The World Health Organisation (WHO) has declared an Ebola outbreak in the Democratic Republic of Congo a “public health emergency of international concern”, raising fears of another pandemic.
The WHO has reported 246 suspected cases and 80 deaths after the outbreak in the eastern Ituri province of the DRC, which has now spread to neighbouring Uganda with two confirmed cases in its capital Kampala, including one death.
The agency said the spread of the disease does not yet meet the criteria of a pandemic emergency. Still, it warned that it could be “a much larger outbreak” than current figures suggest, with a significant risk of local and regional spread due to high connectivity between the province and bordering regions and countries.
The current strain of Ebola is caused by the Bundibugyo virus, for which there are no approved drugs or vaccines, and as such, the WHO considers this event “extraordinary”. The Zaire strain, which caused recent major outbreaks in West Africa, has a vaccine, but it only protects against that specific strain.
The case fatality rate of Ebola virus disease from the Bundibugyo species is estimated at 30 to 40 per cent.
The WHO said the ongoing conflict in eastern DRC, combined with high population mobility, the urban location of the hotspot, and the large number of informal healthcare facilities in the region, increased the risk of spread.
“The event requires international coordination and cooperation to understand the extent of the outbreak, to coordinate surveillance, prevention and response efforts, to scale up and strengthen operations and ensure ability to implement control measures,” the agency said in a statement.
WHO director general Dr Tedros Adhanom Ghebreyesus warned of “significant uncertainties to the true number of infected persons and geographic spread” of the outbreak.
But while this outbreak is raising concerns over its potential to spread, it is not the only one.
A girl is getting inoculated with an Ebola vaccine in Goma, Congo, in 2019 (Photo: Pamela Tulizo/AFP)Ebola
Ebola was first discovered in Zaire (now the DRC) in 1976. There have been 40 confirmed outbreaks of the disease since then across Africa, with some cases spreading to the UK, US, Spain, and Italy, but mainly cases have been located in central and western Africa.
It is a viral haemorrhagic fever thought to have originated in fruit bats. It is transmitted through direct contact with bodily fluids or contaminated materials from an infected person, such as blood.
Symptoms include fever, muscle pain, fatigue, headache and sore throat, and are followed by vomiting, diarrhoea, a rash and bleeding.
Around 15,000 people have died from the virus in African countries over the past 50 years.
The current outbreak ranks as the seventh-largest outbreak across all species of virus, according to experts at Imperial College London. They say this is already the largest documented Bundibugyo outbreak, with only 131 and 38 cases reported in previous outbreaks in 2007 and 2012, respectively.
Dr Ruth McCabe, WHO Liaison Fellow at Imperial College London’s MRC Centre for Global Infectious Disease Analysis, says that previous outbreaks of Ebola suggest that it won’t turn into a pandemic.
“There’s been very, very few exported cases of Ebola outside of the African continent, and so right now that’s not the worry, but I think right now the worry is getting the resources to the people that need them in the affected areas,” she says.
Dr Daniela Manno, Clinical Assistant Professor at the London School of Hygiene and Tropical Medicine, says that “although this is a serious outbreak that requires urgent public health action, there is currently no evidence that it poses a significant risk to the UK public.”
“More broadly, recurrent Ebola outbreaks highlight the importance of sustained investment in surveillance, outbreak preparedness, strong health systems, and understanding the environmental and social drivers of spillover events at the human–animal interface.”
Health workers from the Guinean Ministry of Health prepare forms to register medical staff ahead of their anti-ebola vaccines (Photo: Carol Valade/AFP)Hantavirus
Similar to Ebola, Hantavirus is a zoonotic virus which can be transmitted from animals to humans. In this case, through infected rodents.
There was a recent Andes hantavirus outbreak on 2 May on MV Hondius, a Dutch-flagged cruise ship with passengers and crew from 23 countries.
As of 17 May, a total of twelve cases have been reported, including three people who have died.
According to the WHO, the infection has been known to lead to hantavirus cardiopulmonary syndrome (HCPS) in the Americas, which is a severe respiratory disease affecting the lungs and heart. In Europe and Asia, hantaviruses have been known to cause haemorrhagic fever with renal syndrome (HFRS), which primarily affects the kidneys and blood vessels.
Symptoms of HCPS include coughing, shortness of breath, accumulation of fluid in the lungs and shock. While the later stages of HFRS may include low blood pressure, bleeding disorders and kidney failure.
Damien Tully, associate professor at the London School of Hygiene and Tropical Medicine, says he doesn’t think Ebola or Andes hantavirus are likely to become the next pandemic “as they are self-limiting and not very well transmitted compared with respiratory viruses”.
“However, I do think we got lucky with hantavirus, as if it were something more transmissible, such as H5N1 bird flu, it would be a bit more concerning.”
“The next pandemic is really a question of when, not if,” he says.
“Climate change is likely to alter the infectious disease landscape, creating new opportunities for pathogens to emerge and for known pathogens to re-emerge in new settings. One concern is that investment in pandemic preparedness and public health infrastructure has declined in many countries since Covid-19.”
He adds: “At the same time, there are increasing challenges around misinformation, public trust, and maintaining robust disease surveillance systems. These factors will make outbreaks more difficult to detect, communicate, and contain rapidly.”
Medics escort a patient (second right) evacuated from the MV Hondius cruise ship with a suspected hantavirus infection, to an ambulance after being flown to the Netherlands (Photo: Peter Dejong/AP)Bird Flu
The highly infectious disease, bird flu H5N1, was first detected in domestic waterfowl in China in the 1990s and is now widespread in wild birds around the world. The WHO considers it a major pandemic threat.
The disease can jump from wild birds to farmed birds, infecting poultry and other livestock, such as cows.
There have been cases of humans catching H5N1 from contact with sick animals, in several countries, including Cambodia, Chile, China, Vietnam, Australia, the USA and the UK.
Symptoms include eye redness, respiratory symptoms and fever.
The WHO recorded a total of 463 deaths among 888 cases between January 2003 and March 2024.
The high ratio of deaths to cases (52 per cent) suggests that H5N1 could cause a major public health emergency if there is sustained person-to-person transmission, according to Christopher Dye, professor of epidemiology, and Wendy S Barclay, Action Medical Research chair in virology, writing in the British Medical Journal.
Scientists at the Paracas National Reserve inspecting a dead sea lion after bird flu is believed to have killed 600 of them in Peru in January 2023 (Photo: Sernanp/AFP)Coronavirus
“The next major pandemic will be flu or another coronavirus,” says Professor Michael Marks, Professor of Medicine at the London School of Hygiene and Tropical Medicine. “Almost certainly in the next major outbreak [the] main route of transmission will be respiratory.”
There are seven types of human coronaviruses, which can cause respiratory illness; for some people, it can be as simple as the common cold, while others are much more serious.
Covid-19, which was categorised as a pandemic in 2020, has killed millions of people around the world.
Is the world prepared for another pandemic?
Professor Marks doesn’t think so due to the underfunding of the WHO and the lack of investment in health infrastructure in countries like the DRC, which means that there are repeated outbreaks of diseases, such as Ebola.
Members of the Covid-19 Bereaved Families for Justice hold placards and pictures of loved-ones who died during the pandemic as they gather outside Dorland House during the final hearings of the Covid inquiry earlier this month (Photo: Wiktor Szymanowicz/Getty)However, Dr McCabe says that with every outbreak, the world is getting better at responding to infectious diseases.
“Even in the last couple of weeks, all of the knowledge that’s been accumulated responding to Hantavirus, and now even just in the past 48 hours, the additional knowledge of responding to this new Ebola outbreak, every single time that we have something like this, we learn a bit more and it makes us more prepared,” she says.
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