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Ebola

In the Democratic Republic of Congo, we are currently responding to the second-worst Ebola outbreak in history

Ebola is one of the world’s most deadly diseases.

It is a highly infectious virus that can kill up to 90 percent of the people who catch it, causing terror among infected communities.

Ebola is so infectious that patients need to be treated in isolation by staff wearing protective clothing.

Congo Ebola outbreaks, 2018-19

Map of MSF's Ebola response in northeast DRC
Current outbreak: northeast congo

Ebola has now killed more than 1,300 people in the Democratic Republic of Congo (DRC) as the outbreak in the northeast of the country continues.

With a total of 2,071 cases and 1,396 deaths, as of 10 June 2019, this is the second worst Ebola outbreak in history - following the 2014 West Africa epidemic.

On 1 August 2018, we first began responding to an Ebola outbreak in North Kivu province in the northeast of the country – a region recently characterised by violence and instability. The outbreak has since spread to neighbouring Ituri province, to the north.

The epicentre of the outbreak has moved multiple times. Beginning in the town of Mangina, the outbreak spread to the larger city of Beni, with cases now in hotspots around Butembo and the rural area of Katwa.

New cases

A serious concern is that 82 percent of new Ebola cases in the region cannot be linked to previously known chains of transmission - for example, a new patient may have had no contact with someone already known to have had the disease.

Worryingly, this highlights that although the number of new Ebola cases being reported is high, the real number is likely to be even higher.

North Kivu's proximity to neighbouring Uganda also presents a risk of international spread, with regular trade and traffic across the border.

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Stopping the spread

Since the beginning of the outbreak, the Congolese Ministry of Health has followed up with thousands of people who have been in contact with Ebola patients as part of a reactive vaccination campaign.

So far, 132,264 people have been vaccinated against the disease, including over 5,100 health workers.

To support this, we are also reinforcing health promotion and community engagement teams to help prevent and control the spread.

Violence against healthcare

The response in North Kivu is the first time that MSF has faced an Ebola outbreak in a conflict zone, making our ability to limit the spread of the disease more challenging.

In February 2019, MSF was forced to suspend medical activities at Ebola treatment centres in Katwa, Butembo, Biena and Biakato following successive violent attacks on the facilities. This followed an escalation of tensions around the international Ebola response.

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At several times, contact vaccination campaigns have been temporarily suspended because of threats to the safety of healthcare teams.

The security situation is also discouraging people from seeking care at treatment centres in the first place, increasing the risk of spreading the virus.

Latest: 11 April - Ebola: Running behind the outbreak >

The Equateur outbreak

Between May and July 2018, MSF teams ran a three-month-long emergency intervention in Equateur Province of the Democratic Republic of Congo (DRC) to respond to the Ebola outbreak.

Congolese Ministry of Health teams supported by MSF in Bikoro, Itipo, Mbandaka and Iboko, provided care to 38 confirmed patients, 24 of whom survived and returned to their homes. Sadly 14 people died. 

Map of MSF's Ebola activities in northwest DRC

A total of 3,199 people were vaccinated against Ebola with the investigational Ebola vaccine rVSVDG-ZEBOV-GP under WHO’s Expanded Access Framework by teams from MSF, WHO and the Congolese Ministry of Health.

MSF teams alone vaccinated some 1,673 people in the Bikoro and Itipo areas, including the contacts of confirmed Ebola patients and their contacts, and frontline workers considered to be most at risk of contracting the virus.

MSF ended the response on 2 July 2018, and the outbreak was officially declared over on 24 July.

Help us respond to future outbreaks >

West Africa Ebola outbreak, 2014-16

The Ebola outbreak in West Africa killed 11,315 people after being officially declared on 22 March 2014 in Guinea.

During the Ebola emergency, 28 of our staff members caught Ebola. Fourteen recovered but 14 died.

The vast majority of these infections were found to have occurred in the community.

On 22 December 2016, the results of an experimental Ebola vaccine trial were released by the Lancet. The trial found the vaccine to be highly effective in protecting people against the Zaire strain of Ebola.

“This vaccine will be a powerful tool to help prevent the spread of the Zaire strain of Ebola and to protect health workers," said MSF President Dr Bertrand Draguez. 

"MSF will try to make use of it in any future outbreak of the disease. More research is still needed to determine the length of protection that it offers to people and into vaccines for other strains of Ebola. Progress also still needs to be made in improving the treatment of patients once they are infected with Ebola, to make sure more lives can be saved.”

Ebola management: interactive guides

Hover over the image below for an interactive guide to Ebola

Prior to the 2014 outbreak, it is estimated there had been over 1,800 cases of Ebola, with nearly 1,300 deaths.

Ebola history

The Ebola virus was first associated with an outbreak of 318 cases of a haemorrhagic disease in Zaire (now the Democratic Republic of Congo [DRC]) in 1976. Of the 318 cases, 280 died — and died quickly.

That same year, 284 people in Sudan also became infected with the virus, killing 156.

There are five different strains of the Ebola virus: Bundibugyo, Ivory Coast, Reston, Sudan and Zaire, named after their places of origin.

Four of these five have caused disease in humans. While the Reston virus can infect humans, no illnesses or deaths have been reported.

Before the 2014 outbreak, MSF had treated hundreds of people affected by Ebola in UgandaRepublic of Congo, DRC, Sudan, Gabon and Guinea

In 2007, MSF entirely contained an epidemic of Ebola in Uganda by placing a control area around the treatment centre.

What causes Ebola?

Ebola can be caught from both humans and animals. It is transmitted through close contact with blood, secretions, or other bodily fluids.

Healthcare workers have frequently been infected while treating Ebola patients. This has occurred through close contact without the use of gloves, masks or protective goggles.

In areas of Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found dead or ill in the rainforest.

Burials where mourners have direct contact with the deceased can also transmit the virus, whereas transmission through infected semen can occur up to seven weeks after clinical recovery.

Hear more stories from our staff on the MSF podcast, Everyday Emergency

Symptoms of Ebola

Early on, symptoms are non-specific, making it difficult to diagnose.

The disease is often characterised by the sudden onset of fever, feeling weak, muscle pain, headaches and a sore throat. This is followed by vomiting, diarrhoea, rashes, impaired kidney and liver function and, in some cases, internal and external bleeding.

Symptoms can appear from two to 21 days after exposure. Some patients may go on to experience rashes, red eyes, hiccups, chest pains, difficulty breathing and swallowing.

MSF UK doctor Javid Abdelmoneim reflects on his time battling Ebola in Sierra Leone in this powerful and painful TEDxAthens talk 

Diagnosing Ebola

Diagnosing Ebola is difficult because the early symptoms, such as red eyes and rashes, are common.

Ebola infections can only be diagnosed definitively in the laboratory by five different tests.

Such tests are an extreme biohazard risk and should be conducted under maximum biological containment conditions. A number of human-to-human transmissions have occurred due to a lack of protective clothing. 

“Health workers are particularly susceptible to catching it so, along with treating patients, one of our main priorities is training health staff to reduce the risk of them catching the disease whilst caring for patients,” said Henry Gray, MSF’s emergency coordinator, during an Ebola outbreak in Uganda in 2012. Henry also worked on the 2014 outbreak. 

“We have to put in place extremely rigorous safety procedures to ensure that no health workers are exposed to the virus – through contaminated material from patients or medical waste infected with Ebola.”

Treating Ebola

No specific treatment or vaccine is yet available for Ebola.

Standard treatment for Ebola is limited to supportive therapy. This consists of hydrating the patient, maintaining their oxygen status and blood pressure and treating them for any complicating infections.

Despite the difficulty of diagnosing Ebola in its early stages, those who display its symptoms should be isolated and public health professionals notified.

Supportive therapy can continue with proper protective clothing until samples from the patient are tested to confirm infection. Once a patient recovers from Ebola, they are immune to the strain of the virus they contracted.

An Ebola outbreak is officially considered at an end once 42 days have elapsed without any new confirmed cases.

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