American Doctor Has Ebola | MedPage Today

KINSHASA, Congo — An American doctor is among the newly confirmed cases in an outbreak in Congo of a rare variant of the Ebola virus with no approved vaccines or therapeutics, a Congolese official said Monday, and details emerged about the government’s delayed response to the fast-moving outbreak where deaths have now surpassed 100.

Jean-Jacques Muyembe, MD, PhD, medical director of the Congolese National Institute of Bio-Medical Research, told the Associated Press the doctor is among the cases in Bunia, the capital of Ituri province.

Seven Americans, including one who tested positive late Sunday, are being transported to Germany for monitoring, the CDC’s Satish Pillai, MD, said in a call with reporters. Pillai said the American developed symptoms over the weekend.

CDC officials did not immediately respond to follow-up questions about how the confirmed case or other people may have been exposed to Ebola, or to which facility or facilities in Germany they are being taken, or about what the case patient’s current condition is.

The World Health Organization (WHO) on Sunday declared the outbreak a public health emergency of international concern. As of Monday, there were over 300 suspected cases and 118 deaths in Ituri and North Kivu provinces and two deaths in neighboring Uganda.

The Bundibugyo strain spread undetected for at least a few weeks, health experts and aid workers said. Cases have now been confirmed in Bunia, North Kivu’s rebel-held capital of Goma, Mongbwalu, Butembo, and Nyakunde.

“Because early tests looked for the wrong strain of Ebola, we got false negatives and lost weeks of response time,” said Matthew M. Kavanagh, PhD, director of the Georgetown University Center for Global Health Policy and Politics. “We are playing catch-up against a very dangerous pathogen.”

He criticized the Trump administration’s earlier decision to withdraw from the WHO and make deep cuts in foreign aid. “When you pull billions out of the WHO and dismantle front line USAID programs, you gut the exact surveillance system meant to catch these viruses early,” he said.

Congo’s health minister, Samuel Roger Kamba, said the government was opening three treatment centers. The WHO said it sent a team of experts and supplies.

In the U.S., the CDC on Monday said it was imposing “appropriate measures for identifying individuals with any symptoms” at ports of entry. The agency has issued travel advisories urging Americans traveling in Congo and Uganda to avoid people with symptoms like fever, muscle pain, and rash.

The Original Response Was Delayed

Congo has said the first person died from the virus on April 24 in Bunia, and the body was repatriated to the Mongbwalu health zone, a mining area with a large population.

“That caused the Ebola outbreak to escalate,” Kamba has said.

When another person fell ill on April 26, samples were sent to Kinshasa for testing, according to the Africa CDC. On May 5, the WHO was alerted of about 50 deaths in Mongbwalu, including four health workers. The first case was confirmed on May 14.

Samples from Bunia were initially tested for the more common Ebola strain, Zaire, Congolese officials said. They came back negative, said Richard Kitenge, MD, the Health Ministry Incident Manager for Ebola.

The first confirmation of Ebola came on May 14, and the Bundibugyo strain was confirmed the next day. Now more resources are being rushed to the region.

“The situation is quite worrying and is evolving pretty quickly,” Esther Sterk, MD, with the Medecins Sans Frontieres aid group told the AP. “It was detected quite late.” But she said that was often the case with outbreaks of Ebola, which has similar symptoms to other tropical diseases.

This Is a Rare Variant of Ebola

Ebola is highly contagious and can be contracted via bodily fluids such as vomit, blood, or semen. The disease it causes is rare but severe and often fatal.

The Bundibugyo virus is a rare variant. Although more than 20 Ebola outbreaks have taken place in Congo and Uganda since 1976, this is only the third time that the Bundibugyo virus has been detected.

The U.S. CDC says it causes fever, headache, muscle pain, weakness, diarrhea, vomiting, stomach pain, and unexplained bleeding or bruising.

Gabriel Nsakala, MD, MPH, a professor of public health who has been involved in past Ebola responses, said Congo has extensive experience managing the outbreaks, but response efforts could be complicated by the rare strain.

The Bundibugyo virus was first detected in Uganda’s Bundibugyo district during a 2007-2008 outbreak that infected 149 people and killed 37. The second time was in 2012, in an outbreak in Isiro, Congo, where 57 cases and 29 deaths were reported.

The Africa CDC chief, Jean Kaseya, MD, told Sky News on Sunday he is in “panic mode” due to a lack of medicines and vaccines, but some candidate treatments are anticipated in the coming weeks.

The Region Already Grapples With a Humanitarian Crisis

Ituri’s Mongbwalu is in remote eastern Congo, with poor road networks more than 620 miles from the capital, Kinshasa.

Eastern Congo long has grappled with a humanitarian crisis and the threat of armed groups that have killed dozens and displaced thousands in Ituri in the past year.

“No one really has a full understanding of how serious this crisis is,” said a Bunia-based U.N. official, who spoke on condition of anonymity because they were not authorized to speak publicly on the subject.

Staff have been asked to work from home and avoid physical contact and crowded areas, the official said, adding they were concerned about halting activities in a region that relies on humanitarian aid.

Rwanda closed its land border with Congo on Sunday. AP reporters tried to cross the border on Sunday and Monday morning but were told it was closed except for holders of international flight tickets. Rwandan authorities did not reply to a request for comment.

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