Progress in Fighting Ebola, Yet Resistance to Treatment in the DRC Remains

Mary Choi, MD, MPH, discusses the progress made in treating and preventing Ebola and the challenges of fighting the community resistance of the Congolese.

The Democratic Republic of the Congo has come a long way since 1976 when the first Ebola outbreak was declared. In October of 2018, the country is dealing with the tenth Ebola outbreak that has, this time, occurred in a region ripe with political turmoil.

In a presentation at ID Week 2018, Mary Choi, MD, MPH, Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC) discussed the current outbreak as well as the outbreaks that devastated the nation in the past.

An earlier outbreak in 2018 which was active from May to July, struck in the Èquateur Province located in the Western part of the DRC, an area with a population of 2.5 million. The final case count in the outbreak was 54 confirmed or probable cases.

The current outbreak, which was first reported on July 28, 2018, already has a higher reported number of cases than the previous outbreak did, with 150 cases reported as of September 28, 2018. The provinces affected by this outbreak have a population consisting of an estimated 12.2 million citizens, which increases the risk of transmission.

This region of the country also has a high number of internally displaced citizens with over 4.5 million Congolese displaced with about 100 armed rebel groups who are fighting throughout the nation over politics and civil issues.

The key pillars of Ebola outbreak response are contact tracing, early case identification, infection control, safe burial, vaccination, and therapeutics, according to Dr. Choi.

In the Èquateur Province, there were no major obstacles to any of the intervention methods. Though no therapies were approved for use, vaccination measures were implemented 14 days after the outbreak declaration.

In comparison, the North Kivu outbreak received the approval for vaccination 7 days after the outbreak was declared and several therapies have been made available to treat patients. However, all prevention and intervention methods have been hampered by insecurity and community resistance.

All response members must observe a curfew to avoid violence, there are frequent suspensions of response activities, and continuous population displacement which can include contacts and citizens suspected to have Ebola. In addition, the violence has led to a decrease in the number of international responders who have previously traveled to the country to assist in managing outbreaks.

“All of these events have a negative effect on the response’s ability to engage with the community which we have already seen is a cornerstone of any effective response,” Dr. Choi declared in her presentation.

In addition to the consequences of violence, frontline workers also deal with contacts refusing to be traced, contacts fleeing from tracers, suspected patients refusing admission, and continued unsafe burials.

Why is this occurring? According to Dr. Choi, many members of the population believe in many misconceptions—that Ebola is not real, illness is related to witchcraft, and the outbreak is a government conspiracy designed to delay the upcoming presidential election.

Despite these misconceptions, Dr. Choi reports that there is nearly 100% uptake of the Ebola vaccine and community knowledge about the outbreak has increased.

But regardless of the advances made in this Ebola outbreak which include the uptake in vaccination and the availability of various therapies, there is a dire need to provide education and conduct response activities in order to overcome the barriers built by violence.