Deadly Ebola Surfaces In Africa’s Center Yet Again

Image via Science Magazine

Updated, 2 August, 12:05 p.m:: This story, originally published on 1 August, has been updated to include an identification of the virus species involved in the new outbreak.

)--One week after celebrating the defeat of an Ebola outbreak in Équateur province, the Democratic Republic of the Congo (DRC) has four new confirmed cases of the disease 2500 kilometers across the country in North Kivu province. The DRC’s health ministry says there’s no indication of a link between the outbreaks. “It’s sad,” says Yap Boum, a microbiologist based in Yaoundé who works with Doctors Without Borders, a nongovernmental organization that helped run an Ebola vaccine campaign against the previous outbreak.

Ebola is endemic in the DRC, which now has had 10 outbreaks since the virus first was discovered there in 1976. “Although we did not expect to face a 10th epidemic so early, the detection of the virus is an indicator of the proper functioning of the surveillance system,” a DRC Ministry of Health communique said. Boum adds that the DRC villages today are much more connected than in the past, and many previous small outbreaks may have gone undetected.

The current outbreak is centered in Mangina, a village about 30 kilometers from the city of Béni, which is close to the famed Virunga National Park and the border of Uganda. The North Kivu health division notified the DRC Ministry of Health on 28 July that there were 26 cases of hemorrhagic fever in the area, with 20 deaths. The National Institute of Biomedical Research in Kinshasa confirmed that samples from four hospitalized patients tested positive for Ebola.

Four Ebolavirus species cause disease in humans. In the last DRC outbreak, which was brought to a halt in 2 months after only 54 cases and 33 deaths, physicians and health officials for the first time used an experimental Ebola vaccine as part of the initial response. It’s unclear whether the vaccine aided the traditional surveillance and containment efforts in stemming the outbreak, but none of the 3300 people who received it developed the disease.

The vaccine is made from the Zaire species of the virus, which the ministry of health tells Scienceis the species circulating in Mangina, and was also responsible for the recently ended outbreak. Discussions are now underway about whether to use the vaccine, which proved highly effective in 2015 during an epidemic of the Zaire species in Guinea. The decision will be made "quite fast," says Boum, who helped run the Guinea trial. "Ebola doesn't respect holidays."

The DRC Ministry of Health noted in a communique that the country has experimental Ebola therapies, but they are not already approved for use in clinical trials, unlike the vaccine. Instead, scientific and ethical committees must make complicated decisions about how to test them and who should receive the drugs. Peter Salama, head of the World Health Organization's Health Emergencies Programme in Geneva, Switzerland, and the lead official during the agency’s response to the just-ended outbreak, notes that security and access will be “key determining factors” this time, as Mangina is in a hot conflict zone. A team from the ministry with a mobile lab is expected to arrive in Béni on 2 August.