GENEVA, Switzerland – The Ebola outbreak linked to more than 130 deaths in eastern Democratic Republic of Congo likely began two months ago and is expected to continue growing, the World Health Organization said on Wednesday, May 20.

The outbreak of the rare Bundibugyo strain, for which there is no vaccine, was declared last Friday, May 15, and has alarmed experts because it went undetected for so long while spreading across a densely populated area, making it difficult to trace and isolate contacts of infected people.

The WHO had previously pointed to “a critical four-week detection gap” between when the first known case began showing symptoms and laboratory confirmation of the outbreak.

“Investigations are ongoing to ascertain when and where exactly this outbreak started,” Anais Legand, a WHO technical officer for viral threats, told reporters in Geneva. “Given the scale, we are thinking that it has started probably a couple of months ago.”

Congo has tackled 16 previous Ebola outbreaks, but first responders say they lack basic supplies, ranging from painkillers and face masks to motorcycles needed for contact tracing, undermining efforts to prevent further spread.

Public health emergency

Six hundred suspected cases and 139 suspected deaths have been recorded so far, WHO Director-General Tedros Adhanom Ghebreyesus told reporters in Geneva. Fifty-one cases have been confirmed through laboratory testing in Congo, while two cases have also been confirmed in neighboring Uganda.

Tedros said a WHO Emergency Committee met on Tuesday, May 19, and confirmed the outbreak was a public health emergency of international concern, but not a pandemic emergency.

He declared the emergency over the weekend, marking the first time a WHO chief had taken that step without first consulting experts because of the urgency of the situation.

“The WHO assesses the risk of the epidemic as high at the national and regional levels and low at the global level,” Tedros said.

Super-spreader event suspected

The Bundibugyo strain of Ebola behind the outbreak has an average fatality rate of around 40%, according to the WHO. Unlike the more common Zaire strain, there are no approved virus-specific therapeutics or vaccines, and testing capacity is limited.

WHO experts said two possible vaccines are under consideration for use in the outbreak but could take three to nine months to develop.

A 2018-2020 outbreak of the Zaire strain in eastern DRC was the second-deadliest on record, killing nearly 2,300 people.

“Our absolute priority now is to identify all the existing chains of transmission … that will then enable us to really define the scale of the outbreak and be able to provide care,” said Chikwe Ihekweazu, WHO emergencies chief.

WHO experts said they suspect the outbreak likely began a couple of months ago, with the first suspected death reported on April 20. They believe the first death was followed by a super-spreader event either at a funeral or a healthcare facility.

Reuters reported on Monday, May 18, that confirmation of the outbreak was slowed by missteps by medical personnel, including an initial failure to escalate samples for further testing after they came back negative for the Zaire strain.

US and South Africa commit funds to response

An American doctor working in Congo is among the confirmed Ebola cases. He has been transferred to Germany, and his family is being taken to an isolation ward at the same hospital, Germany’s health ministry said on Wednesday.

The man’s wife and four children had also been in Congo, but the statement did not say whether they were showing symptoms.

Another US doctor who came into contact with an Ebola patient is being transferred from Uganda to a hospital in Prague, Czech officials said on Wednesday.

The US government said it had mobilized an initial $13 million to respond to the outbreak and would help open 50 clinics to treat Ebola cases.

Experts have suggested the delays in detecting the outbreak may also reflect gaps in preparedness following funding cuts by the US and other major global health donors.

Tedros said it was too early to say whether funding cuts in Congo or to the WHO had contributed to delays in detecting or responding to the outbreak.

The Africa Centres for Disease Control and Prevention said on Wednesday that South Africa had pledged $2.5 million to support the Ebola response. – Rappler.com