Update on Ebola outbreak in the Democratic Republic of Congo
The World Health Organization (WHO) has determined that the current Ebola outbreak in the Democratic Republic of the Congo (DRC), which started in August 2018, is a Public Health Emergency of International Concern. This is the second largest outbreak of Ebola since the 2014-2016 outbreak in West Africa.
As of 3 December 2019, 3313 cases (3195 confirmed and 118 probable), including 2207 deaths (a case fatality rate of 67%), have been reported in the North Kivu and Ituri provinces of the DRC. A disproportionate number of women and children have been infected during this outbreak. Of the total number of cases, 56% were female and 28% were children <18 years of age. A total of 163 health care workers (5%) have been infected.
The WHO notes that the prolonged humanitarian crisis and deterioration of security in this area sometimes limits the implementation of response activities. There has been increased violence reported, including large-scale, organized attacks on Ebola treatment centers. Violence, widespread civil unrest, and targeted attacks have severely disrupted the response in multiple locations in the last few weeks, threatening to reverse recent progress.
Ring vaccination in health care workers and contacts of Ebola patients using the rVSV-ZEBOV vaccine is ongoing. WHO have prequalified the vaccine, a step that helps to speed up its licensing, access, and roll out in countries most at risk of Ebola outbreaks. The vaccine has been granted breakthrough therapy designation by the Food and Drug Administration, and a conditional marketing authorization in the European Union for active immunization of adults at risk of infection with Ebola. A second vaccine (Ad26.ZEBOV/MVA-BN-Filo, a 2-dose heterologous vaccine regimen) is also now being used.
The experimental Ebola treatments mAb114, remdesivir, ZMapp, REGN-EB3, and favipiravir have been approved for use in the outbreak under the framework of compassionate use. Initial data from a randomized controlled trial showed that REGN-EB3 and mAb114 were associated with a higher likelihood of survival compared to ZMapp and remdesivir. Patients will now receive one of the two better performing drugs in treatment center going forward.
The WHO rate the risk of national and regional spread as very high, but the global risk level is low. WHO advises against any restriction of travel and trade to the DRC based on the currently available information.
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Summary
Definition
History and exam
Key diagnostic factors
- exposure to Ebola virus in previous 21 days
- fever
- myalgia
- conjunctival injection
Other diagnostic factors
- fatigue
- diarrhea
- nausea/vomiting
- severe headache
- abdominal pain or heartburn
- cough, dyspnea, chest pain
- sore throat
- prostration
- tachypnea
- maculopapular rash
- bleeding
- hepatomegaly
- lymphadenopathy
- hiccups
- tachycardia
- hypotension
- neurological signs
Risk factors
- living or working in, or arrival from, endemic area in previous 21 days
- contact with infected body fluids
- occupational exposure
- butchering or consumption of meat from infected (or potentially infected) animals
- bioterrorism
Diagnostic investigations
Treatment algorithm
Contributors
Authors
Senior Lecturer (Honorary Consultant)
Liverpool School of Tropical Medicine and Royal Liverpool University Hospital
Liverpool
UK
Disclosures
NJB is an author of several references cited in this monograph. NJB is partially supported by the National Institute of Health Research Health Protection Unit in Emerging and Zoonotic Infections at the University of Liverpool and Public Health England. He is affiliated with the Liverpool School of Tropical Medicine. Views expressed in this monograph are those of the contributor and do not necessarily represent the official position of the National Health Service, the National Institute for Health Research, the Department of Health, or Public Health England.
Specialist Trainee in Infectious Diseases
Royal Liverpool University Hospital
Liverpool
UK
Disclosures
MF declares that he has no competing interests.
Wellcome Trust/MoD Research Fellow
Liverpool School of Tropical Medicine
Liverpool
UK
Disclosures
TEF is an author of a number of references cited in this monograph. TEF is a consultant/expert panel member to the World Health Organization, and is funded by the UK Surgeon General and the Wellcome Trust. TEF has received research grants from the Medical Research Council and the UK Public Health Rapid Support Team (UK-PHRST).
Clinical Lecturer
University College London
Honorary Clinical Lecturer
London School of Hygiene and Tropical Medicine
London
UK
Disclosures
CFH declares that she has no competing interests.
Dr Nicholas J. Beeching, Dr Manuel Fenech, Dr Tom E. Fletcher, and Dr Catherine F. Houlihan would like to thank Dr Colin Brown (Infectious Disease Lead, Kings Sierra Leone Partnership) for his helpful comments and insights. CB declares that he has no competing interests.
Peer reviewers
Wade Hampton Frost Professor of Epidemiology
Professor of Medicine, Microbiology, and Pathology
Chief
Division of Infectious Diseases and International Health
University of Virginia
Charlottesville
VA
Disclosures
WAP declares that he has no competing interests.
Professor of Medicine and Epidemiology
UT Health Medical School
Medical Director of Epidemiology
Memorial Hermann Texas Medical Center
Houston
TX
Disclosures
LO-Z declares that he has no competing interests.
Consultant in Microbiology and Infectious Diseases
Royal Free London NHS Foundation Trust
London
UK
Disclosures
SM declares that he has no competing interests.
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