As the DRC records 2000 cases of Ebola, Contagion® spoke with Krutika Kuppalli, MD, about how this outbreak is unique and whether there is an end in sight.
More than 2000 cases of Ebola have been confirmed in the Democratic Republic of the Congo. The outbreak, which has been ongoing since August 2018, has remained contained within the North Kivu and Ituri provinces, but has proved increasingly challenging to slow or stop.
“The increased incidence of violent attacks and its effect on the outbreak is reflected in the numbers; it took 224 days to get from 0-1000 cases and only 71 days to get from 1000-2000 cases,” Krutika Kuppalli, MD, who is the incoming vice chair of the Infectious Disease Society of America’s Global Health Committee, told Contagion®. “The violence is a circle and as long as it continues will erode community engagement and trust, thereby making it very difficult to see how we will control this outbreak.”
According to Mike Ryan, MD, the World Health Organization (WHO) executive director for health emergencies, the average number of new cases in the last 2 weeks has remained steady at 88 per week, a decrease from April, which saw an average of 126 new cases each week.
In a virtual press conference on June 6, 2019, Ryan explained that although we are seeing fewer cases per week, it is possible that community transmission can ramp up in already affected health zones or spread to unaffected areas at any time. This is because of the increasingly complex transmission dynamics that are being seen in this outbreak.
Kuppalli tells Contagion® that this outbreak has been particularly rough in its effects on young children.
“In the current DRC Ebola outbreak, children under 5 years old account for about 15% of the overall cases,” she said. “On May 30, 2019, the World Health Organization announced that in children under 5 years old, 3 out of 4 cases, or 77% are dying of Ebola. This compared to an overall case fatality rate of 67% for the outbreak.”
Ryan says that, in this outbreak situation, more than one-fifth of individual cases seek health care in a different health zone before Ebola is detected. The highly mobile population not only increases the risk of transmission but also makes it difficult to make connections between transmission chains.
According to Medicins San Frontieres (MSF), there is no end in sight for the violence against Ebola response. MSF withdrew from running Ebola treatment centers in Katwa and Butembo after attacks in February, at this time MSF is not running any treatment centers or providing care to confirmed Ebola patients.
“The current Ebola outbreak [is] occurring in the Democratic Republic of Congo, which is considered the home of one of the longest and most complex humanitarian crises,” Kuppalli who is in an affiliated assistant clinical professor in the Division of Infectious Diseases and Geographic Medicine at Stanford University School of Medicine, told Contagion®.“ The North Kivu and Ituri provinces are an area long plagued by violence. The greatest difference in the current DRC outbreak compared to the 2013-2016 West Africa outbreak is the insecurity and targeted violence at response teams and facilities.”
During the West African outbreak, which is the largest Ebola outbreak in history, Kuppalli served as medical director of the Ebola Treatment Unit of the Port Loko Government Hospital in Sierra Leone from 2014 to 2015.
“[I] never had concerns of being attacked. Although there were rumors in the community about the virus I never felt as if my safety or wellbeing was at risk while trying to take care of sick patients,” she said of her time working in Sierra Leone.
Kuppalli hypothesizes that based on the insecurity, violence, and community engagement struggles, the outbreak will continue to grow. She is not alone in thinking this as Robert Redfield, MD, director of the US Centers for Disease Control and Prevention, also expressed uncertainty about the outbreak ending any time soon when he testified in front of the House Foreign Committee on Foreign Affairs on June 4, 2019.
“Given all the challenges faced with insecurity, targeted violence at response teams and facilities, community engagement, identification of cases, contact tracing, safe and dignified burials I think this outbreak is going to go on for a long time,” she concludes.
For the most recent case counts in the DRC Ebola outbreak, visit the Contagion® Outbreak Monitor.