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Saskia v. Popescu, PhD, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist. During her work as an infection preventionist, she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She holds a doctorate in Biodefense from George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control and has worked in both pediatric and adult acute care facilities.

The Complexities of the DRC Ebola Outbreak

JUL 22, 2019 | SASKIA V. POPESCU
The outbreak of Ebola virus disease in the Democratic Republic of the Congo (DRC) is the second largest in history and a lot has happened over the last couple of weeks. Here’s an overview to give you the latest information not only on the outbreak but also on the challenges of response. In a situation that has been marked by conflict and insecurity, response efforts are met with new challenges as health workers try to learn new response tactics to tackle the outbreak.
 
Current Status of Outbreak

The most recent data show that the outbreak has exceeded 2484 confirmed cases, with over 1600 fatalities. Cases have been climbing in the double-digits on a daily basis, which fuels concern for this growing outbreak. On Thursday, July 18, 2019, the DRC Ministry of Health epidemiological situation report noted 10 new confirmed cases and 7 new confirmed deaths, with 402 cases under investigation. One of these new cases is in a vaccinated health care worker, which adds to the growing volume of 137 health care workers who have become infected, 41 of whom have died.

Concern of outbreak spread has grown in recent weeks, following a confirmed travel-associated case in the city of Goma. As such, there has been increased attention at points of entry, with a monitoring team now stationed at Goma International Airport around the clock. As the outbreak is now considered a serious public health threat the potential for airport closures has increased, which is not always beneficial and can heighten the social fear and stigma associated with the disease. 
 
PHEIC Decision

On Wednesday, Tedros Adhanom Ghebreyesus, PhD, Director-General of the World Health Organization (WHO) declared the Ebola outbreak in the DRC a Public Health Emergency of International Concern (PHEIC).

“It is time for the world to take notice and redouble our efforts. We need to work together in solidarity with the DRC to end this outbreak and build a better health system,” Tedros said. “Extraordinary work has been done for almost a year under the most difficult circumstances. We all owe it to these responders—coming from not just WHO but also government, partners, and communities—to shoulder more of the burden.”


The PHEIC designation is big, as the WHO declined to issue the declaration on 3 other occasions within the last year. One reason for so much attention around the PHEIC declaration is that if the outbreak met the definition but was not declared, it could erode the importance and efficacy of the IHR, which is critical for preventing and responding to infectious disease threats. The PHEIC declaration not only reinforces the integrity of the IHR, but it means that member states will be more likely to begin or continue to provide financial support, which can help halt the spread of the disease.
 
Treatment: From Vaccines to Diagnostics 

In the efforts to contain the spread of Ebola in the DRC, the Merck rVSV-ZEBOV vaccine has been used in an experimental capacity. This is the leading vaccine in development, but not the only. Recently, the DRC Ministry of Health and government officials announced that Merck’s rVSV-ZEBOV would be the only vaccine used during the outbreak. According to the latest report from the Ministry of Health, 169,976 individuals have been vaccinated thus far. In the face of the PHEIC declaration and the continued surge of cases, many are wondering why a secondary vaccine is not being deployed for use

These conversations have come following the reports that the US Centers for Disease Control and Prevention (CDC) utilized a synthetic version of the Ebola virus (the strain that is currently spreading in the DRC) to help assess the efficacy of diagnostic testing and treatments. One of the reasons for the development of the synthetic version was due to a lack of samples available to the scientific community from the recent outbreaks in the DRC. “The research, conducted in the agency’s most secure laboratories—BSL4—showed that even though the tests and two of the treatments being used in the field were developed based on earlier variation of Ebola viruses, they continue to be effective against,” StatNews.com reported. Although working with the actual virus is preferable, the efforts with the synthetic virus has been successful and allowed for work on both treatment options (like the antibody cocktail ZMapp) and diagnostic testing. 
 
The PHEIC declaration, combined with, conflict in the outbreak zones, and the use of a novel vaccine, has resulted in stop and go outbreak response, which has challenged containment efforts. The hope is that the new declaration will aid in halting transmission, but fighting Ebola also remains a deeply social and anthropological effort within communities. Understanding the misconceptions of treatment centers/health workers, the stigma of those infected, and overall social challenges of response is critical in not only stopping the spread of the disease but also in preventing future outbreaks of this magnitude. 
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