Violence in Beni Continues to Impede Progress in Ebola Outbreak

Rebel activity, violence, and unpredictable attacks continue to disrupt Ebola response activities in the North Kivu outbreak, notably in the city of Beni.

On Friday, November 16, rebel forces launched an attack in the Boikene District in Beni, the epicenter of the current Ebola outbreak in the Democratic Republic of the Congo (DRC). According to a tweet issued by the World Health Organization (WHO), the attack zeroed in on the residence of health workers participating in the response on behalf of the United Nations (UN). A mortar shell that did not explode hit the residence and as a result, 16 health workers were evacuated to Goma for psychological support.

This latest evacuation of international health workers is not the first to occur in this outbreak. Health workers assisting on behalf of the US Centers for Disease Control and Prevention (CDC) were evacuated from the outbreak zone earlier in the response and are also stationed in Goma and are assisting remotely in Geneva, Switzerland.

The attack disrupted epidemiological activities being conducted by UN responders in the town throughout the weekend and partial activities, including vaccination and contact tracing, resumed on Sunday, November 18, 2018.

“Whenever we have a violent incident, we see a massive drip in our contact tracing performance,” Peter Salama, MD, World Health Organization (WHO) Deputy Director-General of Emergency Preparedness and Response said in a statement, “[This] adds to a vicious cycle of insecurity and community mistrust.”

As of November 19, 2018, a total of 373 cumulative cases of Ebola (326 confirmed; 47 probable) have been reported in this outbreak. There have been 217 deaths, 170 of which were confirmed to be linked to Ebola.

The Center of Strategic and International Studies (CSIS) Commission on Strengthening America’s Health Security and the CSIS Africa Program hosted a panel discussion on the Ebola outbreak on November 14, 2018, which reflected on the first 105 days of the outbreak and where the response is moving.

As part of the discussion, Dr. Salama presented on the current outbreaks characteristics and what health officials have learned about the trends of this situation.

According to Dr. Salama, vaccination using the rVSV-ZEBOV Ebola vaccine has been remarkable during this outbreak. A total of 32,626 individuals in the outbreak zone have been vaccinated since August 8, when the vaccination began.

The North Kivu outbreak has also featured the largest use of investigational therapies that are being used under emergency authorization. At 4 sites throughout the provinces, 145 patients have received an investigational therapy.

Despite the uptick in vaccination and new therapies, the outbreak is not without a few notable challenges, as Contagion® reported previously.

“We are facing arguably the most difficult context we’ve ever faced for stopping an Ebola outbreak,” Dr. Salama said during the discussion, “Security and the related issue of community mistrust are our twin foremost challenges.”

These security issues and lack of trust have contributed to the infection of over 30 health care workers and the high rate of cases in boys under 5 years of age in the Beni health zone.

According to Dr. Salama, the WHO has deduced that individuals who are ill may be misdiagnosed with malaria, which is the principal cause of morbidity and mortality in the nation. Malaria outbreak have driven an increased number of women and children to private health facilities, and this may explain why there has been high rates of infection in young boys, who are being seen in these clinics for what is thought to be malaria, only to become infected with Ebola transmitted by other residents of the clinic or unclean beds/bedclothes.

Furthermore, to treat malaria, DRC health workers use injectable treatments. Many private facilities may reuse unsterile syringes, which can lead to further transmission. Additionally, these facilities do not keep records, which limits the health workers participating in the Ebola response from tracing contacts and initiating vaccination.

At this time, Dr. Salama remains “cautiously optimistic” about the outbreak response. He notes that to stop the outbreak it is important to continue to reduce the number of days from the onset of symptoms to placing the ill in isolation. Additionally, there should be a focus on improving the sensitivity of alert system which involves health workers initiating a rapid response to investigate potential reported cases. A point of concern is that transmission chains indicate many of the newly reported cases were not contacts of previous cases.

At this point, Dr. Salama indicated that if improvements continue to be made, the outbreak could potentially be resolved within a 6-month period.

In bordering nations, preparations continue in case the outbreak spreads. Uganda initiated vaccinations of front-line health workers weeks ago and now South Sudan and Rwanda have preparations underway to vaccinate health workers as well.

Rwanda has established an Ebola treatment center near the DRC border and the WHO is assisting in stocking the facility with medical equipment and supplies. In South Sudan, where a treatment center has already been designated, the WHO has deployed 15 health workers to assist in preparing the facility.

For the most recent case counts associated with the Tenth Ebola Outbreak in the DRC, check out the Contagion® Outbreak Monitor.