WHO declares end of the second largest Ebola outbreak in history
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WHO declared the end of the Democratic Republic of the Congo’s 10th Ebola outbreak today, marking the end of the second largest Ebola outbreak in history.
“Today we are celebrating a joyous occasion the end of the 10th Ebola outbreak in [the Democratic Republic of Congo (DRC)],” WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, wrote on Twitter. “This outbreak took so much from all of us, especially from the people of the DRC, but we came out of it with valuable lessons and tools: a licensed vaccine and identified effective treatments.”
The outbreak was declared on Aug. 1, 2018 just days after the end of the DRC’s ninth outbreak was declared over. Since the start of the outbreak, several factors, including rebel attacks on health care facilities and workers, cases spreading across borders into Uganda and fear of spread from Goma to Rwanda, resulted in the outbreak being declared a Public Health Emergency of International Concern (PHEIC). The emergency committee met four times before ultimately making the decision.
New to this outbreak, and a vital component of containment in addition to the PHEIC declaration, was the widespread use of an Ebola vaccine and the introduction of a second vaccine. The first vaccine, Merck’s V920, was developed to prevent disease caused by the Zaire strain. Preliminary estimates found that the vaccine was more than 97% effective through ring vaccination methods, in which contacts and contacts of contacts of confirmed cases are vaccinated. Throughout the outbreak, hundreds of thousands of people received the vaccine.
The second vaccine from Johnson & Johnson was introduced more than a year into the outbreak in October 2019. Officials reserved the vaccine, which is given in two doses 56 days apart, for at-risk populations in areas without active Ebola transmission.
“I didn't think I would see the day that [this Ebola outbreak] was over because WHO was faced with a seemingly insurmountable task of fighting a global health crisis in a conflict zone amid a complex humanitarian crisis in itself,” Lawrence O. Gostin, JD, professor at Georgetown Law and director of the O’Neill Institute for National and Global Health at Georgetown University, told Healio. “Given the virus, the public distrust, the rapid spread and then having to fight two global health emergencies at the same time in the world, I think WHO deserves enormous credit for being on the ground and being there kudos to WHO.”
Overall, 3,463 cases of Ebola including 3,317 confirmed and 146 probable cases were reported during the outbreak; 2,280 deaths were also reported, for an overall case fatality ratio of 66%. According to WHO, there have been no new cases since April 27, shortly after a small cluster of cases prevented WHO from declaring the outbreak’s end.
“This is something that that none of us expected. Every Ebola outbreak that we have had has been brought under control eventually, but this was the second-largest outbreak ever and, in many ways, it was hardest because of instability, poor governance and violence,” Gostin said. “It’s really delightful to see that, even when WHO was hit with the new health emergencies, and even in the most tragic environment, like the DRC, if they persevere, they can win.”
Despite this, however, Ebola is not over in the DRC. On June 1, a new outbreak was confirmed by WHO on the other side of the country, in Équateur Province. The most recent data available from WHO report 12 cases (nine confirmed and three probable) and eight deaths (five confirmed and three probable) as of June 21.
“Ebola is endemic in DRC and a new outbreak is not a surprise. Having said that, unfortunately, DRC is currently dealing with three ongoing epidemics: a new Ebola outbreak, the world's largest measles outbreak and COVID-19,” Majid Sadigh, MD, director of the global health program at the University of Vermont Larner College of Medicine/Western Connecticut Health Network, and the first chief medical officer for the second American-built Ebola treatment unit in Liberia during the West African epidemic, told Healio. “The public health system is naturally engaged with, and consumed by, COVID-19.”
He added: “Regardless, confinement of Ebola particularly in this peaceful section of the DRC, with the availability of effective vaccines and treatments should not be a difficult task. I am more concerned about the other two epidemics and disruption of the childhood vaccination programs.”
References:
- WHO. Ebola in the Democratic Republic of the Congo: North Kivu, Ituri 2019 - 2020. https://www.who.int/emergencies/diseases/ebola/drc-2019. Accessed June 25, 2020.
- WHO. Ebola in the Democratic Republic of the Congo: Équateur Province. https://www.who.int/emergencies/diseases/ebola/ebola-health-update---%C3%A9quateur-province-democratic-republic-of-the-congo-2020. Accessed June 25, 2020.
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