Butembo: North Kivu has emerged as a major hotspot in the Democratic Republic of Congo's Ebola outbreak, putting treatment centres under growing pressure even as transmission shows signs of slowing in parts of Ituri, which remains the main focus of the epidemic.
The changing pattern of the outbreak is particularly visible in Butembo, a major city in North Kivu. All 29 beds at the Kitatumba Ebola treatment centre were occupied this week as health workers responded to an increase in patients.
Two additional treatment centres were opened in the city this week, bringing the total to four, as authorities and humanitarian organisations work to increase treatment capacity.
The latest Congolese government figures cited on September 25 put the outbreak at 7,820 confirmed cases and 3,779 deaths. Earlier World Health Organization figures, based on data through September 20, recorded 7,733 confirmed cases and 3,732 deaths.
The difference reflects the reporting dates used by health authorities as the outbreak continues to develop.
The epidemic began in Ituri Province and was officially declared on May 15 after laboratory tests confirmed infection with Bundibugyo virus.
Ituri remains the province with the largest cumulative number of cases, but the geographical pattern of the outbreak has been changing. Transmission has declined in some areas of Ituri while North Kivu has recorded a major increase.
On September 7, WHO reported 1,066 confirmed cases in North Kivu, including 453 cases recorded during the previous 21 days. The province also had one of the highest case fatality rates in the outbreak.
Health officials have also seen signs of a recent decline in North Kivu after weeks of rising infections, although transmission remains substantial.
The outbreak has spread across Ituri, North Kivu, South Kivu, Tshopo, Bas Uélé, Haut Uélé and Sud Ubangi provinces. The wide geographical spread has created major challenges for surveillance, contact tracing, patient care and community engagement.
Health authorities are also facing another difficult problem in North Kivu, a lack of trust among some communities.
Some residents have resisted measures introduced to contain Ebola, while response teams and health facilities have faced attacks. Resistance to safe burial procedures and delays in seeking medical treatment can make it harder to identify infections quickly and interrupt transmission.
North Kivu has also experienced years of armed conflict and displacement. Movement of people, insecurity and difficulties reaching some communities have added to the challenges facing health workers.
The current epidemic is caused by Bundibugyo virus, unlike many previous Ebola outbreaks in Congo that were caused by Zaire ebolavirus. There is currently no approved vaccine or specific treatment for Ebola disease caused by Bundibugyo virus.
A vaccination study involving frontline workers was launched in Bunia on September 19. The study is examining whether the existing Ervebo vaccine, which is approved against Zaire ebolavirus, could offer protection against Bundibugyo virus. Its effectiveness against the virus responsible for the current outbreak has not yet been established.
The BRAVO study will follow about 20,000 frontline workers in Ituri and North Kivu over nine to 12 months to assess the potential effectiveness of Ervebo against Bundibugyo virus. Its use against Bundibugyo virus is being studied because the vaccine's effectiveness against this virus is not known.
The outbreak has grown rapidly since it was declared and has become the largest Ebola outbreak recorded in the Democratic Republic of Congo.
Despite the scale of the crisis, health authorities have reported encouraging signs in some areas. Falling transmission in parts of Ituri has provided some encouragement to health authorities and response teams.
However, the rise of North Kivu as a major hotspot shows how quickly the situation can change. Medical teams have warned against assuming that falling admissions in one area mean the wider epidemic is under control.
The continuing appearance of cases in different locations means the response must adapt as the geographical pattern of transmission changes.
For communities in North Kivu, particularly Butembo, the immediate challenge is ensuring that patients can be identified and treated quickly while health authorities work to strengthen treatment capacity, rebuild public trust and prevent further spread.