In May this year, the ninth Ebola outbreak in the Democratic Republic of Congo (DRC) was reported in north-western Équateur province. The outbreak was considered to have enormous potential risk, particularly when cases were reported in a port city with over 1 million inhabitants and easy access to transportation routes. Thankfully, efforts from local authorities, NGO´s and the World Health Organisation (WHO) were rewarded, and the epidemic was declared to be over in July. Nevertheless, 53 cases were reported, of which 38 were confirmed and 29 people died. The rather high fatality rate could be a result of a particularly aggressive disease, limited treatment options and facilities, or both. Congo is a large country with significant challenges in health care and transportation infrastructure. Despite the challenges, the significant effort to combat the epidemic succeeded in Équateur. Frustratingly, it was replaced by a new outbreak only a week later.
The new outbreak was announced on August 1st, this time in the north-eastern provinces of North Kivu and Ituri, along the border to Uganda and about 2.500 km from the previous outbreak. The strain is confirmed to be Ebola Zaire, but not linked to the Équateur outbreak, meaning that this is a new outbreak. As of August 12th, 57 cases have been reported, of which 30 are confirmed and the number of deaths is 41. The case fatality ratio of more than 70 % is alarmingly high. How can we expect the epidemic to be handled, and what is the risk of facing a new major outbreak?
In contrast to the 2014-2015 Ebola outbreak in West Africa, the response from the international community to the 2018 DRC outbreaks has been quicker and more comprehensive. A major breakthrough has been the opportunity to administer vaccines to people identified to be at risk. However, fragile or absent infrastructure and serious safety concerns for teams operating in the area pose major challenges. North Kivu is densely populated with about 8 million inhabitants, with an inherent higher risk of disease dissemination. In addition, the area is afflicted with conflicts between the national military and various local militias and has been the location of numerous abductions and kidnappings. Because of the severe insecurity, more than 1 million people have been displaced internally and many are fleeing to neighbouring countries. It is therefore important to build a robust preparedness in the surrounding provinces and neighbouring countries such as Uganda, and to build robust treatment and transportation systems for contagious patients.