Ebola virus disease first appeared in 1976. One of the world’s most deadly diseases, Ebola has a high mortality rate. While Ebola is a fragile virus that can be easily killed with heat, bleach, chlorine and even soap, it is easily transmitted through close contact – leading to rapidly growing outbreaks that are difficult to contain.

Tenth Ebola outbreak in DRC still rages, one year on

Trish Newport

It’s one year on since the tenth outbreak of Ebola in the Democratic Republic of Congowas declared. The epidemic, which has become the second-largest recorded anywhere and the worst on record in DRC, is still raging.  

The current outbreak was declared on August 1, 2018, just days after the official end of DRC’s ninth outbreak of Ebola, in the country’s northwestern Equateur province.

Trish Newport, deputy manager of MSF’s Ebola programmes in the DRC, reflects on the outbreak and the response over the past year.



Ebola: the response struggling one year into the outbreak

Joanne Liu, International President, visiting the Ebola treatment center in Butembo, DR Conco.

As the worst Ebola outbreak in DRC’s history approaches its second year, the number of new Ebola cases recorded each week is hovering near its highest levels since the beginning of the epidemic. In July, between 80 and 100 people were diagnosed with the disease every week. The outbreak is also continuing to spread geographically. Uganda saw its first Ebola patients in June, though they had travelled from DRC, while Goma, a city of 1.5 million people, recorded its second case just this week.

Following the declaration of the epidemic on August 1 2018, a massive response was rapidly launched, aided by tools that were either unavailable or severely limited in previous Ebola outbreaks, such as an investigational vaccine and developmental treatments.

Despite this, the outbreak seems headed in the wrong direction and in July was declared a Public Health Emergency of International Concern (PHEIC). Since last August, Ebola has infected over 2,600 people, and killed 1,700 in DRC.

Ebola outbreak in Democratic Republic of Congo is a public health emergency of international concern

July 2019 - The signs are clear: people are still dying in their communities, health workers are still infected, and transmission is still going on. The epidemic is not under control and we need a change of gear: but this should not be about movement restrictions or the use of coercion on  the affected population. Communities and patients need to be at the centre of the response, they need to be active participants.  MSF has experienced first hand how difficult it is to respond to this epidemic.  We need to take stock of what is working and what is not working. In a context where contact tracing is not working fully, and all affected people are not reached, a large scale approach is needed for prevention, this means better access to vaccination for the population to reduce transmission.

Uganda: MSF teams intervene to respond to Ebola outbreak 

MSF set up a 30-bed treatment unit for confirmed cases in Mangina, epicentre of the outbreak. It also constructed a treatment unit in nearby Beni, 45 minutes away by car, a town of 400 000 people; the latter has been handed over to ALIMA (though we are wo

A Doctors Without Borders/Médecins Sans Frontières (MSF) medical and logistical team is currently in Kasese district, Uganda, where three cases of Ebola have been declared since June 11. All of them are members of the same family who was traveling from the Democratic Republic of Congo. Two of them sadly died, while the third case and two other members of the family who are showing symptoms consistent with the disease have been repatriated to DRC.

The MSF team is supporting Ugandan health authorities in the management of people who have been in contact with confirmed Ebola patients and show symptoms of the disease. Close monitoring is needed while waiting to confirm whether they are infected.

Ebola outbreak in Democratic Republic of Congo

As of March 7, more than seven months since the beginning of the current Ebola outbreak in the Democratic Republic of Congo (DRC), there have been 907 Ebola cases (841 confirmed and 66 probable), and 569 people have died. It is the second Ebola outbreak to affect DRC in less than a year.

Following the suspension of activities following attacks on Ebola treatment centres in Katwa and Butembo, MSF has maintained Ebola-related activities in the North Kivu towns of Kayna and Lubéru, as well as the management of two Ebola transit  facilities in Ituri province. In the city of Goma, MSF has been supporting emergency preparedness by reinforcing the surveillance system and ensuring there is adequate capacity to manage suspected cases. MSF has also been facilitating a randomized control trial for four potential new Ebola medicines.

Efforts to contain the outbreak have been made even more challenging due to political unrest in DRC, and the fact that response efforts are taking place in areas beset by active conflict.

Watch: Battling Ebola in a conflict zone

Read more here, or follow @MSFcongo on Twitter for more details.

March 2019: Attacks on Ebola treatment centres show significant challenges of response to second recent outbreak in Democratic Republic of Congo

On the night of February 27, 2019, a group of unidentified assailants set fire to an Ebola treatment centre in the city of Butembo, in Democratic Republic of Congo (DRC). No staff or patients were immediately harmed, but medical care was violently interrupted for the facility’s 57 patients, of whom 15 were confirmed to have Ebola.

The attack came three days after a similar assault on another Ebola treatment centre in the nearby district of Katwa. In that incident, a caretaker for one of the facility’s patients was killed, allegedly while trying to flee.

Both facilities were run by the DRC’s Ministry of Health and supported by Doctors Without Borders/Médecins Sans Frontières (MSF). On February 28, MSF announced the suspension of medical activities.

“We are extremely saddened by these attacks on our medical facilities. Not only did they endanger the lives of our staff members, they also endangered the most vulnerable people at the heart of our response: the patients,” said MSF emergency desk manager Hugues Robert.

“In light of these two violent incidents, we have no choice but to suspend our activities until further notice. As medical responders, it is very painful to have to leave behind patients, their families and other members of the community at such a critical time in the Ebola response.”

A deadly outbreak amid conflict and mistrust

The Ebola outbreak currently afflicting DRC is the largest in the country’s history, and is taking place within an increasingly worrisome climate of deepening community mistrust. The medical response being carried out by the World Health Organization, the DRC Ministry of Health and other health organizations — including MSF — has so far failed to bring the epidemic under control.

“We have a striking contradiction,” said MSF’s International President, Canadian physician Dr. Joanne Liu, last week. “On the one hand, a rapid and large outbreak response with new medical tools such as vaccines, and treatments that show promising outcomes when people [seek treatment].”

“On the other hand, people with Ebola are dying in their communities, and do not trust the Ebola response enough to come forward.”

Recent updates

July 2018: MSF hands over Ebola response activities in Equateur, DRC

After a two-month emergency intervention in Equateur Province, Democratic Republic of Congo (DRC), Médecins Sans Frontières/Doctors Without Borders (MSF) teams have begun handing over Ebola response activities to the Congolese Ministry of Health and other non-governmental organizations in Mbandaka, Bikoro, Itipo and Iboko.

Throughout the course of the outbreak, officially declared on May 8, Congolese Ministry of Health teams supported by MSF provided care to 38 confirmed patients, 24 of whom survived and returned to their homes. Sadly, 14 died. Over 120 other patients who presented with symptoms consistent with Ebola were isolated and tested before being allowed to return home after testing negative for the virus.

MSF Pulse: Ebola in Democratic Republic of Congo

Right now, our medical teams are on the ground in Democratic Republic of Congo responding to an outbreak of Ebola. In this episode of MSF Pulse, we look at what Ebola is, how it spreads and what we’re doing to respond to the current outbreak.



Meet Wangui, an Ebola survivor in Democratic Republic of Congo

On May 13, 2018, 29-year-old Wangui Nondi was admitted to MSF's Ebola treatment centre in Bikoro, Democratic Republic of Congo. It was confirmed that he had Ebola. Nine days later, Wangui walked out of the clinic a healthy man.

Democratic Republic of Congo: MSF Ebola vaccination targets remote communities

May 29, 2018 - Médecins Sans Frontières (MSF) started vaccinating Ebola frontline workers yesterday in Bikoro, Equateur Province, Democratic Republic of Congo (DRC), where the organisation has been working with the Ministry of Health and the World Health Organization (WHO) over the past few weeks. This trial vaccination will also be offered to contacts of patients.

Ebola Facts

Ebola virus disease first appeared in 1976. One of the world’s most deadly diseases, Ebola has a high mortality rate. While Ebola is a fragile virus that can be easily killed with heat, bleach, chlorine and even soap, it is easily transmitted through close contact – leading to rapidly growing outbreaks that are difficult to contain.

TRANSMISSION: 

The Ebola virus is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals; human-to-human transmission occurs through direct contact with blood, bodily secretions, organs and sick people.

SIGNS AND SYMPTOMS: 

Sudden onset of fever, fatigue, muscle pain, headache and sore throat is followed by vomiting, diarrhea, rash, symptoms of impaired kidney and liver function, and in some cases both internal and external bleeding.

DIAGNOSIS: 

On clinical basis, Ebola can be difficult to distinguish from a number of other infectious diseases; confirmation can be made using a number of different laboratory tests.

TREATMENT: 

There are no proven treatments or licensed vaccines for Ebola; however two vaccines are undergoing human safety studies.

PREVENTION AND CONTROL: 

Outbreak control requires a package of interventions, including case management, surveillance and contact tracing, laboratory services, safe burials and social mobilization.

 

Ebola: A Q&A about a promising new Canadian-made vaccine, and MSF's role in the clinical trial

An interim review published in the medical journal The Lancet indicates very promising results for an Ebola vaccine candidate designed by scientists working at Canada’s National Microbiology Laboratory in Winnipeg. 

Dr. Bertrand Draguez, who has been spearheading the MSF platform on experimental tools for Ebola, tells us what that means for the fight against the disease.

The 2014-2015 Ebola Outbreak in West Africa

The largest outbreak of Ebola in history was officially declared on March 22 2014 in Guinea. It claimed more than 11,300 lives in six affected countries in West Africa (GuineaLiberiaMaliNigeria, Senegal and Sierra Leone), including over 500 healthcare staff – more than all previous outbreaks combined. Earlier outbreaks of Ebola occurred in remote villages in Central Africa, but the outbreak that began in 2014 included major urban areas as well, making contact tracing and control of transmission more difficult. The outbreak and its impact were exacerbated by high mobility of the population, weak health systems and lack of infrastructure and human resources in Guinea, Liberia and Sierra Leone, the three worst-affected countries.

On January 14, 2016, Liberia celebrated 42 days without any new Ebola infections, effectively marking the end of the Ebola outbreak in West Africa. The outbreak officially ended in June 2016.

The international medical humanitarian organization Doctors Without Borders/ Médecins Sans Frontières (MSF) now calls on the global health community to draw on lessons learned in order to be better prepared for future outbreaks, such as the one currently ongoing in Democratic Republic of the Congo (DRC). MSF is continuing its Ebola activities in Liberia, Sierra Leone and Guinea by running support clinics for Ebola survivors.

The MSF response

MSF has intervened in almost all reported Ebola outbreaks in recent years, but until 2014 these were usually geographically contained and involved more remote locations. From the very beginning of the West African Ebola epidemic, MSF responded in the worst affected countries – Guinea, Liberia and Sierra Leone – by setting up Ebola management centres and providing services such as psychological support, health promotion, surveillance and contact tracing. At its peak, MSF employed nearly 4,000 national staff and over 325 international staff to combat the epidemic across the three countries. MSF admitted a total of 10,376 patients to its Ebola management centres, of which 5,226 were confirmed Ebola cases. In total, the organization spent over 96 million euros on tackling the epidemic.

Those who survived Ebola often found the battle was not over. Many faced significant medical and mental health problems such as joint pain, chronic fatigue, and hearing and vision problems. They also suffered from stigmatisation in their communities and required specific and tailored care. MSF set up dedicated survivors’ clinics in the three worst-affected countries.

The Aftermath

The transmission of Ebola from the big outbreak which affected more than 28,000 people in West Africa is over. However there is plenty of long-term impact felt in each of the three countries, from economic impact, to schools closing, to medical schools closing for an extended period of time. MSF was one of the biggest actors in the response to the Ebola outbreak in West Africa in all three countries. 

Pushed to the limit and beyond: MSF on the global response to the Ebola outbreak 

In March 2015, MSF released a critical analysis of the Ebola epidemic over the previous year, revealing the shortcomings of the global response to the crisis and warning that the outbreak, despite an overall decline in cases, is not yet over. 

How MSF treats Ebola patients: medical protocols

Follow the link below to read a Q&A with MSF public health specialist Dr. Armand Sprecher, who describes the clinical protocols MSF has used and adapted during its response to the West African Ebola outbreak:

Eyewitness: Ebola

 

Reine Lebel, a Canadian psychologist, talks about her work with Ebola patients. 

The Boy Who Tricked Ebola

Mamadee is an eleven-year-old patient in Liberia who survived Ebola. Read his story here