DRC Ebola outbreak contained but Guinea’s simmers - long virus life demands vigilance

With no more confirmed cases and the discharge of the last Ebola patient from a health centre in Katwa city on Monday, the latest outbreak of Ebola virus in the Democratic Republic of Congo may now have ended.

However, global health officials warn that vigilance needs to remain high.  That is particularly true, in light of the recent evidence that the Guinea outbreak was apparently triggered by an Ebola survivor who carried the virus unknowingly for five years before transmitting it to someone else.

The Republic of Guinea was one of the countries at the center of West Africa’s Ebola virus epidemic that raged from 2013-2016 claiming 11,000 lives.  The DRC faced a major outbreak in 2018, that concluded a year later, but has been followed by others. During the most recent DRC outbreak in February, 12 cases were confirmed leading to six deaths – while 1,737 people were vaccinated against the virus, according to the WHO – with IFRC teams on the ground providing key support.

The last #Ebola patient in #DRC🇨🇩 was discharged from a treatment centre in Katwa yesterday!

With no more confirmed Ebola cases, a 42-day countdown to declaring the end of DRC's Ebola outbreak begun just 37 days after the resurgence of the virus. pic.twitter.com/vfOBUrrBrV

— WHO African Region (@WHOAFRO) March 23, 2021

“The main objective of the Red Cross’ intervention on the ground, over the past two years or so, is to ensure Ebola is contained, and does not spread to other areas and across borders into countries such as South Sudan and Rwanda,” Dr Balla Conde, who is managing the IFRC response on the ground with a team of 100 health workers, told Geneva Solutions.

In the case of the Guinea, the outbreak declared on 14 February 2021 in the N’Zerekore region is another nexus of grave concern. As of 19 March, 14 cases of Ebola were confirmed in Guinea, including five deaths and eight recoveries with an additional four probable cases.

Read also: West African countries on high alert after deadly Ebola resurgence in Guinea

Patient “O” in 2021 Guinea outbreak harbored the virus for five years. Meanwhile it is believed that a single Ebola survivor of that last West African epidemic may have also triggered the current outbreak in Guinea.

The new research findings hold serious implications for the longevity of one of the world’s most deadly pathogens

The discovery made was in the course of contact tracing and genetic sequencing of virus strains in Guinea’s present-day patients, which linked those cases to a recovered patient and strains prevalent in 2014, according to three independent studies released. Given the lengthy interval between the two events this comes as a “shock” to virologists.  It had been previously believed that the outbreak was transmitted by an animal such as a bat.

“This is truly mind-blowing,” Dr Angela Rasmussen, a virologist at Georgetown University in Washington DC, wrote on Twitter. “The implications for controlling Ebola are extremely worrisome.”

Previously, the longest reported duration of virus persistence in an Ebola virus disease (EVD) survivor was 531 days, in 2016. Researchers reported the case of the 56-year-old survivor whose seminal fluid contained the virus 17 months after the onset of the disease. It was claimed this person had sexually transmitted the virus 470 days after the onset of his symptoms, triggering further cases in Guinea-one of whom was carried back to Liberia.

While it is rare for survivors to harbour and transmit the virus after such a long period, scientists now understand that the virus can remain in the body for a sustained period of time in places such as the eyes, spinal cord and testes - which are not easily reached by immune defences.

Naomi Nolte, IFRC emergency communication coordinator, called the new research findings “worrying” - although she emphasised that the findings remain preliminary.

The overriding message, she said, is that people must “remain vigilant, keep physical distancing, disinfect spaces and ensure that people have all the right information.”

Potential for EVD sexual transmission could stigmatise Ebola survivors. Reports linking some of the episodes of virus resurgence to sexual transmission could wind up stigmatising  Ebola survivors, warned Gwen Eamer, public health expert in emergencies at the IFRC.

“Although the findings of the virus sticking around for a long time may be true, it is important that we do not jump to conclusions that it is due to sexual transmission as this has very real impacts on survivors,” said Eamer.

Surveillance key to containment. Meanwhile, IFRC officials said that they are supporting local health systems by building capacity for community-based disease surveillance. In these cases, trained community volunteers seek out and report cases of people whose symptoms appear to meet EVD definitions, and take blood samples to confirm suspected cases.

Such training is vital as many common illnesses, including influenza, malaria, typhoid and cholera have similar symptoms of vomiting, and fever to Ebola.

Another pillar of preparedness is ensuring safe and dignified burials - since the Ebola virus is also very easily transmitted after the person has died of the disease.

“We know from the previous outbreak in Guinea and neighbouring countries that burials and funerals were key drivers of transmission, because of traditional burial practices that involve touching the body,” said Eamer.

To ensure “safe and dignified burials, we provide the team with personal protective equipment,” said Eamer, adding that the teams actively support the family, while “adapting funeral rituals ensuring that the dignity of the deceased remains intact, taking into account the mental health, social, cultural and religious perspectives.”

There is a higher level of trust today between communities and Red Cross field workers - something that represents a very positive shift from the 2013-2016 Ebola epidemic - and makes it easier for the organization to do it’s work, adds Nolte.

She adds that Covid-19 also has highlighted to policymakers the importance of preparedness for other highly contagious viruses, e.g. Ebola, which pose “perpetual” threats to countries’ economies and societies.

However, the new research findings have also renewed calls for more widespread EVD immunisation campaigns across larger parts in West and Central Africa.

That would require more funding, including some 8.5 million Swiss francs that the Red Cross says it needs for the Ebola response - which has only garnered less than a one million so far.

“We really don't want to wait for another humanitarian shock like we had during the last outbreak in Guinea in 2013-2016 or are in DRC between 2018 and 2020,” said Nolte.

Images taken by Naomi Nolte IFRC emergency communication coordinator. Nzérékoré, 5 March - 16  March 2021.