WHO upgrades Congo Ebola risk

The World Health Organization raised its risk assessment for the Ebola outbreak in the Democratic Republic of the Congo to “very high” at the national level on May 22, saying the epidemic was spreading rapidly. WHO Director-General Tedros Adhanom Ghebreyesus said the regional risk remained “high” and the global risk “low,” even as suspected cases and deaths climbed well beyond the confirmed toll. The outbreak involves the Bundibugyo species of Ebola, a strain for which there is no licensed vaccine or specific treatment. WHO says the outbreak was confirmed in the Democratic Republic of the Congo and Uganda in May and is unfolding in a setting marked by insecurity, population movement and a humanitarian crisis. ### Why did WHO raise the risk level now? Tedros said on May 22 that the Democratic Republic of the Congo had almost 750 suspected cases and 177 suspected deaths, compared with 82 confirmed cases and seven confirmed deaths. He said the gap showed the epidemic was larger than the laboratory-confirmed figures alone. WHO’s revised assessment puts the outbreak at “very high” nationally, “high” regionally and “low” globally. (news.un.org) A WHO disease outbreak notice published on May 21 had reported 516 suspected cases and 131 suspected deaths in the Democratic Republic of the Congo as of May 18, along with 33 confirmed cases and four confirmed deaths there. The same notice said Uganda had reported two confirmed imported cases, including one death, in Kampala. The increase between May 18 and May 22 reflects the speed at which suspected counts were rising during the response. (news.un.org) ### Where is the outbreak centered, and how far has it spread? Ituri Province in northeastern Democratic Republic of the Congo is the center of the outbreak, according to WHO. The agency said the first alert came on May 5 after reports of a high-mortality illness in Mongbwalu Health Zone, including deaths among health workers. Laboratory testing by the Institut National de la Recherche Biomédicale in Kinshasa confirmed Bundibugyo virus disease on May 15, and Congo declared its 17th Ebola outbreak the same day. (iris.who.int) WHO’s first weekly external situation report said suspected and confirmed cases had been identified across health zones in Ituri and North Kivu provinces, including Bunia, Rwampara, Mongbwalu, Nyankunde, Butembo, Goma and Katwa. Uganda’s two confirmed cases were linked to travel from Congo, and WHO said cross-border preparedness had become part of the response. (who.int) ### Why is Bundibugyo drawing so much attention from researchers? Bundibugyo virus is an Ebola species for which no vaccine or specific treatment is licensed, WHO says. That distinguishes this outbreak from outbreaks caused by the Zaire species, for which tools including Merck’s Ervebo vaccine already exist. WHO says work is under way to test promising candidates for Bundibugyo, but none is ready for routine use in this outbreak. (iris.who.int) Vasee Moorthy, WHO’s acting lead for the R&D Blueprint for Action to Prevent Epidemics, told reporters in comments reported by Politico that two experimental vaccine approaches exist. One candidate built on the Ervebo platform has no doses available for a clinical trial and would need to be prioritized, he said. A second candidate, developed on the same platform as AstraZeneca’s Covid-19 shot, could have doses for clinical trials in two to three months, though Moorthy said there was significant uncertainty about whether it would work. (who.int) ### What is making the response harder on the ground? WHO said the outbreak is unfolding in a remote and densely populated area affected by insecurity, humanitarian strain and high population and trade movements. The agency said it was scaling up surveillance, contact tracing, clinical management, supplies, community engagement and cross-border preparedness with the governments of Congo and Uganda. WHO has also said community engagement will be central to bringing the outbreak under control. (politico.com) UN News reported on May 22 that the outbreak was spreading amid intensified fighting, displacement and distrust of outside authorities, with emergency staff, supplies and funding being moved into the region. WHO and partners are also preparing clinical trials for experimental treatments and possible vaccines targeting the Bundibugyo strain, according to the same report. (who.int) ### What happens next in the outbreak response? WHO said on May 22 that it was organizing a scientific consultation to review and align research on vaccines, drugs and diagnostics for Bundibugyo. The agency’s outbreak pages say support operations in Congo and Uganda are continuing, including contact tracing, treatment preparedness and cross-border surveillance. The next public milestones are likely to come through WHO situation reports, disease outbreak notices and statements tied to the ongoing international emergency response. (news.un.org) (politico.com)