Update: On July 17, 2019, WHO declared the Ebola outbreak in the DRC a Public Health Emergency of International Concern (PHEIC), prompting the highest level of mobilization from WHO. According to the CDC, "a PHEIC is declared if an extraordinary event poses a public health threat to other nations through the spread of disease and requires a more robust coordinated international response."
As of June 2019, more than 2,000 people have been infected with Ebola virus during the ongoing outbreak in the Democratic Republic of Congo (DRC), according to the World Health Organization (WHO). The WHO and the U.S. Centers for Disease Control and Prevention (CDC) have also reported the first confirmed cases of Ebola in neighboring Uganda since 2013. The first confirmed patient became infected while visiting the DRC, then returned to Uganda and sought treatment. Since then, two relatives of that first patient have also been confirmed as having Ebola infections. The people they came in contact with have been identified and are being monitored.
Even one case of Ebola outside the area of the current outbreak is a cause for concern because the potential for the deadly infection to spread to other people in the region is high. Depending on the outbreak, the death rate from Ebola can range from 25% to 90%, but averages about 50%, according to the WHO.
"This is a sobering development that everyone has been working to avoid and highlights the complexity of the Ebola outbreak in the Democratic Republic of the Congo," said CDC Director Robert R. Redfield, M.D. in a statement on June 11th.
As of July 6th, the WHO reported 2,408 cases, including 1,625 deaths in the DRC, though as of that date the pace of deaths had fallen since April of this year. The number of cases is updated regularly by the WHO.
Ebola, first discovered in 1976, is a rare disease that most commonly affects humans and primates, including monkeys, gorillas and chimpanzees. The virus was first found in the DRC and since its discovery has caused periodic outbreaks in several West African countries. The largest outbreak recorded so far was the West African outbreak that began in 2014 and ended in 2016, with 15,261 laboratory-confirmed cases, according to the WHO.
There have been no cases of Ebola in the U.S. since the 2014-2016 outbreak when eleven people with Ebola were treated in the U.S. All contracted the virus in Africa except for two nurses who contracted Ebola while caring for a patient who had been transported to the U.S. for treatment.
Ebola virus is spread through direct contact with blood or other body fluids of someone who is infected with Ebola or has died of the virus. It may also be spread through contact with objects contaminated with body fluids from a sick individual and contaminated needles. It only takes a small number of viruses to cause infection. The virus gets into the body through breaks in the skin or through mucous membranes, such as those in the nose, mouth or eyes, or through sexual contact.
Signs and symptoms of Ebola infection can be non-specific in the early stages and are easily confused with symptoms of other infections. They may include high fever, weakness, diarrhea, fatigue, vomiting, stomach pain, and unexplained bleeding and bruising. Generally, symptoms appear between eight and ten days after exposure to the virus.
Cases of Ebola infection can be confirmed through laboratory tests that detect Ebola virus genetic material (RNA), proteins called antigens made by the virus or antibodies produced in response to the infection. According to the CDC, since Ebola cases are extremely rare in the U.S., someone should not be tested for the virus unless that person has symptoms of Ebola plus one risk factor for infection, such as a history of being near an Ebola outbreak or contact with an infected person. Ebola virus can be detected in the blood after symptoms, especially fever, begin, though it can take up to three days after symptoms start for the virus to reach detectable levels.
Currently, there is no specific treatment for Ebola other than supportive care including oxygen, intravenous fluids and medications to relieve diarrhea and increase blood pressure. Experimental drugs to treat Ebola have been shown to be effective in primates but have not yet been tested on humans.
An experimental vaccine called rVSV-ZEBOV has been shown in clinical trials to be very effective and is expected to be approved by the Food and Drug Administration this year. It has been widely used in the DRC, but political unrest and fear that the vaccine will cause harm has prevented vaccination of many people whose lives could potentially be saved by the vaccine.
In a recent phone call with reporters, Dr. Mike Ryan, WHO executive director for health emergencies, said that "a tremendous amount of work has been done in the field by our WHO and UNICEF teams and the ministry teams to try and improve [the] trust relationship but…the situation is extremely volatile. We need to continue with that investment, and we welcome the arrival of NGOs [non-governmental organizations] and others to support that intervention in the field."