutation despite its rapid spread. But containment efforts continue to be hampered by insecurity, population displacement, a health workers’ strike and intense population movement.
The WHO said in its Aug. 28 assessment that the outbreak’s roughly 48 percent case-fatality ratio highlights continuing problems with timely detection, access to clinical care and interruption of transmission.
Congo deploys vaccine as concern grows over children
Congo began vaccinating health workers and other frontline responders on Aug. 27 as authorities search for additional ways to slow the epidemic.
The difficulty is that there is no licensed vaccine specifically approved for Bundibugyo Ebola.
Instead, authorities are using Ervebo, an Ebola vaccine that has proved effective against the more common Zaire Ebola virus. Because Bundibugyo is a different virus, researchers do not yet know how much protection Ervebo will provide during the current epidemic.
“We have decided to use the Ervebo vaccine to protect first those who are on the front line,” Congolese Health Minister Roger Kamba said at the launch of the vaccination campaign in Kisangani, according to the Associated Press.
More than 50,000 doses had already arrived in Congo when the campaign began. The WHO approved 70,000 doses for use in the country, with about 50,000 intended for health and frontline workers and approximately 20,000 designated for a clinical trial examining whether Ervebo provides protection against Bundibugyo virus, the Associated Press reported. The initial campaign is expected to cover 14 health zones in Tshopo, Bas-Uélé and Haut-Uélé provinces.
Researchers are simultaneously studying possible vaccines and treatments specifically targeting the Bundibugyo strain.
The outbreak has caused particular concern for children. Children age four and younger have experienced a case-fatality rate of about 60 percent, the highest of any age group, according to health data cited by the Associated Press.
With schools scheduled to reopen Sept. 1, some parents and teachers in the hard-hit Ituri province have urged authorities to delay the return to classrooms.
“We want to resume classes, but not at the cost of our lives,” Bunia teacher Fazila Rebecca told AP. “As long as the disease is circulating and protective measures remain inadequate, returning to the classroom means taking a risk we cannot ignore.”
Attack on response team highlights containment challenges
The difficulties confronting health authorities were underscored over the weekend when an Ebola response team was attacked near Mambasa in Ituri province.
The team had gone to a funeral site Saturday to secure the body of a person suspected of having Ebola when young people armed with machetes confronted the workers, forcing them to flee, the Associated Press reported. One response worker was injured.
“We demand greater security so we can operate in the field and do our work without endangering our lives,” response team member Floribert Magene told the Associated Press.
Such incidents can seriously undermine Ebola containment because bringing an outbreak under control depends heavily on rapidly identifying patients, tracing their contacts and ensuring that people who die from the virus are buried safely.
The outbreak has also demonstrated its ability to cross international borders. Uganda recorded 20 cases and two deaths linked to transmission originating in Congo before the WHO declared the Ugandan outbreak over. Reuters reported on Aug. 26 that WHO monitoring had found no evidence that additional transmission chains remained in Uganda.
Cases originating in Congo have also been detected outside Africa. The WHO reported in July that German authorities had confirmed a Bundibugyo Ebola infection in a humanitarian worker medically evacuated from Congo. France also reported a laboratory-confirmed case in a doctor returning from Congo.
Funding remains another major obstacle. Belizaire said the response faces an immediate $30 million funding gap for logistics, medical supplies and personal protective equipment in the hardest-hit areas.
“Without this immediate investment, we risk stalling the momentum we have built,” Belizaire said, according to Reuters.
The wider funding shortfall is considerably larger. U.N. Secretary-General António Guterres said an additional $1.1 billion was urgently needed, with the United Nations’ $2.13 billion response plan only 48 percent funded, according to the Associated Press.
The current epidemic has already surpassed Congo’s 2018–2020 outbreak, which recorded 3,317 cases, making the Bundibugyo epidemic the largest Ebola outbreak in the country’s history. The 2014–2016 West Africa epidemic remains the largest Ebola outbreak ever recorded globally and killed more than 11,000 people.
For now, Congo’s numbers continue to rise. Between Aug. 26 and Aug. 31 alone, confirmed infections increased from 5,794 to 6,041 and deaths rose from 2,786 to 2,911.
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