The World Health Organization has determined that the current outbreak of Ebola disease caused by Bundibugyo virus in the Democratic Republic of the Congo (DRC) and Uganda constitutes a public health emergency of international concern (PHEIC), but does not meet the criteria of a pandemic emergency. This conclusion was announced in a statement on 17 May.
The outbreak meets the criteria of the definition of PHEIC, for several reasons.
Firstly, as of 16 May, there have been eight laboratory-confirmed cases, 246 suspected cases and 80 suspected deaths in Ituri Province of the DRC, as well as two laboratory-confirmed cases (including one death) in Kampala, Uganda, in individuals travelling from the DRC. In addition, unusual clusters of deaths with symptoms compatible with Bundibugyo virus disease (BVD) have been reported across several health zones in Ituri, as well as four deaths among healthcare workers suggestive of viral haemorrhagic fever.
At present, there are significant uncertainties as to the true number of infected persons and geographic spread associated with the outbreak, but the high positivity rate of the initial samples collected and the confirmation of cases in Kampala, as well as trends in the reporting of suspected cases across Ituri Province, indicate a potentially much larger outbreak that what is currently being detected and reported.
Confirmation of the two cases in Uganda strongly indicates a public health risk through the international spread of disease, WHO says. Countries sharing a land border with the DRC are considered at high risk for further spread as a result of population mobility, trade and travel linkages, and continuing epidemiological uncertainty. International coordination and cooperation are vital to understand the extent of the outbreak, coordinate surveillance, prevention, and response efforts, scale up operations, and to ensure implementation of control measure.
WHO advice to countries where the outbreak is occurring includes:
- establishing a national emergency operation centre to coordinate BVD control, including improved surveillance, infection prevention and control (IPC), risk communication, laboratory testing, and case management;.
- establishing dedicated surveillance cells, enhancing community surveillance, and decentralising laboratory testing for Bundibugyo virus in affected and neighbouring provinces, and strengthening measures to prevent hospital-acquired infections;
- implementing clinical trials to advance the development and use of candidate therapeutics and vaccine, supported by partners and;
- implementing cross-border and internal screening, including exit screening at airports, seaports, and land crossings, for Bundibugyo virus disease.
For countries that have land borders with the DRC or Uganda, WHO advises active surveillance across health facilities and establishing access to a qualified diagnostic laboratory. Any country detecting a suspected or confirmed Bundibugyo virus disease case or contact, or clusters of unexplained deaths, should treat it as a health emergency and take immediate steps to investigate and halt a potential outbreak. If BVD is detected, the same measures as for countries where the outbreak is already confirmed should be implemented, and the outbreak reported to WHO. Public information, especially at points of entry, should be increased, and approvals for investigational therapeutics should put in place as a priority.
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