Wednesday 19 September 2018

First urban case of Ebola in Congo a 'game-changer'

Fears that death toll of 23 will now ‘explode’

Health workers don protective clothing as they prepare to attend to patients in the isolation ward to diagnose and treat suspected Ebola patients, at Bikoro Hospital in Bikoro, the rural area where the Ebola outbreak was announced in Congo. (Mark Naftalin/UNICEF via AP)
Health workers don protective clothing as they prepare to attend to patients in the isolation ward to diagnose and treat suspected Ebola patients, at Bikoro Hospital in Bikoro, the rural area where the Ebola outbreak was announced in Congo. (Mark Naftalin/UNICEF via AP)

Max Bearak in Nairobi

Congo has confirmed a case of Ebola in Mbandaka, a city of 1.2 million, marking the first urban case in the latest outbreak of the disease. The World Health Organisation's lead response official called the development "a game-changer".

Confirmed cases of Ebola had previously been limited to a remote area more than 160km south of Mbandaka, in the rainforest of Congo's Equateur province. The case in Mbandaka is only the third confirmed case of the current outbreak; 20 others are probable, and 21 are suspected, bringing the total potential cases to 44. The death toll is now 23.

"This is a major development in the outbreak," said Peter Salama, the WHO's deputy director-general of emergency preparedness and response. "We have urban Ebola, which is a very different animal from rural Ebola. The potential for an explosive increase in cases is now there."

The port city of Mbandaka lies on the eastern bank of the Congo river, Africa's second longest after the Nile. Tens of millions of people live along the river, and the capitals of Congo, Central African Republic, and the Republic of Congo lie along it and its tributaries.

Ebola is notoriously hard to contain, though recent outbreaks in Congo have been managed swiftly by the government and global health institutions. This is the ninth Ebola outbreak in Congo since the 1970s, and the first since May of last year, when five confirmed cases resulted in four deaths.

An outbreak between 2014 and 2016 in west Africa was the worst ever, and killed more than 11,000. There were no cases in the Congo during that outbreak.

The disease causes internal bleeding and spreads rapidly through contact with small amounts of bodily fluid. Its early symptoms are not obvious and the worst effects may take weeks to show. Ebola, endemic in Congo, is often transmitted to humans through eating contaminated meat, but can be caught through any close contact with an infected animal.

The international response to the current Congo outbreak has been substantial, and is expected to grow in size and urgency after the announcement of a confirmed urban case. On Wednesday, the WHO delivered 4,000 injections of an experimental vaccine with proven efficacy in recent trials, with more batches expected soon.

The WHO is also deploying 30 experts to Mbandaka to "conduct surveillance in the city and is working with the Ministry of Health and partners to engage with communities on prevention and treatment and the reporting of new cases".

Persistent rain and lack of roads has hampered the effort to contain the outbreak so far.

Cases had previously only been confirmed in Bikoro, a small town whose health clinic only has "limited functionality," according to the WHO. Helicopter and motorcycle are the only ways to reach Bikoro from Mbandaka, but an airstrip has been rapidly cleared for small planes to land with supplies.

Part of the difficulty in deploying the vaccine is that it must be transported and stored at between -50C and -60C, requiring powerful refrigerators. The vaccine, produced by Merck, is not yet licensed, but the WHO has cleared it for "compassionate use".

"The remote location of the outbreak hampers both the information about the outbreak and interventions to control it," said Cyrus Shahpar, director of epidemic prevention at Resolve to Save Lives, a New York-based organisation. (© Washington Post)

Irish Independent

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