WHO warns Ebola outbreak growing

The World Health Organization said on May 20 that an Ebola outbreak centered in eastern Democratic Republic of Congo is expected to keep growing, with spillover cases already identified in Uganda. WHO officials said the risk is high at national and regional levels in Congo and Uganda, but low globally. The outbreak involves the Bundibugyo strain of Ebola, a rarer species for which there is no approved vaccine. WHO has said the event qualifies as a public health emergency of international concern, but not as a pandemic emergency under the International Health Regulations. ### Why is WHO saying the outbreak will grow? WHO officials said the outbreak was likely circulating for about two months before it was formally identified, which means many chains of transmission may still be undetected. Reuters reported that 139 suspected deaths had been counted by May 20 and that WHO expects case numbers to rise further. WHO experts said the first known death may have been followed by a superspreading event at either a funeral or a healthcare facility. (usnews.com) STAT reported that WHO believes the scale is larger than the confirmed case count suggests, with signs that many infections were missed before the outbreak was declared. WHO said it was alerted to a possible Ebola outbreak on May 5 and sent a team to Ituri province, but early tests came back negative. ### What makes the Bundibugyo strain harder to contain? (usnews.com) The Bundibugyo species has caused only a small number of documented outbreaks, making it less familiar to frontline systems than the more common Zaire strain. WHO officials said the initial testing in the affected area was geared toward Ebola Zaire, not Bundibugyo. Samples had to be sent to Kinshasa for more advanced testing, delaying confirmation, according to STAT. (statnews.com) AP reported that there are no specific vaccines or treatments approved for Bundibugyo virus. That has left the response centered on surveillance, isolation, contact tracing and infection control rather than a vaccination campaign. Reuters also reported that the lack of a vaccine is one reason WHO expects the outbreak to expand before it is brought under control. (statnews.com) ### Where has the outbreak been detected? WHO said that, as of May 16, 246 suspected cases and 80 suspected deaths had been reported in Ituri province in Congo across at least three health zones, including Bunia, Rwampara and Mongbwalu. The agency also said two laboratory-confirmed cases, including one death, were reported in Kampala, Uganda, on May 15 and May 16 among travelers from Congo. (apnews.com) UN News reported on May 20 that WHO Director-General Tedros Adhanom Ghebreyesus described the risk as high inside Congo and Uganda because of weak surveillance, insecurity and population movement, but low at the global level. That distinction is central to WHO’s message: the outbreak is serious and cross-border, but the agency is not describing it as a worldwide pandemic threat. ### If it is not a pandemic emergency, what did WHO actually declare? (who.int) WHO said on May 17 that the outbreak constitutes a public health emergency of international concern, the agency’s highest formal alarm under the International Health Regulations. In the same determination, Tedros said the event does not meet the criteria for a pandemic emergency. The WHO statement said the decision was based on the scale of suspected cases in Congo, confirmed cross-border infections in Uganda and the risk of further international spread. (news.un.org) CBS reported that Tedros also pushed back on criticism from U.S. Secretary of State Marco Rubio, who said WHO had been late in identifying the outbreak. Tedros said such criticism could reflect a misunderstanding of how the International Health Regulations assign responsibilities between countries and WHO. ### What does the Geneva dispute over pathogen sharing have to do with this outbreak? (who.int) Geneva delegates meeting at the World Health Assembly have remained deadlocked over pathogen access and benefit-sharing rules tied to the WHO pandemic agreement, according to the source briefing and related coverage. Those talks concern how countries share samples and how any resulting vaccines, tests or treatments are distributed. The dispute has not changed WHO’s Ebola declaration, but it has unfolded at the same time as the agency responds to an outbreak of a strain with no approved vaccine. (cbsnews.com) The next public markers are likely to be updated WHO case counts and any emergency committee follow-up as Congo and Uganda continue surveillance and contact tracing. WHO’s May 17 determination remains in force while health officials track suspected cases in Ituri, North Kivu and Kampala. (who.int)