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Bloomberg

A rare Ebola outbreak that may have circulated undetected in northeastern Democratic Republic of Congo (DRC) for several weeks has exposed the difficulty of detecting deadly viruses in regions where malaria, typhoid and other fever-causing illnesses are common and health systems are stretched thin.
The World Health Organization (WHO) on Sunday declared the Ebola disease outbreak a public health emergency of international concern.
As of Monday, there were over 390 suspected cases and 105 deaths in DR Congo and two deaths in neighbouring Uganda.
A separate case was also reported on Sunday in Goma, the eastern Congolese city controlled by Rwanda-backed M23 rebels.
“Hospitals are already under pressure,” Samuel Roger Kamba, the Congolese health minister, told reporters on Sunday in Bunia, the capital of Ituri province, where the outbreak is believed to have begun in April and hospitalised 59 people.

“It’s not a mystical illness,” he said, urging people with symptoms to seek treatment quickly.
“Make yourself known so that you can be taken care of and so that we can prevent the disease from spreading.”
A delegation led by him arrived in Bunia with tents to set up treatment centres to support strained local hospitals.
WHO’s representative in ⁠the DRC, Anne Ancia, said WHO had emptied its stocks of protective equipment in the capital Kinshasa and was preparing a cargo plane to bring additional supplies from a depot in Kenya.
The outbreak is caused by the Bundibugyo strain of Ebola virus. DR Congo’s presumed first patient, a nurse in Bunia, developed symptoms on April 24, according to Jean Kaseya, director general of the Africa Centres for Disease Control and Prevention.
By the time health authorities were first alerted to the outbreak on social media on May 5, 50 deaths had already been recorded, the Africa CDC said.
The delayed detection has emerged as a central concern for international health authorities because Bundibugyo remains far less studied than the Zaire strain that caused the devastating West African epidemic a decade ago.

While Zaire Ebola became the focus of intensive vaccine and therapeutic development after the 2013-2016 outbreak killed more than 11,000 people, Bundibugyo has triggered only two previous outbreaks and has no approved vaccine or antibody treatment.
It was first detected in Uganda’s Bundibugyo district during a 2007-2008 outbreak that infected 149 people and killed 37. The second time was in 2012, in an outbreak in Isiro, Congo, where 57 cases and 29 deaths were reported.
Early symptoms – including fever, weakness, headache, vomiting and diarrhoea – can resemble malaria and other common tropical illnesses, making cases harder to identify quickly in overstretched clinics.
The World Health Organization declared the outbreak a public health emergency of international concern on Sunday, citing cross-border spread, unexplained deaths, healthcare worker infections and uncertainty over the true scale of the epidemic after what officials described as a four-week detection delay.
The declaration was intended to accelerate international funding, coordination and emergency response efforts.
The outbreak met the threshold for its highest level of alarm, WHO said, because Bundibugyo has no approved vaccine or treatment and the virus was spreading in a conflict-affected region with poor infrastructure and high population mobility.
Initial tests for the more common Zaire strain were negative before additional analysis confirmed Bundibugyo on May 14, according to WHO.
Rapid Ebola tests commonly used in the region may not reliably detect Bundibugyo infections, potentially slowing isolation and contact tracing efforts, according to Robert Garry, a virologist at Tulane University who worked during the West African Ebola epidemic.
The apparent delay in recognising the outbreak was reminiscent of the early stages of the West African epidemic, when transmission spread between villages before health authorities understood the scale of the crisis, he said.
The outbreak underscores the need for Bundibugyo-specific diagnostics across central and eastern Africa to identify infections earlier in patients with mild symptoms, according to Kirsten Spann, associate dean of research in the Faculty of Health at Queensland University of Technology.
DR Congo has faced several outbreaks of unexplained febrile illness in recent years, including clusters initially suspected to involve malaria, influenza or contaminated food and water before laboratory investigations clarified the causes.
The previous outbreak of Ebola was in August in the region, with at least 34 people dying before it was declared eradicated in December.
The disease, over the past 50 years, has killed around 15,000 people in Africa, despite advances in vaccines and treatment.
Nearly 2,300 people died in the deadliest outbreak in the DR Congo between 2018 and 2020.
Delays can allow dangerous pathogens to spread silently for weeks before health authorities fully understand what they are dealing with.
At least four healthcare workers have died in circumstances consistent with viral haemorrhagic fever, according to the European Centre for Disease Prevention and Control, raising concerns that transmission may have been occurring unnoticed inside clinics before Ebola was identified.
Global health experts have also warned that cuts to foreign aid and disease-surveillance programmes could weaken outbreak detection capacity in fragile regions.
The true scale of the outbreak remains unclear because many suspected cases and deaths across Ituri and North Kivu provinces were still under investigation, the WHO said.
Additional reporting by Associated Press and Agence France-Presse


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Africa

A four-week detection delay for the Bundibugyo variant has left dozens dead in DR Congo and triggered a global alert


A four-week detection delay for the Bundibugyo variant has left dozens dead in DR Congo and triggered a global alert.


Democratic Republic of Congo (DRC)

Ebola virus

World Health Organization (WHO)

Silent spread of rare and deadly Ebola strain exposes surveillance gaps

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}A four-week detection delay for the Bundibugyo variant has left dozens dead in DR Congo and triggered a global alert

A four-week detection delay for the Bundibugyo variant has left dozens dead in DR Congo and triggered a global alert