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An outbreak in two eastern provinces of the Democratic Republic of the Congo has become the worst known epidemic of the deadly Ebola virus in the country’s history.
The Congolese Health Ministry said in a statement Saturday that 326 people had been infected with the Ebola virus in North Kivu and Ituri provinces.
That makes this outbreak worse than a 1976 epidemic in Yambuku, which infected 318 people and left 280 dead. That outbreak was the first time scientists identified what is now known to be the deadliest strain of the Ebola virus. An outbreak in the city of Kikwit in 1995 infected 315 people, 250 of whom died.
The current outbreak is now the third-worst Ebola epidemic in modern history. An outbreak in West African from 2013 to 2015 infected more than 28,600 people mostly in Liberia, Guinea and Sierra Leone. An outbreak in Uganda in 2000 of the Sudan strain of the Ebola virus infected more than 400 people.
After initially appearing under control, the number of cases in North Kivu Province spiked in September and October, worrying public health officials around the globe. In a briefing on Capitol Hill last week, Robert Redfield, the director of the Centers for Disease Control and Prevention, warned that the outbreak might spread so widely that the Ebola virus could become endemic to Central Africa.
The Congolese health ministry, the World Health Organization and non-governmental groups like the Red Cross and Doctors Without Borders have sent hundreds of people to the epicenter of the outbreak. They have vaccinated more than 28,000 people, including those who have come into contact with Ebola victims and frontline health care workers who would be most susceptible to the virus.
But the response has been stymied in part by a volatile security situation in which dozens of armed groups that oppose the government have threatened or attacked health workers.
A bombing in late August, blamed on Islamist militants from across the border in Uganda, shut down the response in the city of Beni for several days, allowing the virus to spread further. Last month, two health workers employed by the Congolese military were killed in an ambush.
“No other epidemic in the world has been as complex as the one we are currently experiencing. Since their arrival in the region, the response teams have faced threats, physical assaults, repeated destruction of their equipment, and kidnapping,” Oly Ilunga Kalenga, the Congolese health minister, said in a statement.
The current outbreak began in late July, likely when the virus spread at a funeral through the family of a woman who had taken ill. The virus later spread to Beni, a regional trading hub of about a quarter million residents. From there, it spread to Butembo, an international trading hub on the border with Uganda.
About half of the cases identified so far, 159, have popped up in Beni. Another 36 have been identified in Butembo. The World Health Organization has sent aid to Uganda, Rwanda, Burundi and South Sudan in anticipation of the chance that the virus could cross international borders.
“There remains a challenging road ahead to control intense transmission in the city of Beni and emerging hotspots in villages around Beni and Butembo,” the World Health Organization said in a weekly assessment of the situation on the ground.
North Kivu is home to about eight million people, about a million of whom are internally displaced after years of ethnic conflict. It is the largest province in Congo outside of the capital, Kinshasa.
Oliver Johnson, a visiting lecturer in global health at King’s College London and the co-author of “Getting to Zero,” a book about the 2014-2015 Ebola outbreak in West Africa, said the conflict in eastern Congo has bred distrust of the government in Kinshasa, and of any international groups that might arrive on the scene to try to help.
“There’s a lot of suspicion that the messages about Ebola and the outbreak are false and part of a conspiracy, making it very difficult to convince people to seek treatment or change behavior to protect themselves,” Johnson said in an email Sunday. “There’s a real challenge in responders getting physical access to affected communities — be that to collect a sick patient by ambulance to take them to a treatment centre, to engage with communities on preventing further spread or to distribute the vaccine.”
The violence in North Kivu has limited the American response to the outbreak. After an attack on a Congolese Army base in August, the State Department ordered responders from the U.S. Agency for International Development and the Centers for Disease Control and Prevention out of the area, first to the regional capital Goma and then to Kinshasa, 1,700 miles away from the outbreak’s epicenter.
Moving CDC field staff back to the capital “puts the response at risk of failure at a critical time,” Johnson said.
The World Health Organization said 29 new cases had appeared in the region over just the last week. Three health workers were among the new victims.
The WHO said the risk of the virus spreading across domestic or international borders “remains very high.” The Ministry of Health has deployed preparedness experts to ten provinces around North Kivu.
Health officials are keeping an eye on more than 5,400 people who have come into contact with Ebola victims, a practice known as contact tracing, with the goal of getting any new cases into treatment at the first sign of infection.
“The epidemic remains dangerous and unpredictable, and we must not let our guard down,” the Health Minister Ilunga Kalenga said. “We must continue to pursue a very dynamic response that requires permanent readjustments and real ownership at the community level.”
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