What is Ebola and why is it so difficult to stop the latest outbreak?
James Gallagher,Health and science correspondent,
Emery Makumeno,BBC Africa, KinshasaAnd
Hafsa Khalil
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The Ebola outbreak in the Democratic Republic of Congo has been declared a public health emergency of international concern by the World Health Organization (WHO).
The latest outbreak is a challenge because it involves a rare strain of Ebola for which there is no vaccine, and cases were found in a conflict-affected area.
The WHO told the BBC the outbreak could spread faster than initially thought.
What is Ebola and what are the symptoms?
Ebola is a rare but deadly disease caused by a virus.
Ebola viruses normally infect animals, usually fruit bats, but outbreaks in humans can sometimes start when people eat or handle infected animals.
It takes two to 21 days for symptoms to appear. They appear suddenly and start like the flu, with fever, headache and fatigue.
As the disease progresses, vomiting and diarrhea develop and can lead to organ failure. Some, but not all, patients develop internal and external bleeding.
The virus is spread from person to person through contact with infected bodily fluids such as blood or vomit.
Why is this Ebola outbreak different and is there a vaccine?
This outbreak is caused by the rare Bundibugyo Ebola species, which has not been seen for more than a decade.
Bundibugyo has only caused two previous outbreaks, where it killed about a third of those infected.
The first blood tests for Ebola in affected areas came back negative as they aimed to identify the most common species of the disease.
There is no approved vaccine against Bundibugyo, but experimental vaccines are under development. It is possible that a vaccine against another species of Ebola called Zaire will provide some protection.
There are also no medications targeting Bundibugyo, making it more difficult to treat.
Another complication is that the outbreak is occurring in a conflict zone, with a quarter of a million people displaced from their homes and people crossing porous borders into neighboring countries.
However, the WHO’s declaration of a public health emergency of international concern does not mean that we are in the early stages of a Covid-like pandemic. The risk of Ebola outside East Africa is minimal.
How did the current Ebola outbreak start in the DRC?
The first known case was a nurse who developed symptoms on April 24, meaning the virus had been spreading undetected for weeks.
She died in Bunia, the capital of Ituri province in eastern DRC, according to Congolese Health Minister Samuel Roger Kamba.
The nurse’s body was repatriated to Mongwalu, one of the two gold mining towns where the majority of cases were reported.
Kamba said one of the reasons the virus spread so quickly was the number of people exposed to the body during the funeral ceremony.
The Africa Centers for Disease Control and Prevention told the BBC World Service that funerals were of particular concern because they also helped spread the disease in previous outbreaks.
Director Dr Jean Kaseya said the public health information campaigns “provided information on how to handle funerals” and the importance of basic hygiene and sanitation, as well as protective measures for health workers.
Kamba explained that there have been delays in reporting Ebola cases because infected communities believe the disease is “witchcraft” or a “mystical illness,” leading people to seek treatment at prayer centers and witchdoctors rather than in hospitals.
How many Ebola cases have been reported and where are they located?
WHO chief Tedros Adhanom Ghebreyesus said he was “deeply concerned about the scale and speed of the outbreak.”
As of May 19, authorities said more than 513 cases were suspected in the Democratic Republic of Congo, where at least 131 people have died. Another person died in Kampala, the capital of neighboring Uganda.
But modeling from the London-based MRC Center for Global Analysis of Infectious Diseases, released on May 18, suggests there has been “substantial” under-detection and that there could be more than 1,000 active cases.
The first reported cases occurred in the towns of Mongwalu and Rwampara, in Ituri, as well as in Bunia.
American doctor Peter Stafford tested positive after treating patients at Nyankunde hospital in Bunia, where he has worked since 2023.
A case was also confirmed in Goma, the largest city in eastern Democratic Republic of Congo. It has around 850,000 inhabitants and is controlled by rebels from the AFC-M23 group.
The patient traveled to the city after her husband died of Ebola in Bunia, Jean-Jacques Muyembe, director of the Congolese National Institute of Biomedical Research (INRB), told the AFP news agency.
Another person is still being treated in Uganda. The two cases identified are both Congolese nationals who recently traveled to the country.
What are we doing in the DRC to fight the current Ebola epidemic?
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The DRC government has sent health teams to Bunia equipped with protective equipment.
The WHO and the medical association Médecins Sans Frontières (MSF) are also present in the affected areas. They are setting up treatment centers and working on a response plan.
A free number, 151, is available to report symptoms.
Residents are invited to take measures such as:
- call immediately when symptoms appear
- avoid contact with the bodies of people who have died with symptoms or with dead animals
- do not eat raw meat, as undercooked food can transmit the virus
- practice social distancing
How did the rebels react to the latest Ebola outbreak?
The AFC-M23 group says it is creating an Ebola response team to prevent the spread of the disease in areas it controls.
On May 17, spokesperson Lawrence Kanyuka said the group “immediately activated” response mechanisms in collaboration with local health departments and medical facilities.
Neither the government nor the rebels have explicitly indicated whether they are willing to work together to combat the outbreak.
However, the Goma case was confirmed by a public body, the INRB.
Caitlin Brady, country director of the Danish Refugee Council, is currently in Goma preparing her organization’s response. She said she was informed by the rebels that they were using contact tracing and taking all appropriate measures to contain the virus.
She told the BBC World Service’s Newsday program that “many health officials and health workers remained and continued to work” after rebels captured the city, meaning “the capacity to respond remained.”
What are Rwanda and other neighboring countries doing about the Ebola epidemic?
The Africa CDC has warned of high risk for countries bordering the Democratic Republic of Congo, particularly Uganda, Rwanda and South Sudan.
Several African countries are strengthening border controls and strengthening health facilities.
Rwanda has closed its borders with DR Congo.
Uganda has asked people to avoid kissing and shaking hands. President Yoweri Museveni also postponed the Martyrs’ Day pilgrimage, a Christian holiday celebrated on June 3 each year and which usually attracts thousands of Congolese nationals to join the festivities.
