Ebola Virus in DR Congo: CDC Not Ready to Issue Travel Advisory

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British health workers lift a newly admitted Ebola patient onto a wheeled stretcher in to the Kerry town Ebola treatment centre outside Freetown December 22, 2014. Ebola is back, this time in the Democratic Republic of Congo. Baz Ratner/REUTERS

Updated | The U.S. Centers for Disease Control and Prevention (CDC) is still mulling over whether to issue a travel advisory regarding the developing Ebola outbreak in the Democratic Republic of Congo. When asked whether the agency planned to recommend restricting travel to the country and surrounding regions, a spokesperson from the CDC told Newsweek “not at this point.”

The agency says several factors are considered when deciding on the timing of a travel advisory, “including the size of the outbreak and number of people infected. As we learn more that will guide the decision to issue an advisory or not,” the CDC spokesperson added. "It comes down to risk/threat assessment and so far risk does not warrant advisory."

So far there are 29 suspected or confirmed cases of Ebola in the DR Congo, and at least three confirmed deaths, according to the World Health Organization (WHO). Earlier this week there were rumors as well that one suspected case of the virus cropped up in South Sudan at the border of DR Congo. On Friday, WHO confirmed through lab testing that there are no cases of Ebola outside the DR Congo. 

However, if Ebola were to spread outside of the country it might mean an alarming start to a larger outbreak that will likely continue for some time, says Dr. Daniel Lucey, a spokesperson for the Infectious Diseases Society of America, an Ebola expert and senior scholar with the O'Neill Institute for National and Global Health Law at Georgetown University. Lucey says the 2014 epidemic in West Africa that sickened 28,646 and killed 11,323 as of March 2016, taught us that the virus becomes more difficult to contain once it shows up in a new country.  That outbreak which was said to begin in Guinea spread in a matter of months to Liberia and Sierra Leone.

“The crossing of borders means you have to have a regional response and not just a national response. It adds another layer,” says Lucey. Handling any outbreak of an infectious disease takes huge coordination between public health officials, health care workers, local governments and international organizations. “That can be hard to do for one country, but then you have to do it for two or three it’s a new level of complexity.”

Health officials confirmed the first case in the DR Congo on April 21, which is in a remote area in the province of Bas-Uele in the northeastern part of the country. “It’s a huge human and logistical challenge. Affected populations are located in areas only reachable by helicopter or by moto-bike,” Dr. Nafissa Dan-Bouzoua, the medical manager in the DR Congo for the Alliance for International Medical Action, told Newsweek.

The WHO still has yet to issue any travel restrictions or advisories to the DR Congo. Because the area is remote the WHO has deemed the risk assessment for this event is “high” at the national level, medium at the regional level and low at the global level. There have been two previous Ebola outbreaks in the DR Congo, according to the WHO. One occurred in 1976. The second, in 2014, killed 49 people.

However, some countries are choosing to take precautions. According to the WHO, as of May 18, seven countries have enforced entry screening at airports and ports of entry. These include Kenya, Nigeria, Rwanda, South Africa, the United Republic of Tanzania, Zambia and Zimbabwe. Rwanda issued a travel advisory strongly recommending against travel to the DR Congo. The United Kingdom also recommends against traveling in the areas around the epicenter of the epidemic. Two countries (Kenya and Rwanda) implemented information checking arrival for passengers with travel history from and through the DR Congo. According to Mashable NG, the government in Liberia issued orders to screen all arriving passengers at Murtala Muhammed International Airport.

WHO did confirm that reports from earlier this week of a border closure by South Sudan were false. However, as a precaution earlier this week, South Sudanese officials began to set up medical support services at the border, particularly the airport in Juba and border-crossing checkpoints.

Though Ebola isn't currently in South Sudan, officials are still on high alert for a potential Ebola outbreak, especially because outbreaks have occurred there in the past: In 2004, the WHO confirmed 20 cases, including five deaths from Ebola, were in Yambio County in southern Sudan.

Last month, South Sudanese health officials became concerned when more than two dozen people fell ill with symptoms of bloody diarrhea (a common symptom of Ebola). However, the rush of illnesses were suspected to be linked to dysentery caused by the bacteria Shigella.

Symptoms of Ebola include fever, headache, muscle pain. At a later, acute phase some patients have internal bleeding that causes vomiting or coughing up blood. The virus has between a 20- and 90-percent fatality rate based on the public health reponse.

Addressing an Ebola outbreak requires setting up temporary medical facilities that adhere to certain regulations. It takes the local on-the-ground work of epidemiologists and other public health care personnel who are familiar with the arduous process of contact-tracing needed to stop the train of transmission. The WHO reports there are some 400 people who were likely to have been exposed to people who have the virus in DR Congo, and that means locating each and every one of them to monitor their health and test them for the virus.  Lucey is confident this won’t be the end of contact-tracing: “I would predict that in another couple days there will be more than 400 contacts.”

Meanwhile, the WHO is awaiting a greenlight from the DR Congo health and regulatory agencies to import a supply of an experimental Ebola vaccine, produced by Merck and known as rVSV-ZEBOV.  According to a study conducted in 2015 in Guinea that involved 11,841 people, the vaccine can prevent illness in people who have been exposed to the virus. But Lucey says researchers still aren’t completely certain how long the vaccine remains effective once a person receives it. 

Updated: This story has been updated to reflect information from the WHO stating there are no longer any lab-confirmed or suspected cases of Ebola in South Sudan, or on the border of DR Congo.