August 21 Update on Ebola in DR Congo

This morning, WHO reported 15 suspected cases and ten deaths in the Orientale Province of the Democratic Republic of Congo. Of the suspected cases, two have been confirmed as Ebola-Bundibugyo. The Congolese Ministry of Health is working with WHO, UNICEF, Médecins Sans Frontières Suisse and Médecins Sans Frontières Belgique, and the U.S. CDC to control the epidemic. Activities include case finding, case management and contact tracing. For the time being, the WHO does not recommend any trade or travel restrictions for DR Congo.

Neighboring Uganda is reportedly sending assistance in the form of Ebola experts. The Isiro Health Zone claims nine suspected cases and shares a border with Uganda. According to Uganda’s New Vision, the Ugandan Ministry of Health wants to send aid to prevent the outbreak from spilling over into its country.

Brief History of Ebola

Ebola hemorrhagic fever was first discovered in 1976, in the town of Yambuku, Zaire (now the Democratic Republic of Congo). Part of the Bumba Zone of the Equateur Region, the town is situated near the Ebola River, which is the namesake of the virus. On September 1, 1976, a man was treated for suspected malaria in the outpatient clinic at Yambuku Mission Hospital. He received an injection of chloroquine. His fever subsided, only to return a few days later accompanied by gastrointestinal bleeding. He died on September 8. Several other people, who had also received injections at Yambuku Mission Hospital, presented similar symptoms shortly after. Within a month, the hospital had closed and 11 of the 17 staff members had died from the disease. The Ministry of Health quarantined the Bumba Zone to prevent the spread of the mystery illness on October 3. By the end of the epidemic, there were 318 probable cases and 280 deaths (case fatality rate of 88 percent). The WHO reports that Yambuku Mission Hospital was a significant player in the transmission of the virus because injections (intramuscular, subcutaneous) were the main method of medicinal administration at the time. In a WHO report on this first outbreak, it was stated that five needles and syringes were given to the nursing staff of the outpatient clinic each morning. These needles were rinsed, not sterilized between use.

Since this first outbreak, DR Congo has experienced four others and is in the midst of its fifth. In 1977, the Ebola-Zaire strain returned to the area, claiming the life of one victim. In 1995, Ebola-Zaire surfaced in Kikwit, a city in the Bandundu Province, causing 315 cases and 250 deaths. The same strain was the cause of the 2007 and 2008 outbreaks in Kasai Occidental Province.

According to the CDC, this is the first time that the Bundibugyo strain has affected the DR Congo. This strain was discovered in December 2007 in the Ugandan district of Bundibugyo. It caused 131 cases and 42 deaths, giving it a relatively low case fatality rate (37 percent) when compared to other strains and outbreaks.

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