Overview

continuing Ebola outbreak in the Democratic Republic of the Congo (DRC) — that was declared on Aug. 1, 2018 — is the second largest and second deadliest Ebola outbreak in history. While it is significantly smaller than the West African outbreak of 2014 which killed more than 11,000 people, as of August 19, 2019, the World Health Organization (WHO) reported more than 2,909 confirmed and probable cases with 1,953 deaths (1,859 confirmed and 94 probable cases). The overall case fatality ratio is 67 percent, higher than the average of 50 percent. Of those affected, 56 percent are female and 28 percent are children younger than 18 years old.

In mid-August 2019, the World Health Organization and the Institut National de Recherche Biomedicale (DRC’s National Institute of Health) announced a significant new treatment and potential cure. Beginning in November of 2018, patients at four treatment centers were offered one of four medications: ZMapp, Remdesivir, REGN-EB3 and mAb114. ZMapp was the drug used to battle the Ebola virus in West Africa during the previous outbreak. With no treatment, the mortality rate is over 75 percent. The results from the treatments were astounding — mortality rates for patients being given REGN-EB3 was 29 percent and mAb114’s rate was 34 percent, compared to 49 percent for ZMapp and 53 percent for Remdesivir. If patients began treatment right after being infected, the mortality rates were six percent for REGN-EB3, 11 percent for mAb114, 24 percent for ZMapp and 33 percent for Remdesivir. Because of the significant successes of the test, it has been canceled and all patients will now be treated with REGN-EB3 or mAb114. Ebola is no longer an incurable disease.

On July 15, 2019, the first case of Ebola was discovered in the Goma, the largest city in eastern Congo and a major transport hub. There have now been four cases (with two deaths) in the city. This raised concerns that the virus could spread quickly in the city of almost two million people on the border with Rwanda. After this development, WHO declared the outbreak in the DRC a Public Health Emergency of International Concern (PHEIC): “The declaration followed a meeting of the International Health Regulations Emergency Committee for EVD. The Committee cited recent developments in the outbreak in making its recommendation, including the first confirmed case in Goma.”

Delivering vaccines and health care in an area filled with violent clashes is tough – 140 healthcare workers have been affected, representing five percent of all cases. Mistrust of health officials, violence and conflict continuously complicate efforts to stop the outbreak.

Key Dates

  • Aug. 1, 2018 — Outbreak declared in Democratic Republic of the Congo.
  • March 24, 2019 — Outbreak surpassed 1000 cases.
  • April 12, 2019 — The WHO Emergency Committee convened to discuss the Ebola outbreak. The committee decided, “the ongoing Ebola outbreak in North Kivu and Ituri provinces of the Democratic Republic of the Congo does not constitute a Public Health Emergency of International Concern.”
  • April 19, 2019 — WHO epidemiologist killed in an attack on Butembo University Hospital.
  • Week of April 21, 2019 — Two records were broken for this outbreak: most cases in a single week (126 in 7 days) and most cases in a single day (27 on Sunday, April 28).
  • June 4, 2019 — Outbreak surpassed 2,000 cases.
  • June 11, 2019 — First case of Ebola confirmed in Uganda.
  • June 14, 2019 — Two Ebola health workers were attacked and killed in eastern Congo.
  • July 15, 2019 — First case of Ebola discovered in the Goma.
  • July 17, 2019 — WHO declared the outbreak a Public Health Emergency of International Concern.
  • August 2019 – A breakthrough in two treatments during a trial phase saw tremendous progress. The trial was canceled in lieu of implementing treatments for all patients immediately.

Background
One-third of the probable cases occurred before the outbreak was declared in August 2018 and in the majority of the remaining cases the bodies were buried before they could be tested. Retrospective analysis point to the outbreak beginning in May 2018 when an individual and several members of the family developed hemorrhagic fever and died. The outbreak was declared after a subsequent joint Ministry of Health/WHO investigation which found four positive cases on site.

The Institut National de Recherche Biomédicale (INRB) confirmed by genetic sequencing in early August that this outbreak is caused by the Zaire ebolavirus species. This is the most dangerous strain of Ebola viruses and is the same strain that occurred in the 2014-2016 Ebola outbreak in Western Africa.

While a vaccine showed great success in reducing transmission, limited supplies and difficulties accessing populations in conflict zones prevented full vaccination efforts. The vaccination was administered  in a method known as ring vaccination which means family, friends, neighbors, colleagues etc. of an infected or deceased person are offered vaccinations.

In May 2019, the World Health Organization stated: “The main drivers behind the continued rise in cases stems from insecurity hampering access to critical hotspot areas, persistent pockets of poor community acceptance and hesitation to participate in response activities, and delayed detection and late presentation of EVD cases to Ebola Treatment Centres (ETCs)/Transit Centres (TCs). Of particular concern are the community deaths resulting from the culmination of these factors. Community deaths denote all EVD (confirmed and probable) cases who died outside of an ETC/TC. This includes cases who die at home, as well as those who die within public/private hospitals and other health centres. On average, community deaths comprise approximately 40% of cases reported each week…Of the total deaths (1147) currently listed in surveillance systems, approximately two thirds (68%) occurred outside of ETCs. Many of the patients who arrive at ETCs, often do so in a severe condition with a poor prognosis, and subsequently die shortly after admission. Community deaths also pose a major transmission risk as these cases have spent more time in the community while symptomatic and remain highly infectious at the time of their death and thereafter; propagating EVD to other members of the community such as family members and healthcare workers.”

Critical Needs

Financial support to help administer and deliver the vaccine to as many people as possible. This includes funding for medical personnel, transportation, security, personal protective equipment, public awareness and education, and the vaccine itself.

Funding for communication of information and educational programs about the disease.

InterAction’s NGO Aid Map can help funders find organizations working in the Democratic Republic of the Congo.

CDP has a Global Recovery Fund that provides an opportunity for donors to meet the ongoing and ever-expanding challenges presented by global crises.

Contact

If you are a responding NGO or a donor, please send updates on how you are working in this crisis to tanya.gulliver-garcia@disasterphilanthropy.org.

If you are a donor looking for recommendations on how to help in this crisis, please email regine.webster@disasterphilanthropy.org.

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Featured image source: USAID Photo/Morgana Wingard