The conventional wisdom on Ebola - at least, prior to the 2014 West African epidemic - was that outbreaks nearly always occurred in very remote and sparsely populated villages in Central Africa - and due to its rapid disease progression and high fatality rate - they tended to burn out before spreading.
But viruses, and/or their environment, can change over time.In the more than 40 years since Ebola Zaire was first discovered, transportation (roads, buses, number of commercial & personal vehicles, etc.) in Central Africa have improved. While it is often still difficult, people are traveling farther and more often for work or commerce.
As a result, viral outbreaks once more or less stranded in remote regions interior Africa now have more opportunities to hitch a ride into highly populated urban centers.Last night the news broke of a single confirmed Ebola infection in Wangata, part of the heavily populated city of Mbandaka (pop. 1.2 million), some 150 km from the initial outbreak in the Bikoro health zone.
Details on this case, how the carrier made it all the way to Mbandaka, and how many people may have been exposed along the way are pending.While none of this assures a repeat of 2014, containment of this Ebola outbreak has arguably become much tougher, as the tracing of this patient's contacts now becomes a top priority.
Expressing concern, we have the following statement from the WHO.
17 May 2018
One new case of Ebola virus disease (EVD) has been confirmed in Wangata, one of the three health zones of Mbandaka, a city of nearly 1.2 million people in Equateur Province in northwestern Democratic Republic of the Congo.
The Ministry of Health of the Democratic Republic of the Congo announced the finding, after laboratory tests conducted by the Institut National de Recherche Biomédicale (INRB) confirmed one specimen as positive for EVD.
Until now, all the confirmed Ebola cases were reported from Bikoro health zone, which is also in Equateur Province but at a distance of nearly 150 km from Mbandaka. The health facilities in Bikoro have very limited functionality and the affected areas are difficult to reach, particularly during the current rainy season, as the roads are often impassable.
"This is a concerning development, but we now have better tools than ever before to combat Ebola," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO and our partners are taking decisive action to stop further spread of the virus."
WHO is deploying around 30 experts to conduct surveillance in the city and is working with the Ministry of Health and partners to engage with communities on prevention and treatment and the reporting of new cases.
"The arrival of Ebola in an urban area is very concerning and WHO and partners are working together to rapidly scale up the search for all contacts of the confirmed case in the Mbandaka area," said Dr Matshidiso Moeti, WHO Regional Director for Africa.
WHO is also working with Médecins Sans Frontières (MSF) and other partners to strengthen the capacity of health facilities to treat Ebola patients in special isolation wards.
As of 15 May, a total of 44 Ebola virus disease cases have been reported: 3 confirmed, 20 probable, and 21 suspected.
WHO partners in the DRC Ebola response include:
The International Federation of Red Cross and Red Crescent Societies (IFRC), the Congolese Red Cross (Congo ICRC), the Red Cross of the Democratic Republic of the Congo (DRC ICRC), Médecins Sans Frontières (MSF), the Disaster Relief Emergency Fund (DREF), the Africa Centers for Disease Control and Prevention (Africa-CDC), the US Centers for Disease Control and Prevention (US-CDC), the World Food Programme (WFP), UNICEF, UNOCHA, MONUSCO, International Organization for Migration (IOM), the FAO Emergency Management Centre – Animal Health (EMC-AH), the International Humanitarian Partnership (IHP), Gavi – the Vaccine Alliance, the African Field Epidemiology Network (AFENET), the UK Public Health Rapid Support team, the EPIET Alumni Network (EAN), and the International Organisation for Animal Health (OIE) and and the Emerging Diseases Clinical Assessment and Response Network (EDCARN). Additional coordination and technical support is forthcoming through the Global Outbreak Alert and Response Network (GOARN) and Emergency Medical Teams (EMT).