Ebola has killed more than 5,000 people in the Democratic Republic of Congo, according to Ministry of Health data released on 31 October. The government counted 5,026 deaths among 10,351 cases, as relayed by the Associated Press, a fatality rate close to 50%. The outbreak is caused by the Bundibugyo virus, for which no vaccine or specific treatment is approved.
The outbreak was declared on 15 May. It is now the largest Ebola outbreak the country has recorded, passing the 2018–2020 epidemic in July, and the second largest anywhere after West Africa’s 2014–2016 epidemic, which killed about 11,000 people. Eight of the country’s 26 provinces are affected. Ituri and North Kivu account for 9,782 cases and 4,792 deaths between them.
Why the outbreak is hard to stop
Containment depends on finding people who were exposed and watching them for 21 days. That is failing at scale. Africa CDC says about 80% of new cases are emerging outside monitored contact chains, and a WHO official said a third of recorded deaths occurred outside treatment centres, before the patient was tested.
The setting makes this harder. Ituri is a conflict zone, and WHO has said insecurity and attacks on health facilities have restricted access for response teams. In late October, a nurse was killed and another health worker seriously injured in Bafwasende, in Tshopo province, after youths accused them of contaminating water, according to UN-backed Radio Okapi. AP also reported that workers at a treatment centre in Tchomia, Ituri, stopped work last week over four months of unpaid wages.
Cases outside Congo
Kenya has confirmed nine cases and two deaths, all linked to a cluster that began with a traveller who came from Congo via Uganda. Nigeria confirmed its first imported case in Abuja on 20 October, in a patient who had travelled in Uganda. Uganda recorded about 20 cases earlier in the outbreak and was declared free of the disease in August.
Nigeria has since ruled out two further suspected cases. Two people reported in Yola, Adamawa State, tested negative after two rounds of laboratory testing, and the Nigeria Centre for Disease Control says the Abuja patient remains the only confirmed case in the country. Genetic sequencing has tied the Kenyan and Nigerian cases to the same lineage as Congo’s, but how the Nigerian patient was infected is unresolved. Afrikeye covered that question in our report on the sequencing results.
The vaccine gap
A trial named Tumaini, Swahili for “hope”, began in Bunia on 23 October. It starts with Ervebo, a vaccine licensed for the Zaire species of Ebola, to test whether it protects against Bundibugyo. Bundibugyo-specific candidates are expected to join later, and results will take time because efficacy depends on enough exposures among participants.
Analysis: The absence of a vaccine is the central difference between this outbreak and the Zaire outbreaks Africa has learned to manage. Africa CDC director-general Jean Kaseya has argued that international partners showed little interest in developing one, and says the agency is backing trials, including a candidate from a manufacturer in Egypt. Until a vaccine exists, the response rests on tracing, isolation, safe burials and community trust, the same tools that are currently falling short.
The next markers are whether the share of cases coming from known contacts rises, whether pay and security for health workers improve, and whether Kenya’s and Nigeria’s clusters stay contained. More coverage is in Afrikeye’s Health section.
