The Ebola outbreak in Democratic Republic of Congo, now in its seventh month, has spread to another health zone, making it 19 locations in all with this new case reported in Bunia in the conflict-prone Ituri province.

“The case of Bunia is the 6-month-old baby of a woman from Katwa who fled to Bunia and whose dead body was intercepted in Komanda,” said the country’s Ministry of Health. The baby was transferred to the care center in Komanda, an Ituri town where there have been 33 cases and 17 confirmed fatalities.

The baby adds to a total now at 829, according to Thursday’s report from the ministry. The new total includes 768 confirmed cases and 61 probable. Another 201 suspected cases are under investigation in what is now the second-largest Ebola outbreak in global history, after the 2014 West African outbreak. The death toll stands at 521.

Also added to the expanding community list is Alimbongo in North Kivu, with one suspected case but none confirmed. That makes for 22 monitored health zones in the eastern Congolese provinces that border South Sudan and Uganda. They include what are now 207 confirmed cases, 117 of them fatal, in Katwa, with 24 more suspected cases under investigation. Katwa remains a hotspot with the most fatalities behind Beni, which has stabilized in recent weeks at 138 confirmed deaths and nine more suspected.

The new case – one that originates in Katwa, tracks to Bunia and ends up in Komanda – underscores the difficulty of tracking Ebola exposures and containing its spread in the hazardous region. Katwa and Butembo reported 72 percent of the cases in the past three weeks, according to Tuesday’s update from the World Health Organization, with smaller clusters continuing to occur across a geographically dispersed area.

More than 79,000 people have received the approved rVSV-ZEBOV experimental vaccine, with roughly 20,000 each in Beni and Katwa. At least 68 health workers have contracted the virus, including new cases in Katwa, according to the most recent WHO update. At least 21 health workers have died.

Treating the Ebola outbreak patients

Katwa and Butembo also are communities where Doctors Without Borders is (MSF) conducting clinical trials of four potential new treatments for the disease. “The trial, being run in collaboration with the Ministry of Health, originally began in November 2018 in another treatment center in the region, and MSF facilities are now able to contribute to providing valuable information on these developmental drugs,” the global health NGO announced this week.

The treatments for the clinical trial are the drugs remdesivir, mAb114, REGN-EB3 and ZMapp. They have been offered to patients since the beginning of the current Ebola outbreak under Monitored Emergency Use of Unregistered and Investigational Interventions (MEURI) protocols, MSF said.

That’s a special framework developed by WHO for situations when no proven treatment exists for people suffering during a high-mortality disease outbreak like the Ebola virus. Drugs that have shown promise, but without the rigorous clinical trials, can be used provided that health workers do so in a carefully monitored way –minimizing the risks, and communicating them to patients and policymakers.

Yet newer cases in Kyondo have pushed east into the Virunga National Park, where nine fatilities are confirmed, while cases in Kayina showed a pattern of Ebola infections mapping toward the south. Though the five confirmed cases at Kayina have held steady, it still raises concerns about a relentless Ebola spread.

The city of Goma near the Rwandan border remains under surveillance with eight suspected cases but none confirmed. Health officials ramped up preparation efforts ahead of any Ebola cases in Goma because it is a travel and trade hub that opens the door to a more worrisome regional and international spread. Rwanda is next to begin vaccination of its health workers, following South Sudan and Uganda.

On Thursday, officials gathered in the border crossing city of Gatumba where about 5,000 people pass daily between the DR Congo and Burundi to demonstrate Ebola screening readiness. Other countries involved in regional cooperation include Central African Republic, Tanzania and Congo Brazzaville.

Community, conflict and continued challenges 

On Wednesday, Congolese health minister Dr. Oly Ilunga introduced the next phase of the Ebola response plan during a presentation in Kinshasa. It highlighted the response in the existing hotspots, but also high-risk areas where it’s difficult for health worker teams to gain access because of terrain and infrastructure, ongoing conflict risks, community mistrust, resource challenges or combinations of them all. Recent incidents include an attack on health workers in Muchanga, in the Katwa zone, and the destruction of property in a triage area at Mabuku, in the Kalunguta health zone.

That community mistrust broadened this week to include the concerns of women who say they face sexual abuse and exploitation in exchange for receiving vaccines or, in some cases, employment with the health response teams. The allegations, reported by The Guardian and other media outlets, surfaced during a research presentation in Beni where NGOs described their findings.

The Congolese health ministry responded by acknowledging that some women and girls participating in International Rescue Committee (IRC) focus groups described those concerns, but no known specific cases of abuse exist. The IRC also described increasing pressure on women, whose home and caregiving responsibilities leave them open to accusations that they did not do enough to prevent Ebola in the family or community.

Image: WHO Africa file