Ebola outbreak in central Africa spreads rapidly, prompting international alarm

The World Health Organization declared the Ebola outbreak in the Democratic Republic of the Congo and Uganda a Public Health Emergency of International Concern on May 17, citing rising cases, cross-border spread and uncertainty over the epidemic’s scale. WHO said the outbreak involves the Bundibugyo strain, a rarer form of Ebola for which there is no approved vaccine or specific treatment. U.S. health officials said the risk to the American public remains low, even as case counts rose sharply in central Africa and one American exposed in the DRC tested positive and was moved to Germany for care. ### Where is the outbreak spreading now? The Democratic Republic of the Congo is the center of the outbreak, with transmission reported in northeastern Ituri Province and in Nord-Kivu Province, according to the CDC and WHO’s Africa office. WHO said the DRC confirmed the outbreak in Ituri, and described a backdrop of insecurity, high population mobility, cross-border trade and refugee movements. (news.un.org) Uganda has also reported infections linked to travel from the DRC. The United Nations said two infected people crossed into Uganda from the DRC, and the CDC said the outbreak totals reported by May 19 included two confirmed Ugandan cases, one of them fatal. ### How fast are the numbers rising? As of May 19, the CDC said the DRC and Uganda ministries of health had reported 536 suspected cases, 105 probable cases, 34 confirmed cases and 134 suspected deaths. (cdc.gov) The agency said 26 new confirmed cases and 143 new suspected cases were identified in the prior 24 to 48 hours. The BMJ reported on May 21 that the outbreak had grown to almost 600 suspected cases and 139 suspected deaths. (news.un.org) WHO Director-General Tedros Adhanom Ghebreyesus has warned about the “scale and speed” of the epidemic, according to multiple reports cited in coverage of the outbreak. ### Why are health officials especially concerned? WHO said the outbreak is likely larger than currently detected because of unexplained death clusters, a high positivity rate among tested samples and gaps in understanding how transmission is unfolding. (cdc.gov) The agency also said at least four healthcare workers had died, raising concern about infection prevention in health facilities. (bmj.com) Scientific American reported that experts say the chance of a global pandemic remains low, even as international alarm has grown. MPR News said infectious-disease specialists are focused on what is driving the outbreak and what resources will be needed to contain it. ### Why isn’t this being treated as a likely global pandemic? (news.un.org) The CDC said no Ebola cases tied to this outbreak have been confirmed in the United States and that the overall risk to the American public and travelers remains low. On May 18, CDC and the Department of Homeland Security began enhanced travel screening, entry restrictions and other public-health measures aimed at preventing Ebola from entering the United States. (scientificamerican.com) WHO said the situation is serious but does not currently meet the criteria for a pandemic emergency under the International Health Regulations. The agency said it does not recommend international travel or trade restrictions, and instead urged countries to strengthen surveillance, preparedness and public information. ### What is making this outbreak harder to contain? (cdc.gov) The Bundibugyo strain has no approved vaccine or specific treatment, WHO said, which leaves containment dependent on faster testing, tracing, infection control and supportive care. WHO’s Africa office said the outbreak is unfolding in a setting shaped by insecurity, mobile populations, mining-related trade routes and humanitarian pressures. (news.un.org) An American aid worker or clinician exposed while caring for patients in the DRC tested positive on May 17 and was transferred to Germany, the CDC said. The agency said high-risk contacts linked to that exposure were also being moved to Germany and Czechia, and no additional American cases had been reported. ### What happens next? WHO said authorities in the DRC and Uganda have been advised to activate emergency response mechanisms, expand contact tracing and laboratory testing, improve infection prevention and scale up treatment capacity. (news.un.org) The agency also said community engagement with local and religious leaders will be critical to the response. An Emergency Committee is expected to provide further recommendations as WHO and partner agencies expand support to the DRC response. (cdc.gov) The WHO Africa office said on May 19 that it was ramping up support in the DRC, while the CDC said the situation remains rapidly evolving and case counts are subject to change. (afro.who.int) (news.un.org)