WHO raises Ebola risk in DRC

The World Health Organization raised its national risk assessment for Ebola in the Democratic Republic of Congo to “very high” on May 22 after saying the outbreak in the country’s east was expanding fast. Congolese authorities responded by banning funeral wakes and gatherings of more than 50 people in affected districts, according to the Associated Press. The outbreak has spread in a region already strained by conflict, displacement and weak health services, and Uganda has also reported imported cases linked to travel from Congo. WHO said the global risk remains low. ### Why did WHO raise the risk level now? WHO Director-General Tedros Adhanom Ghebreyesus said on May 22 that the outbreak was “spreading rapidly” in eastern Congo, prompting the agency to lift its national risk assessment from “high” to “very high.” The U.N. agency said the change reflected rising case numbers, geographic spread and the difficulty of mounting a response in insecure areas. (apnews.com) A WHO statement published on May 17 had already determined that Ebola disease caused by Bundibugyo virus in the Democratic Republic of Congo and Uganda constituted a public health emergency of international concern, though not a pandemic emergency under the International Health Regulations. That earlier determination cited confirmed cases in Ituri province and two confirmed cases in Kampala, Uganda, among travelers from Congo. (apnews.com) ### What do the latest numbers show? The U.S. Centers for Disease Control and Prevention said that, as of May 22, health ministries in Congo and Uganda had reported 744 suspected cases, 83 confirmed cases and 176 suspected deaths. The CDC said those totals included two confirmed cases in Uganda, one of them fatal, in people who had traveled from Congo. The CDC also said a new confirmed case had been identified in Sud-Kivu province, adding to earlier confirmed cases in Ituri and North Kivu. (who.int) The agency described the situation as “rapidly evolving” and said case counts were subject to change. ### Why are funeral wakes and crowd limits part of the response? Authorities in northeastern Congo banned funeral wakes and gatherings of more than 50 people on May 22 in an effort to reduce transmission. (cdc.gov) Ebola can spread through direct contact with the bodily fluids of infected people, including during care and burial practices, which is why funerals have often been a focus of control measures in past outbreaks. The Associated Press reported that the restrictions were imposed in affected districts as suspected cases and deaths rose. Local officials were also responding to pressure on a health system that has struggled with limited resources and resistance from some residents. ### Why is this outbreak drawing so much concern from health officials? (apnews.com) The virus involved in this outbreak is the Bundibugyo species of Ebola, a less common strain for which there is no approved vaccine, according to CARE and other outbreak briefings. That has complicated response planning compared with outbreaks caused by the Zaire strain, for which vaccines and more established protocols are available. (apnews.com) Foreign Policy, citing Annie Sparrow of Mount Sinai and Daniel Lucey of Dartmouth, said the outbreak showed how pandemic preparedness can break down in conflict zones where surveillance, laboratory access and routine healthcare are weaker. Politico separately reported experts saying aid cuts and insecurity had made it harder to build resilient services in eastern Congo. (care.org) ### What is the risk outside the region? The CDC said on May 22 that no Ebola cases associated with this outbreak had been reported in the United States and that the risk to the general public remained low. WHO likewise said the global risk was low even as it upgraded the assessment for Congo itself. The U.S. State Department said it set up an interagency coordination cell on May 15, within 24 hours of learning of confirmed cases, and said it was working with partners to help contain the outbreak in Congo and Uganda. (foreignpolicy.com) WHO and national health authorities are expected to keep updating case totals and response measures as surveillance expands in Ituri, North Kivu and Sud-Kivu. (state.gov) (cdc.gov)