Ebola Outbreak in DRC Spreads to Sixth Province

The Ebola outbreak in the Democratic Republic of Congo (DRC) has spread to a sixth province after a death was recorded in Bas-Uele. According to Africa CDC Director-General Jean Kaseya, a man who had traveled from Isiro in Haut-Uele province died in Buta, the capital of Bas-Uele. The outbreak is now considered the fastest-growing one yet and is on track to surpass the deadliest one in history, which erupted over a decade ago and killed over 11,000 people.

The current outbreak has surpassed 4,500 confirmed cases, causing over 2,100 deaths. This death toll was reached almost three times faster than in the 2014-16 West Africa outbreak. The outbreak was declared on May 15, but sequencing indicates it started in February. Early cases were misdiagnosed as malaria and typhoid, delaying the response.

Health workers at the Nizi Treatment Center in Ituri province went on strike over unpaid wages for three months, leading to the temporary closure of the center. Dr Jean-Marie Akandabo, who manages patients at a clinic in Ituri, stated that without proper management, Ebola will not end in this province. The strikes have worsened access to healthcare already challenged by rebel conflict.

The outbreak is centered in Ituri province, one of Congo’s most remote and vulnerable areas near the borders of South Sudan, Uganda, and Rwanda. WHO Director-General Tedros Adhanom Ghebreyesus visited Kinshasa to assess the situation and called for a massive scale-up in response efforts. The World Health Organization has declared the outbreak a public health emergency of international concern due to its rapid spread.

New research published in Nature Medicine reveals this outbreak stems from a previously unseen variant of the Bundibugyo strain, indicating a new animal-to-human transmission event rather than from variants linked to earlier outbreaks. Genetic analysis confirmed that cases detected in Uganda were linked to the DRC outbreak.

The Bundibugyo strain causing this outbreak has no approved treatment or vaccine, making containment efforts more challenging. Clinical trials for those have begun in Ituri province, the epicenter of the outbreak. The case fatality rate stands at 45.9%, higher than the 39.6% rate recorded in the 2014-2016 West Africa outbreak.

Moderna has begun its first human trial of an experimental vaccine called mRNA-1469 to protect against the Bundibugyo strain. Health Canada cleared the early-stage study, and the first volunteers have already received the shot. The trial aims to enroll about 80 healthy adults to check if the vaccine is safe and triggers an immune response.

Researchers have also begun studying two possible Ebola treatments in Ituri province: Gilead Sciences' remdesivir, approved for COVID-19 but showing potential against Bundibugyo in lab tests, and Mapp Biopharmaceutical's experimental MBP134 antibodies targeting Ebola viruses. The WHO notes it could take months to determine if either drug works.

The outbreak is unfolding amidst significant challenges including strikes by unpaid health workers, threats from rebel groups, community mistrust, and misinformation about the virus. Health teams face remote terrain, shortages of protective gear, and a displaced population struggling with reliable water sources for hygiene. Traditional funeral practices that involve body contact have been restricted, causing anger in some communities.