The Democratic Republic of the Congo is confronting the world’s second-largest recorded Ebola outbreak as the Bundibugyo virus spreads across multiple provinces, kills nearly half of confirmed patients and prompts expanded U.S. travel restrictions, billion-dollar response efforts and emergency vaccine research.
By yourNEWS Media Newsroom
The Ebola outbreak sweeping the Democratic Republic of the Congo has surpassed 8,000 confirmed infections, making it the second-largest recorded outbreak of the disease worldwide as health authorities race to contain a rare Bundibugyo virus epidemic that has expanded at an unusually rapid pace.
The outbreak has spread across seven provinces in the DRC and has killed thousands since it was declared in May. The Centers for Disease Control and Prevention has characterized the epidemic as spreading substantially faster than previous Ebola outbreaks and says it is now second in size only to the devastating 2014-2016 West African epidemic.
The speed of transmission has been one of the most striking characteristics of the current emergency.
The DRC outbreak crossed 1,000 confirmed cases within approximately 40 days of the response being activated. By comparison, the country’s major 2018 Ebola outbreak required roughly 235 days to exceed the same threshold, according to the CDC.
By Sept. 23, the World Health Organization reported 7,890 confirmed infections in the DRC and 3,799 deaths, producing a case-fatality rate of 48.1%. More current figures subsequently pushed the confirmed case total beyond 8,000.
The WHO said infections had been recorded across 63 health zones in seven of the country’s 26 provinces, with Ituri accounting for the largest share. North Kivu has also experienced substantial transmission.
The outbreak is now the largest Ebola epidemic ever recorded in the DRC, regardless of the Ebola virus species responsible.
Bundibugyo virus disease is caused by a different Ebola virus species than the Zaire ebolavirus responsible for the 2014-2016 West African epidemic. The Bundibugyo virus can produce severe illness and spreads through direct contact with blood, secretions, organs or other bodily fluids from infected people, as well as contaminated materials.
Its incubation period can range from two to 21 days. People are not considered infectious until symptoms develop, but the lengthy incubation period means someone who has been exposed can travel internationally before becoming visibly ill.
Those characteristics have prompted an extensive U.S. response both inside Africa and at American borders.
The U.S. government has committed more than $1 billion to Ebola response activities, according to information provided by the Department of Health and Human Services. HHS and the State Department are coordinating with governments and health organizations operating in the affected region.
“More than 500 CDC staff are supporting the response, including more than 120 personnel deployed to affected countries, where they are providing expertise in disease surveillance and contact tracing, laboratory testing, infection prevention and control, border health, clinical guidance and training, and community engagement,” an HHS spokesperson said.
From May 21 through Sept. 21, CDC personnel conducted enhanced public-health entry screening for more than 15,000 travelers at Washington Dulles International Airport, John F. Kennedy International Airport in New York and Hartsfield-Jackson Atlanta International Airport, according to a U.S. official.
Washington has also imposed unusually restrictive travel measures intended to limit the possibility that infected travelers could carry the virus into the United States during its incubation period.
Under updated Title 42 public-health authorities, entry restrictions have been applied to travelers with recent presence in affected countries. Current CDC guidance says travelers, including U.S. citizens, who have been in the DRC within 21 days of a U.S.-bound flight cannot board commercial flights to the United States until that period has elapsed.
Americans who have recently been in the DRC are therefore advised to remain outside the country for 21 days before attempting to return to the United States.
The CDC says no cases connected with the current outbreak have been confirmed in the United States and continues to assess the overall risk to the American public as low.
“Protecting Americans from importation and combating the outbreak at its source are both essential parts of our response. HHS will continue pursuing both with urgency,” the HHS spokesperson said. “[HHS] Secretary Robert Kennedy Jr. has received regular briefings on the Ebola outbreak from career experts across the agency — including CDC, FDA [Food and Drug Administration], and ASPR [Administration for Strategic Preparedness and Response] — and is deeply engaged in U.S. response activities.”
Kennedy also traveled to CDC headquarters in Atlanta in August to meet with personnel involved in the Ebola response and receive in-person briefings, according to HHS.
Containing the outbreak inside the DRC has been complicated by limited medical infrastructure, armed conflict, population displacement, cross-border movement, attacks on health workers, shortages of protective equipment and difficulties tracing the enormous number of people who may have been exposed.
Unlike outbreaks caused by Zaire ebolavirus, health authorities do not currently have an approved vaccine specifically designed to protect against Bundibugyo virus disease.
That gap has triggered an accelerated international research effort.
Shortly after the outbreak emerged, Gavi, the Vaccine Alliance, committed up to $50 million toward the development and production of experimental Bundibugyo vaccine candidates and the broader outbreak response.
Up to $40 million of that commitment was designated to accelerate access to investigational vaccines, with another $10 million directed toward response activities and protection of routine immunization programs in affected areas.
“We need to act now to ensure that once one or more vaccine candidates are ready, manufacturers are in position to start producing doses at scale,” Dr. Sania Nishtar, CEO of Gavi, said in the May 29 announcement.
Gavi is a global public-private vaccine partnership whose participating organizations include national governments, the WHO, UNICEF, the World Bank, vaccine manufacturers, civil society organizations and the Gates Foundation.
As vaccines specifically targeting Bundibugyo remain under development, researchers have turned to an existing Ebola vaccine to determine whether it could offer at least some protection.
Doctors Without Borders and its epidemiological research center Epicentre began the BRAVO study Sept. 19 in cooperation with Congolese authorities, Africa CDC and other scientific partners.
The study involves 20,000 frontline workers in Ituri and North Kivu and is evaluating the ERVEBO vaccine under real-world outbreak conditions.
ERVEBO has an established safety record and regulatory approvals for use against Zaire ebolavirus, but it was not developed or licensed specifically for Bundibugyo virus.
Researchers are therefore studying whether protection against one Ebola species can provide meaningful benefit against another.
The study is expected to run nine to 12 months, including approximately three months of vaccination followed by at least six months of monitoring.
In addition to doses being used for research, international health authorities have released tens of thousands of ERVEBO doses for use among people facing elevated exposure during the response.
The United Nations reported that 70,000 doses were allocated to the DRC from the international Ebola vaccine stockpile for research and limited outbreak-response use.
“The Ervebo vaccine has been ‘highly effective’ against Ebola Zaire virus in the past, but it is not yet known whether it can provide ‘meaningful protection’ against Ebola Bundibugyo disease, which is still spreading in the DRC,” the UN’s website said.
That distinction remains important. ERVEBO’s established effectiveness involves Zaire ebolavirus, while researchers are still determining whether it provides significant protection against the Bundibugyo species driving the present epidemic.
The WHO says there is currently no approved vaccine or specific treatment for Bundibugyo virus disease. Outbreak control therefore continues to depend heavily on identifying cases quickly, isolating infected patients, tracing contacts, preventing infections inside medical facilities, conducting safe burials and persuading communities to cooperate with health authorities.
The current epidemic has demonstrated how rapidly those systems can be overwhelmed.
By late September, tens of thousands of contacts required monitoring across affected regions, while continued transmission into additional health zones increased the possibility of further geographic and cross-border spread.
Cases associated with the outbreak have also been identified outside the DRC, although the overwhelming majority remain concentrated inside the country.
The CDC said the outbreak’s rapid trajectory sets it apart from previous Ebola emergencies in the DRC. Despite the expanding international response, the virus continues circulating at levels that have made the epidemic the second-largest known Ebola outbreak and the deadliest the DRC has experienced.
With thousands already dead, health authorities are simultaneously attempting to suppress transmission, protect frontline medical workers, prevent international spread and determine whether existing or experimental vaccines can provide effective protection against a strain for which no specifically approved vaccine currently exists.
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