Chief Medical Officer
Extracted from our World Health Report June 2019
While armed militia groups continue to disrupt the efforts of the health authorities of the DRC to contain the Ebola outbreak in the north east of the country, the first ever cases of Ebola have been confirmed in neighbouring Uganda. A five year old boy and his grandmother, who visited DRC, have died.
The boy’s family went over to DRC to attend the funeral of his grandfather who had died of Ebola virus disease. The boy and his grandmother developed symptoms of fever and bleeding when they returned to Uganda and went to Kagando Hospital in Kasese district, Western Uganda. They were transferred immediately to an Ebola treatment unit in nearby Bwera, where the healthcare workers had already been vaccinated. They died soon after and there are seven other suspected cases in isolation, and over 50 contacts of these cases under observation. Doctors have confirmed that another relative – a three year old child who was repatriated to DRC from Uganda – has also died.
The Ugandan government has deployed an emergency response team and suspended all mass gatherings including prayer meetings and market gatherings, some of which attract tens of thousands of people. They have also already vaccinated thousands of health workers in anticipation of this development, and set up Ebola treatment centres along the border in readiness for the expected cases.
This Ebola outbreak has already become the worst since the West African outbreak of 2013-16, where there were 28,616 cases, mostly in Guinea, Liberia and Sierra Leone – 11,310 people died. On 1 August 2018, the Ministry of Health of the DRC declared the 10th outbreak of Ebola virus disease in the country, affecting North Kivu and Ituri Provinces in the northeast. It took over seven months for the number of cases to reach 1,000, but just a further two months to reach 2,000. Nearly 1,400 people have died, with a fatality ratio of around 70% of confirmed cases. Nearly 200 health facilities have been attacked in the DRC this year, forcing health workers to suspend or delay vaccinations and treatments. In February, medical charity Médecins Sans Frontières (MSF) put its activities on hold in Butembo and Katwa – two eastern cities in the outbreak’s epicentre.
A Public Health Emergency of International Concern?
Despite acknowledging the evidence of international spread of the disease to Uganda, WHO has announced that the Ebola virus disease outbreak does not meet the criteria to declare a Public Health Emergency of International Concern (PHEIC). The Committee maintains that there is a low risk of the outbreak spreading beyond the immediate region.
A PHEIC might allow WHO and its partners to mount a stronger attack against the disease with increased resources and larger international teams of responders helping stop the spread and treat the infected. WHO has declared a PHEIC only four times since the tool was introduced into the agency’s arsenal in 2005: for the 2014 West African Ebola outbreak, pandemic flu in 2009, polio in 2014, and the Zika virus in 2016. WHO has stressed that other countries within the region must take this opportunity to prepare for an outbreak within their borders.
There were 12 outbreaks between 2000 and 2010, averaging fewer than 100 cases. It is believed that a number of factors have combined to make outbreaks more likely to occur and to rapidly multiply in size beyond the capabilities of nations to control them. Among these are: climate change; the spread of emerging diseases; exploitation of the rainforest; large and highly mobile populations; weak governments; and conflicts causing mass movements of people. Currently, WHO is tracking an unprecedented 160 disease events around the world, nine of which are grade III emergencies (the WHO’s highest emergency level).
Despite positive indicators that the outbreak is under control in the epicentres of Butembo and Katwa, the trend in other areas like Mabalako indicates extension and reinfection of EVD. This is down to the challenges around community acceptance and insurgent activity, and the straining of resources. The cluster of cases in Uganda is not unexpected; though the rapid response and initial containment is a testament to the importance of preparedness in neighbouring countries. Rwanda and Burundi remain on high alert.
ADVICE TO TRAVELLERS TO EVD AFFECTED COUNTRIES…
Take the following enhanced precautions and your risk of becoming infected is low:
- Avoid contact with symptomatic patients and their body fluids
- Avoid contact with the corpses and body fluids from deceased Ebola virus disease victims
- Avoid contact with all wild animals and their corpses
- Avoid handling/eating bush or wild meat
- Wash and peel fruits and vegetables before consumption
- Wash hands regularly and carefully with soap and water/alcohol gel
- Practise safer sex using barrier contraception
- Seek immediate medical advice if you become ill within 21 days of leaving the EVD affected area.
Read our Ebola Virus Disease Medical Briefing for more information.