New York: Health experts have warned that the Ebola outbreak in the Democratic Republic of the Congo could spread further as the number of new infections remains persistently high, despite months of efforts to contain the disease. The continuing transmission has raised concerns that weaknesses in contact tracing, limited healthcare access and insecurity in affected regions could allow the virus to reach more communities and neighbouring countries.
The outbreak appears to have reached a plateau, with earlier reports indicating that approximately 400 to 500 new infections were being recorded each week. However, experts caution that a stable infection rate does not mean the disease is under control. Instead, it suggests that transmission is continuing without the sustained decline needed to bring the outbreak to an end.
One of the biggest concerns is the difficulty of identifying people who have been exposed to infected patients. Recent reporting indicated that fewer than one quarter of newly confirmed patients had previously been identified as contacts of known cases. This suggests that health workers may be missing important chains of transmission, allowing the virus to spread before infected people are detected.
Although health authorities are continuing their surveillance efforts, the situation remains challenging. According to figures published on October 29 by the European Centre for Disease Prevention and Control, 85.4 per cent of identified contacts in affected provinces were under monitoring. However, this figure does not include people whose exposure to the virus has not yet been identified.
The latest available figures show that the Democratic Republic of the Congo had recorded 10,193 confirmed cases and 4,960 deaths as of October 27. The outbreak has affected eight provinces, with Ituri and North Kivu accounting for most of the infections and deaths.
The continuing spread has also raised concerns about the possibility of further infections outside the country. Kenya and Nigeria have reported cases linked to the wider outbreak, demonstrating how movement across borders can complicate efforts to contain the virus.
Kenya had recorded nine confirmed cases and two deaths by October 26. The infections were linked to an initial patient who had travelled from the Democratic Republic of the Congo through Uganda. Health authorities have been monitoring contacts to identify possible additional infections.
Nigeria confirmed its first case on October 20 after a woman who had travelled from Uganda developed symptoms and sought medical care in Abuja. She was medically evacuated to Switzerland on October 26, while her husband was also placed in isolation as a close contact. Investigations into the source of her infection were continuing.
Uganda, which previously recorded 20 confirmed cases and two deaths, declared its outbreak over in July. The World Health Organization subsequently confirmed the end of the outbreak in August. However, the movement of people between countries remains an important consideration for regional health authorities.
Another major concern is the number of infected people who die outside treatment facilities. In its October 23 update, the World Health Organization reported that 307 of 482 deaths recorded during the reporting period had occurred in communities, compared with 175 in treatment centres. Such deaths can increase the risk of exposure among family members and caregivers, particularly when infections are not recognised early.
The response has been further complicated by armed conflict, shortages of healthcare workers, inadequate medical facilities and difficulties reaching remote communities. Misinformation and mistrust have also affected efforts to encourage early treatment and cooperation with contact tracing teams.
The outbreak is caused by the Bundibugyo virus, which differs from the Zaire ebolavirus responsible for several previous major epidemics. This difference has created additional challenges because vaccines and treatments developed for other Ebola virus species cannot automatically be assumed to provide protection against Bundibugyo virus.
A new clinical trial began in Bunia, in Ituri province, on October 23 to assess potential vaccines against the virus. The TUMAINI trial is examining vaccine candidates, including Ervebo, which is already licensed against Zaire ebolavirus. However, its effectiveness against Bundibugyo virus has not yet been established.
Health researchers have also warned that projections about the future course of the outbreak remain uncertain. Earlier computer models examined scenarios involving thousands of additional infections, but such estimates depend on several factors, including the effectiveness of surveillance, access to treatment and the ability of health teams to interrupt transmission.
The current outbreak has already become the largest and deadliest Ebola epidemic in the history of the Democratic Republic of the Congo and the second largest recorded globally. The West African epidemic between 2014 and 2016 remains the largest, with approximately 28,600 infections and more than 11,000 deaths.
Despite the serious situation, health authorities continue to strengthen surveillance, monitor contacts and improve access to treatment. The latest reported figures also included 2,749 recoveries in the Democratic Republic of the Congo.
Experts remain concerned that the continuing high number of infections could lead to further transmission unless more cases are identified early and affected communities receive adequate medical support. The coming weeks will be important in determining whether the outbreak begins