By Stan Deresinski, MD, FACP, FIDSA, FESCMID

Clinical Professor of Medicine, Stanford University

Dr. Deresinski reports no financial relationships relevant to this field of study.

SYNOPSIS: The second largest outbreak of Ebola virus infection has come under control.

SOURCE: Aruna A, Mbala P, Minikulu L, et al. Ebola virus disease outbreak — Democratic Republic of the Congo, August 2018–November 2019. MMWR Morb Mortal Wkly Rep 2019;68:1162-1165.

In August 2018, the Democratic Republic of the Congo (DRC) officially declared an outbreak of Ebola and, six weeks later, the World Health Organization designated the outbreak involving North Kivu province and Ituri a public health emergency of international concern. By Nov. 17, 2019, this had become the second largest documented outbreak of Ebola in West Africa, with 3,296 cases and 2,196 (67%) deaths. The largest previous outbreak was the 2014-2016 epidemic, with 28,600 cases and 11,325 deaths.

The recognition that the outbreak was of international concern was the result of two observations. Cases occurred in Uganda after members of a family had traveled from that country to DRC to attend the funeral of another family member who had died due to Ebola virus infection. These were the first-ever cases of the Zaire Ebola strain infection in Uganda and the first case of Ebola since 2013. Also, a small number of cases occurred in Goma, the capital of North Kivu province on the border with Rwanda, with a population of as many as 2 million people.

Among the interventions was a novel one: the use of an investigational vaccine (since approved), with primary use in a ring vaccination strategy focusing on recent primary and secondary contacts of Ebola virus infection. It also was provided to healthcare and front-line workers. At the same time, four investigational therapeutics were administered in a clinical trial to patients with proven disease.

COMMENTARY

Any Ebola outbreak is a fearful event. In this case, residents and healthcare workers must have felt that they had crossed the River Styx and descended into lowest level of Hades. One could have despaired because of, among other things, the very limited existing infrastructure, ongoing armed conflict among rebel groups and DRC armed forces, and attacks on civilians by militant groups. At the same time, the breakdown led to a loss of any residual trust in authority. Individuals avoided or delayed seeking care for fear of, e.g., acquiring infection within healthcare facilities.

The experimental vaccine, which was administered to more than a quarter of a million individuals, proved to be highly effective. Although cases continue to occur,1 use of the vaccine likely contributed to the eventual control of the outbreak. (See Figure 1.)

Figure 1: Confirmed and Probable Cases of Ebola Virus Disease, By Week of Illness Onset and Cumulative Number of Cases — Democratic Republic of the Congo, April 30, 2018–Nov. 17, 2019

Ebola graph

Source: Centers for Disease Control and Prevention

REFERENCE

  1. World Health Organization. Ebola Virus Disease Democratic Republic of Congo: External Situation Report 74 / 2019. Jan. 7, 2019. Available at: https://www.who.int/publications-detail/ebola-virus-disease-democratic-republic-of-congo-external-situation-report-74-2019. Accessed Jan. 10, 2020.