The World Health Organisation has declared the Ebola outbreak in the Democratic Republic of Congo and Uganda a public health emergency of international concern. Given that there is no cure or vaccine for this disease, cross-border testing and monitoring remain crucial to prevent its spread, explains Sreya Deb.
What is driving the current concern?
The latest Ebola outbreak has been identified as being caused by the Bundibugyo virus strain, causing the Bundibugyo virus disease (BVD) —a rare type of Ebola disease that has no approved therapeutics or vaccines. Although more than 20 Ebola outbreaks have taken place in the Democratic Republic of Congo (DRC) and Uganda, this is only the third time BVD has been reported.
A WHO release said that so far eight laboratory-confirmed cases, 246 suspected cases and 80 suspected deaths have been reported from the DRC. Two other laboratory confirmed cases including one death with no apparent links with the first few have been reported in Kampala, Uganda, on May 15 and May 16 among two individuals travelling from the DRC.
As per the WHO, this trend “points towards a potentially much larger outbreak than what is currently being detected and reported, with significant local and regional risk of spread.” Its emergency declaration shows the event is serious, there is a risk of global spread and it requires a coordinated international response.
What are the WHO’s observations?
Dr. Tedros Adhanom Ghebreyesus, director-general of the WHO, has said that there are “significant uncertainties to the true number of infected persons and geographic spread associated with this event at the present time.” In an X post, the WHO said most of the suspected cases are between 20 and 39 years old, with females accounting for over 60%, suggesting significant risks associated with household and caregiver transmission.
The WHO has said that neighbouring countries sharing land borders with DRC and Uganda were at high risk due to population mobility, trade and travel linkages. Its response guidelines include deployment of rapid response teams, delivery of medical supplies, surveillance, laboratory confirmation, infection prevention and control assessments, setting up safe treatment centres, and community engagement. However, it has emphasised that the outbreak does not meet the criteria of pandemic emergency.
How BVD spreads
Bundibugyo Virus Disease (BVD) is a severe and often fatal form of Ebola disease. It is a zoonotic disease, with fruit bats suspected to be the natural reservoir. Human infection occurs through close contact with the blood or secretions of infected wildlife, such as bats or non-human primates, and subsequently spreads from person to person through direct contact with the blood, organs, secretions or other body fluids of infected individuals or contaminated surfaces.
First detected in Uganda’s Bundibugyo district, the BVD virus has had only two outbreaks in the region prior to this, in 2007 and in 2012. The case fatality rates have ranged from 30- 50%. The 2007 outbreak infected 149 people and killed 37. In the second outbreak in Isiro, Congo, 57 cases and 29 deaths were reported.
India reported its only known Ebola case in November 2014, when a 26-year-old man who had travelled from Liberia tested positive for the virus in Delhi.
What makes the disease so fatal?
Unlike the Ebola virus disease, there is no licensed vaccine or specific therapeutics against the BVD virus. However, early supportive care can be lifesaving. The incubation period ranges from 2 to 21 days, and individuals are usually not infectious until symptom onset. Early symptoms are non-specific, including fever, fatigue, muscle pain, headache, and sore throat, which complicates clinical diagnosis and can delay detection. “These can progress to gastrointestinal symptoms, organ dysfunction, and in some cases haemorrhagic manifestations,” said a WHO statement.
There are currently two licensed Ebola vaccines prequalified by WHO for Ebola virus disease (EVD) caused by Ebola virus. They are Ervebo vaccine, recommended for use in outbreak settings, and Zabdeno and Mvabea vaccine, administered in a two-dose regimen.
Should India be concerned?
A concern. post the news of the Ebola outbreak, has been on the chances of the virus rearing its head in India. The question has also arisen in regard to its potential entry through the state of Kerala, given that outbreaks of Nipah, Zika, Japanese Encephalitis, and others have shown up first in this state. This tends to happen due to the state having the largest overseas diaspora, compared to other states in the country. An estimated 2.5 million people from that state work in Gulf countries, with millions more across Africa, Southeast Asia, Europe and the US.
However, the current risk of an Ebola outbreak in India is low. Primarily, since the WHO has issued guidelines for preventative measures for affected states and those sharing borders with the DRC and Uganda, and much lighter measures for other countries.
Moreover, the BVD is not spread by airborne transmission like the flu, rather through direct physical contact. However, the National Centre for Disease Control is closely monitoring developments, while a review meeting was also held to assess India’s preparedness, screening mechanisms and response strategy.