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An epidemic of the deadly Ebola virus is on the rise in a hub of regional trade in the Democratic Republic of Congo, while terrified residents, including those who have been infected, are avoiding health workers.
Public health officials watched with increasing concern last week that the number of Ebola cases in the densely populated provinces of North Kivu and Ituri had increased more than two months after the discovery of the outbreak.
The Congolese Ministry of Health announced Wednesday that 194 cases of haemorrhagic fever had been reported in the two provinces of eastern Congo along the border with Uganda.
This represents an increase of 32 cases in just one week, a surprising figure for a virus that usually declines soon after public health officials begin treating the outbreak.
One hundred and twenty-two people have died so far. Another 53 people left the Ebola treatment centers after surviving the disease.
In a typical Ebola outbreak, the number of cases begins to decline after the intervention of public health authorities to stop the spread of the virus.
"Usually, at this stage of the response, we would have hoped not to see any more cases," said Tarik Jasarevic, spokesperson for the World Health Organization, who visited the cities in center of the epidemic last month.
Public health officials who have responded to the outbreak closely monitor Beni, a city of about a quarter of a million inhabitants and an important regional shopping center with links to neighboring Uganda. . Of the 32 new cases identified last week, 26 occurred in Beni.
Beni has been the scene of several attacks by Ugandan-based Islamist militants, who have terrorized urban residents and hindered response operations. Health officials had to suspend their intervention for several days to honor a period of mourning across the city against those killed in the most violent attacks last month.
Anne Rimoin, an epidemiologist at the University of California at Los Angeles, is studying the Ebola virus and other infectious diseases from Kinshasa.
"Intervention teams have limited work schedules to reduce security risks after dark and must be accompanied by security details," Rimoin said in an email.
The Ministry of Health announced that more than 15,500 people had received a new Ebola vaccine, created as a result of the 2014-2015 epidemic, which killed more than 11,300 people in three poor countries. 39, West Africa.
Jessica Ilunga, a spokeswoman for the Congolese Ministry of Health, said the new cases of Ebola in Beni were worrisome.
"For more than a month, we have witnessed an increase in community resistance in the city of Beni, despite all our efforts for community involvement, some people continue to refuse to collaborate with the response teams," said Ilunga in an email. . "All medical intervention is in place and working well, so everything now depends on the attitude of the community with respect to the intervention."
The province of North Kivu has proved to be a particularly difficult area to prospect for suspected cases. The province is the most populated Congo outside Kinshasa, the capital. It is estimated that 1 million of its 8 million inhabitants are internally displaced persons who have fled ethnic violence in the east of the country for decades.
The province of Ituri, which has a little more than half of the population of North Kivu, has also suffered ethnic violence and cross-border attacks by Islamist rebels in Uganda.
Those who respond to an epidemic spend most of their time looking for those with a virus and understanding how this virus has spread. They then identify people who have had contact with people infected with a virus so that anyone with symptoms can be treated quickly.
These standard procedures become much more difficult in a situation where virus hunters have to worry about their own safety, or where populations such as internally displaced people move frequently.
"Identifying all chains of transmission can be difficult as local communities in the affected areas are highly mobile and move from village to village for work and family reasons, as well as seeking health care. access to certain areas is limited due to insecurity proceed to search for contacts, "Rimoin said.
An epidemic earlier this year in Equateur province, along the Congo River, was brought under control within a few weeks in a much more stable security situation.
The current outbreak is the 14th known outbreak of the Zairian strain of Ebola virus, known as epidemiology under the name of EBOV. This is the strain with the highest mortality rate; in most outbreaks, more than 60% of people with the disease die.
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