Nine new suspected cases of Ebola were reported in the northwestern Democratic Republic of Congo as authorities tackling the outbreak face challenges including resistance by local communities and multiple chains of transmission.
Fifty-eight cases, including 30 confirmed and 14 probable, have been registered since the outbreak was declared on May 8, Congo’s Health Ministry said in a statement Thursday. Of the nine new suspected cases, three are in Mbandaka, a provincial capital of 1.2 million inhabitants where four cases have so far been confirmed. Twenty-seven people have died, according to the World Health Organization.
Congo’s latest Ebola outbreak was first identified around the remote town of Bikoro, 150 kilometers (93 miles) from Mbandaka. The detection of the virus in an urban center connected by busy river routes to Congo’s capital, Kinshasa, home to about 12 million people, as well as cities in the Republic of Congo and Central African Republic, has fueled concerns the disease could spread more widely.
On Monday, the Health Ministry and WHO launched a “ring vaccination” campaign in Mbandaka and Bikoro with the still-unlicensed rVSV-ZEBOV treatment, whose manufacturer, Merck & Co., has donated 7,540 doses that arrived in Congo last week. Another 8,000 doses will be made available, the WHO said.
Health professionals who’ve been exposed to confirmed cases, as well the patients’ direct and indirect contacts, will be offered the vaccination. Over 600 people have been traced, the WHO said Wednesday.
This week, three people confirmed to be carrying Ebola were removed by their families from an isolation ward in Mbandaka, the Health Ministry said. Two have died while one has returned to hospital and is under observation.
“All efforts were made by staff to convince the patients, as well as their families, to not leave the center,” but “Ebola treatment centers are not prisons,” the ministry said. “Even in an epidemic period, health professionals have the duty to respect the will and dignity of patients.”
Medical teams have to tread carefully, Henry Gray, Doctors Without Borders’ emergency coordinator in Mbandaka, said by phone on Thursday
“We don’t want to criminalize patients because if we criminalize people, they hide,” he said. At the same time, medical organizations are working to ensure that “the families and the patients understand what’s going on, that they understand the best chance of a full recovery is in a center where they can be looked after.”
Health workers were unable to take samples from a dead person in Bikoro “because of the resistance of the community,” the Health Ministry said. The fatality was accordingly classified as a probable case of Ebola.
There was a “lot of fear and confusion” about Ebola in the affected communities, the ministry said.
Medical teams in Mbandaka are investigating three separate transmission chains — one associated with a funeral in Bikoro, another linked to a health center near Bikoro and the third related to a church service.
“Each one has the potential to expand if not controlled,” WHO Deputy Director-General for Emergency Preparedness and Response Peter Salama said Wednesday at a briefing in Geneva. “It’s the detective work of epidemiology which will make or break the response to this outbreak.”
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