A public health emergency of international concern differs from a pandemic in that it involves disease spread across international borders but remains geographically concentrated, as demonstrated by the WHO's declaration of the Ebola outbreak in the Democratic Republic of Congo (246 suspected cases, 80+ deaths) which is confined to East Africa despite crossing borders between DRC, Uganda, South Sudan, and Rwanda. The Bundibugyo virus strain, unlike the Zaire strain which has FDA-approved vaccines, currently has no approved drugs or vaccines, making supportive care critical for treatment. Effective outbreak control requires coordinated regional responses including contact tracing, temperature screening at ports, and community education to encourage healthcare-seeking behavior rather than relying on religious interventions.
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W.H.O Declares New Ebola Cases In DR Congo An International EmergencyAdded:
Hello and thanks for joining us. Welcome to the program. I am Precious and I I will start here in Africa with an emergency. The World Health Organization has declared the Ebola outbreak in the Democratic Republic of Congo a public health emergency of international concern.
The organization says the outbreak currently affecting the eastern Ituri province of the DRC Congo has recorded about 246 suspected cases and more than 80 deaths.
Early symptoms of Ebola include fever, muscle pain, fatigue, headache, and sore throat, which may later progress to vomiting, diarrhea, rash, and internal or external bleeding. According to the WHO, the current strain of Ebola is caused by the Bundibugyo virus, and there are no approved drugs or vaccines.
WHO warned that the outbreak could grow far beyond the cases presently identified and reported and reported, raising concerns over possible local and regional transmission.
And joining us via Zoom from Abuja is Vice President of Medical Initiative for Africa, Dr. Akudo Ikemba. Good to have you join us, Dr. Ikemba.
Thanks for having me.
A public health emergency of international concern is how the WHO describes this particular outbreak, but says it does not meet a pandemic criteria.
I wanted you to speak to the difference between both and how far long do we have before it becomes a pandemic?
Uh the key difference is that you don't have many countries involved, but it has crossed international borders that are contiguous. And then the number of patients also involved. But if you look at the current outbreak, the current outbreak is mainly in East Africa and the countries involved have been restricted to East Africa, principally starting from Bunia to Mbandaka, which is within the DRC. And then spreading from there to Kampala and then obviously, also spreading to Kinshasa and Goma area and South Sudan.
So, all of these are still restricted within the East East African region. And again, some of these states, even if they are in two different or three different countries, typically just a day or a bus ride away from each other. And these are These are locations that are contiguously integrated because mining activities uh require people moving around these regions, yeah.
And I want to get to, you know, just the population movement in that area in a moment, but does it seem like for this particular outbreak that we are perhaps you know, walking it back to the past or rather that you know, cases there's been a lot of transmission and now they're trying to walk it back to the present. And not necessarily starting from the present to see how it spreads.
Yeah, in a way, the Bundibugyo um virus is actually hasn't really been at play for a while since 2027 20 2007.
The last two major outbreaks we had in 2014 and 2018 respectively were driven by the Zaire strain principally. So, the Bundibugyo virus hasn't really been at play. But more importantly, also when it was first at play, it only affected two countries, DRC and um and Uganda. And they were basically well contained. The only challenge in this current situation is that it has now gone to South Sudan and it has gone to a city called Goma. A city has with an international airport and it's quite contiguous to Rwanda. So, you have countries like Tanzania, Rwanda, Uganda, DRC, South Sudan, and obviously Kenya all within that region. And if you contextualize that, because of the increased population movement, obviously, there's a risk. But these these regions have strong history in control of hemorrhagic disease diseases like this. I mean, they are they have In the past, they have actually gained a lot of experience in controlling diseases like this. So, I I think we do not need to panic.
There is hope, but there's been significant international response. The WHO has mobilized funds, and I think has sent as much as 500,000 USD as initial emergency contingency funds for basic equipments for basic personal protective equipments and medications and mobilizing critical human resource to this area. So, we expect positive outcomes, but we should not let our guards down.
I will get to them cuz you're making a lot of critical points. I want to start with the with not the hope. Um the idea of hope. This is the 17th outbreak so far. Um but this particular strain has no vaccine. And how concerned should people be, and how good are we now in terms of picking picking up signals?
Okay, yes. You're you're absolutely right.
It has no vaccine, and it has no particular medication. As opposed to the Zaire virus, which we already have two an FDA-approved vaccine. And we also have what we call monoclonal antibodies that can be used specifically to treat.
So, in the case of the particular virus, we do not have vaccine. But what do we need to do? The advantage we do have now is that it has a significant incubation period of 2 days to 21 days. But more importantly is that when patients Patients do not typically transmit this infection until they are symptomatic.
Unfortunately, the commonest symptoms is fever, body aches, headaches, nausea, vomiting, and all of those things. And tip In the first instance, you you may suspect malaria. But it's important to have a high index of suspicion, especially for patients who have unusual symptoms like bleeding. But, we must put in place measures to to to monitor people with temperature, screen them properly, especially their travel history, and have protocols in place to mobilize resources that are required for supportive care. Because, since we do not have treat particular treatment for this condition, supportive care is critical. For patients that are vomiting, you give them antiemetics. For patients who are dehydrated from diarrhea and long chronic acute severe vomiting, you can give them fluids. Patients who have temperature, you you control that. But, also, you must isolate these patients and prevent transmission. Because, inasmuch as in places like DRC, where one of the delicacies they enjoy is the the the the fruit bat, and the fruit bat is principally responsible. You need to be able to talk to people around that area.
I mean, we've been talking to them for a while, but they seem not to be in interested in in discarding that particular delicacy, which is the major means of transmission to humans. But, once it gets to humans, once we start interacting at close contact with people that are infected, from saliva to sweat, to body fluids, seminal fluids, and all kinds of body fluids, the transmission is very very significant and high.
So, you you talked about the incubation period being 2 to 21 days.
It sounds like a good sign, but it is also concerning because you add that to the fact that these areas are very densely populated. There is heavy population movement, and especially in the place like DRC, where you also have armed groups involved in fighting there. I'm wondering how complicated all of this makes contact contact tracing.
I mean, you you are absolutely right again.
In a place like Kinshasa uh where you have uh I mean a population of almost as much as 18 million people and you go to uh Kampala where you have 2 million people, 1.8 million people or thereabouts.
And uh with the flow of patients all the way from places like Bunia and Mungwala and Bento, all these areas, there's a lot of mining activities going on there.
So, people travel from maybe Kinshasa and from uh Kampala all across the border and come for mining activities for a couple of days and if they're infected, they can't take it. So, that is significant. Another thing obviously that you pointed out is the security situation. We have the M23 always in conflict with the the Congolese army and with some suspected support from some international countries that have interests around that area. So, that has disrupted what uh to the limits we can do in terms of health intervention, organized health system, but it and has created a hiatus. All of these are challenges, but we do have some strengths. I think in that region with uh Ebola is a very uh endemic condition.
The health care workers there have significant experience with managing Ebola outbreaks. What we need to do is to mobilize resources to support them.
Another key factor that needs to be strengthened obviously is what the population knows. Some of the patients that died in that region actually when they develop symptoms and were suspected to be Ebola patients, did not go to the hospital or health facility. They went to religious organizations and uh opted for spiritual interventions and in the absence of supportive care for fluid loss, for vomiting and all of those things, patients would die of conditions that they they probably would not have died of. So, we need to communicate strategically to let people know that look, if you have these symptoms, you go to the health care facility around that area. More importantly, we can also cut transmission from the point where people would eat bats, we would need to cut that transmission of that. And there may need to be a regional effort that involves Rwanda, uh DRC, Uganda, and of course Tanzania, and South Sudan that will allow an integrated regional response that improves regulation of people movement, uh port port authority interventions that allow temperature checks, uh procedures and structure and frameworks for isolation of patient, early testing of patient, and confirmation of people who have Ebola, and the institution of center a structure treatment in centers where you have people who have the training to offer the supportive care. It's also important that as you pointed out, contact tracing is put in place. And what is contact tracing? You simply need to put these people in restricted areas, even if it's in their homes, a room in their home where you can monitor them, check temperatures on a daily basis. And at the point these people develop temperature, you must be able to move on to what? Screening. To but when you have when you discuss all of these and you realize that Nigeria is about well, Abuja is about 3,700 to 2,600 >> And and Dr. Eko, I was going to ask you but I have a few seconds left. I was I was going to ask you because the WHO is saying, "Look, countries should not shut down borders. No one should panic." But when you also consider, you know, some of the things you have said, what sort of mechanisms can countries begin to put in place to ensure that it doesn't spread for that, especially for Africa?
Well, because of time, we'll focus on the key thing is port health. For example, in the case of Nigeria, we see about a traffic of about 8,000 to 20,000 East Africans coming in by air to Nigeria.
So, if you look at that number, they're coming through Ethiopian Airlines, Rwanda Airlines, Kenyan Airlines, and a few other airlines, and some private jets. All the populations that come in should be screened at the port. And when they are screened at the port, entry, land, sea, air, as the case may be. If they have temperature or if they have a travel history that is significant, they should be able to have a procedure that allows them to be isolated and tested early to confirm. But I'm sure that Dr. Chikwe Ihekweazu at the Nigerian Centre for Disease Control, I mean, he is a fantastic public health physician and I'm sure he will put measures in place.
Well, we're following developments. I'm sure that you are, too. And as things progress, we'll continue to have this conversation with you.
Vice President, Initiative for Africa, Dr. Ihekweazu, thank you so much for your time.
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