In a race against time, scientists are striving to comprehend a surging outbreak of the Ebola Bundibugyo strain in the Democratic Republic of the Congo. Medical professionals warn that significant knowledge gaps are impeding the identification and treatment of affected individuals.
Since the outbreak’s declaration in mid-May, over 1,100 instances and nearly 300 deaths have been reported by the Congolese government, marking the largest outbreak of the Bundibugyo strain recorded to date. Meanwhile, Uganda has confirmed 20 cases and two deaths across the border.
“We’re facing an outbreak that we are, to be honest, only just beginning to understand,” expressed Chikwe Ihekweazu, the World Health Organization’s emergencies director, during a Wednesday briefing.
There have been only two prior incidences of the Bundibugyo strain: one in Uganda in 2007 and another in Congo in 2012, collectively accounting for approximately 200 cases. While differing from Ebola Zaire, which led to the West African epidemic from 2014 to 2016, Bundibugyo is part of the same filovirus family and results in similar symptoms such as fever, vomiting, diarrhea, and occasionally, bleeding.
Lesser-known threat
This outbreak went undetected initially because standard tests are tailored for Ebola Zaire, not Bundibugyo. Unlike its Zaire counterpart, Bundibugyo lacks vaccines and approved treatments, although clinical trials are slated to commence next week.
The scarcity of data regarding detection is posing challenges, state Congolese officials and doctors, as initial symptoms also mimic other diseases like malaria. These early symptoms appear milder in Bundibugyo cases, leading to delays in seeking medical attention.
“For those in the early stage of the disease, it looks milder than Zaire, and I believe that is one of the reasons we are seeing more than 50% of patients at an advanced stage,” noted Abdou Sebushishe, a senior adviser at the International Medical Corps in eastern Congo, where multiple Ebola treatment centers operate.
Bleeding tends to occur in the later stages of Ebola and has become notably associated with past Zaire outbreaks in the same region in 2018 and 2019, stated Dr. Emmanuel Musingusi Bulemu, a Congolese health official investigating cases in Ituri province’s Nizi area, the hardest-hit region.
About 40% of Ebola patients experience bleeding, according to estimates by the U.S. Centers for Disease Control and Prevention.
Early indicators suggest that bleeding is less prevalent in the Bundibugyo outbreak, according to the World Health Organization and research published by the Congo’s National Institute for Biomedical Research. Evidence from 505 confirmed cases revealed that only 10% exhibited this symptom.
“As a result, people in the community say, ‘Before, it was bleeding. We haven’t seen any bleeding in our sick relative, so you’re lying to us,’” Musingusi explained. “That perception strengthens resistance to response efforts.”
Resistance and violence against Ebola responders have hampered efforts to manage the outbreak.
Same steps still key
Despite different Ebola strains, experts assert that the foundational response measures remain vital, including testing, isolating, and treating patients.
“It’s the same things,” remarked Peter Piot, professor at the London School of Hygiene and Tropical Medicine and a co-discoverer of Ebola Zaire.
“But I have never seen this many cases this quickly,” he added, illuminating the complexities of responding in a conflict-ridden area. “Without peace I fear we will not stop this outbreak.”
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