What’s happening: Ebola outbreak in DRC and Uganda

On 5 May the WHO was notified of an unknown disease, and an outbreak of Bundibugyo virus disease (BVD) was subsequently confirmed on 13 May. The first known suspected case had reported onset of symptoms on 24 April. 

Bundibugyo virus disease (BVD) is a form of Ebola disease. It is endemic to the Democratic Republic of the Congo and Uganda, and the case fatality rate has historically ranged from 30%-50%. There is no specific medicine or vaccine available to effectively treat Bundibugyo virus. There is no vaccine for Bundibugyo virus. Treatment of Ebola caused by Bundibugyo virus is supportive – there are no specific targeted treatments available for this virus.

How is the current situation progressing?

As of 19 May, 395 suspected cases and 106 fatalities have been reported in the Democratic Republic of Congo (DRC). This outbreak is larger than the last BVD outbreak in the DRC in 2012, where 38 confirmed and 21 probable cases were reported alongside 34 deaths. Epidemiologists on the ground have yet to determine where this outbreak started or who the earliest case was. The large number of deaths which have already been recorded suggests the possibility of a much larger number of contacts, most of whom will not have been traced at this point.

Two imported cases of BVD have been confirmed in Uganda from this outbreak. However, no community transmission has been reported in Kampala, or the rest of Uganda at this time; elevated risks remain present.

What are the challenges with containment?

The delayed identification of this outbreak hindered containment measures and response team effectiveness, which is likely to have severely exacerbated the event. Bundibugyo is a relatively uncommon strain of ebolavirus. As a result, it took longer than usual for this outbreak to be recognised as Ebola, given the initial testing was not sensitive to Bundibugyo ebolavirus. This setback is also likely a contributing factor to the high case numbers and may lead to elevated case fatality rates for this event.

The lack of a vaccine for Bundibugyo virus poses further challenges for containment. Vaccinating contacts can be an effective containment strategy for other Ebola outbreaks where vaccines are available. This increases the risks for surrounding countries.

DRC’s Ituri Province is prone to conflict and is significantly impoverished, which poses challenges in implementing public health measures to manage this outbreak. Conflict presents obstacles for response teams deployed to assist with the situation. Contact tracing will prove challenging; local populations are highly mobile including migrant workers and displaced populations, increasing the risk of being unable to reach potential contacts.

The spread of Ebola beyond DRC and Uganda into the wider region is possible amid these challenges, despite the public health response. 

What mitigation measures should I take?

Regional governments are working with international health authorities to closely monitor the Ebola outbreak, particularly in neighbouring countries. Similarly, it is important for travellers and organisations to closely track developments and consider the operational necessity of planned travel to affected regions. 

It is critical to abide by official health directives, including within countries where no cases are reported. Regional governments are increasingly likely to introduce enhanced screening measures and heavily scrutinise points of entry. Even governments outside the region may reinforce screening protocols – Indonesia and the Philippines have introduced such measures at ports of entry as a precaution. 

Short notice travel disruption is credible due to containment measures, particularly for travellers originating from DRC and Uganda. The indefinite border closure between Goma in DRC’s North Kivu and Rubavu in Rwanda’s Western Province from 17 May demonstrates the elevated risks, especially for neighbouring countries. The suspension of US visa services in DRC, South Sudan and Uganda from 18 May further exemplifies the potential for increased travel barriers. The above examples underscore the need for those in affected countries to reconfirm the viability of travel amid the outbreak. 

Advice for travellers

For travellers in DRC and Uganda, key prevention strategies include the following:

• Do not engage closely with anyone displaying symptoms of illness.
• Avoid travelling to areas experiencing outbreaks of the virus.
• Seek medical care immediately if you become unwell yourself.
• Practice good hand hygiene – wash hands frequently and use alcohol-based sanitisers.
• Peel fruit, cook food thoroughly, and do not eat bush-meat.
• Avoid all contact with human remains and deceased individuals (e.g. preparing for funerals).
• Contact your assistance provider immediately if you believe that you have had contact with someone suffering from Ebola.