As Ebola Bundibugyo outbreak rages, knowledge gaps still challenge response

LONDON, June 25 - As scientists race to understand the growing Ebola Bundibugyo outbreak in Democratic Republic of Congo, medics say knowledge gaps are still hampering detection and care for sick patients.

Since the outbreak was declared in mid-May, Congo’s government has reported more than 1,100 cases and almost 300 deaths, by far the biggest outbreak of the Bundibugyo strain of Ebola to date. There have also been 20 confirmed cases and two deaths in neighbouring Uganda.

“We’re facing an outbreak… that we’re just, to be honest, beginning to understand,” World Health Organization emergencies director Chikwe Ihekweazu told a press conference on Wednesday. There have only been two previous outbreaks, in Uganda in 2007 and Congo in 2012, which caused roughly 200 cases.

Ebola Bundibugyo is distinct from the better-known Ebola Zaire, which caused the largest-ever outbreak in West Africa in 2014 to 2016. But it is part of the same family of filoviruses and causes similar symptoms, including fever, vomiting and diarrhea, and sometimes bleeding.

LESSER-KNOWN THREAT

The current outbreak was found late because the most common tests detect Zaire, not Bundibugyo. And unlike for Zaire, there are no vaccines or treatments to help tackle it, although treatment trials start next week.

The lack of data on how to spot the disease is still causing problems, Congolese officials and doctors said, particularly because the early symptoms are also common in other diseases like malaria, and seem to start mildly for Bundibugyo, meaning people may delay seeking care.

“For those at [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% patients at an advanced stage,” said Abdou Sebushishe, a senior adviser at the International Medical Corps in eastern Congo, which runs several Ebola treatment centres.

Bleeding is also linked to later stages of Ebola, particularly in the minds of the community who experienced the Zaire outbreak in the same region of Congo in 2018 and 2019, said Dr Emmanuel Musingusi Bulemu, a Congolese health official investigating cases in the Nizi area of Ituri Province, the worst-hit region.

Around 40% of Ebola patients experience bleeding, according to United States Centers for Disease Control and Prevention estimates.

But there are early signs bleeding is less common in this Bundibugyo outbreak, according to the WHO and evidence published by scientists at Congo’s National Institute for Biomedical Research on Wednesday evening. They found only 10% of people experienced the symptom, among 505 confirmed cases studied.

“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,'” said Musingusi. “That perception strengthens resistance to the response efforts.”

Resistance and violence against Ebola responders have limited efforts to contain this outbreak.

SAME STEPS STILL KEY

Some scientists said that despite the differences between the Ebola outbreaks, similar measures were needed, including testing, isolating and treating patients.

"It's the same things," said 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, pointing out the challenges of responding in a conflict-hit region. "Without peace I fear we will not stop this (outbreak)." REUTERS