A cluster of Ebola cases in the Democratic Republic of Congo — just one week after it declared an end to an outbreak on the other side of the country — is especially worrying because the new infections are in a war zone.
Moreover, a new Ebola vaccine that helped defeat the earlier outbreak may not work this time because the culprit strain of Ebola virus may be different, health officials and aid groups said Thursday.
At least 20 people are believed to have died from the latest outbreak since mid-July, and four of six samples taken from survivors tested positive for Ebola, officials said Wednesday.
The virus, which causes fevers and potentially fatal hemorrhaging, can often spread out of control, as it did during a 2015 outbreak in West Africa.
But North Kivu Province, the volatile region in the Democratic Republic of Congo where the new outbreak is centered, creates security complications that health officials did not confront in the outbreak they just defeated in northwest Équateur Province, 1,550 miles away. The World Health Organization is worried about the safety of medical workers in North Kivu and their access to areas controlled by militants.
“This new cluster is occurring in an environment which is very different from where we were operating in the northwest,” said Dr. Peter Salama, the deputy director general of the health agency and the head of its emergency response unit. “This is an active conflict zone. The major barrier will be safely accessing the affected population.”
The new cases are in and around the remote village of Mangina, near the city of Beni and the border with Uganda. The area has been chronically plagued by fighting between government forces and armed rebel groups. Last year, 15 United Nations peacekeepers were killed in an attack on a compound in North Kivu.
The region also hosts more than one million people displaced by conflict throughout the country and shares porous borders with Rwanda and Uganda.
The World Health Organization said it was working with those neighboring nations to ensure that they were prepared to respond to the disease.
But aid groups fear that the fighting and humanitarian crisis in North Kivu will only compound the difficulties of defeating Ebola. People on the move can frustrate the critical need to determine chains of infection.
“People are hungry and at risk of disease, and many have had to flee their homes,” said Jose Barahona, Oxfam’s country director for the Democratic Republic of Congo. “Ebola poses a serious risk to communities already on the edge and threatens our ability to help them.”
The Équateur outbreak, which killed at least 33 people, was contained within a few months and was officially declared over on July 24.
Health officials believe the use of an experimental vaccine on more than 3,300 people was a major factor in containing that outbreak, but it can only protect against one strain of the virus — Zaire Ebola.
Officials are still working to identify the Ebola strain in North Kivu, the 10th Ebola outbreak in the Democratic Republic of Congo since it was first discovered in the country in 1976, when it was known as Zaire.
Michelle Gayer, the director of emergency health for the International Rescue Committee, said the new outbreak’s location made it unlike what she saw in Équateur and West Africa.
“We are in a different context again in the sense that, yes, it’s actually in small rural areas that we know of to date, however it’s in a zone where there has been a lot of insecurity and a lot of armed groups and a large amount of displacement,” Ms. Gayer said.
Simply getting to an affected community, she said, would be challenging.
“It is already hard because of geography,” Ms. Gayer explained. “And we can only go where we can go if there is this insecurity.”
Lack of basic resources after years of war, including limited health care, puts North Kivu residents further at risk. Ebola can often spread through community gatherings or funerals, or though contamination at health clinics.
The Health Ministry said a team of 12 experts arrived in the affected area on Thursday, with a mobile laboratory and protective equipment to begin a coordinated response.
The ministry also said additional security measures were in place to ensure the protection of health care workers. The World Health Organization also began sending experts to the area.
“Since we are coming out of another Ebola outbreak, we have kept staff and equipment in place,” said Dr. Matshidiso Moeti, the organization’s regional director for Africa. “This allows us to have a head start in response to this cluster.”
Orignially published in NYT.