Health Professionals

Clinical Updates

20 August 2012

Ebola haemorrhagic fever: Democratic Republic of Congo

On 17 August 2012, the World Health Organization (WHO) was informed of confirmed cases of Ebola haemorrhagic fever by the Ministry of Health, Democratic Republic of Congo (DRC).  Cases and deaths have been reported from Isiro (nine cases, five deaths) and Dungo (one fatal case) health zones in Province Orientale, Eastern DRC.  The diagnosis of Ebola (Bundibugyo serotype) was confirmed in two patients by the Uganda Virus Research Institute [1]. This is the first report of this serotype in DRC (the serotype was first identified in an outbreak in Bundibugyo district, Uganda in December 2007) [2].

The Ministry of Health, DRC has convened a National Task Force in response to this outbreak. Other organizations, including WHO, US Centers for Disease Control and Prevention and Médecins Sans Frontières are assisting in the investigation and management of the outbreak.  Control activities include surveillance, case finding and contact tracing and education reinforcing infection control measures [1].

There is no evidence to suggest that this outbreak is linked to the current outbreak in Kibaale district of western Uganda in which eleven cases have been confirmed as Ebola Sudan serotype [3].

Ebola is known to occur in DRC [4-6]; the previous most recent outbreak, in Mweka and Luebo Health Districts, Province Kasai-Occidental was declared over in February, 2009 [6].

Ebola haemorrhagic fever

Ebola haemorrhagic fever is a severe disease caused by a virus of the Filoviridae family. There are five serotypes of Ebola virus, of which four have caused disease in humans: Ebola Zaïre, Ebola Sudan, Ebola Côte d’Ivoire, and Ebola Bundibugyo [7].  The natural reservoir for Ebola is not known, but non-human primates can become ill with Ebola [8].

Following an incubation period of four to 10 days (range two to 21 days) illness presents with the sudden onset of fever, headache, joint and muscle aches, and weakness. As the infection progresses, nausea, vomiting and diarrhoea, shortness of breath, confusion, and haemorrhage can occur.

This can lead to multi-organ failure, shock, and death. Ebola is transmitted via direct contact with the bodily fluids of an infected person. Ebola has also been reported following contact with the tissues of infected animals.

Advice for travellers

The risk to a traveller of contracting Ebola is very low in the absence of direct contact with the blood or body fluids of an infected person, animal, or objects, such as needles, that have been contaminated with blood or body fluids. There have been no known imported cases of Ebola in the United Kingdom.

Travellers should avoid all contact with infected patients. Those who are providing medical care or are involved in the evaluation of an outbreak should observe strict barrier precautions.

Travellers who have been potentially exposed to Ebola virus should seek medical attention immediately if they experience any symptoms consistent with Ebola within the first 21 days of return to the UK.

United Kingdom guidance on the management and control of viral haemorrhagic fevers (VHF) has been written by the Advisory Committee on Dangerous Pathogens.

Guidance for healthcare workers who will be working with VHF patients in African healthcare settings has been written by the CDC in conjunction with WHO.

References

1. World Health Organization. Ebola Outbreak in Democratic Republic of Congo. [Accessed 20 August, 2012]. Available at: http://www.who.int/csr/don/2012_08_18/en/index.html

2. Centers for Disease Control and Prevention. Special Pathogens branch. Known Cases and Outbreaks of Ebola Hemorrhagic Fever, in Chronological Order [Accessed 20 August, 2012]. Available at: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/

ebola/ebolatable.htm

3. World Health Organization, Regional Office for Africa. Ebola Outbreak in Uganda (as of 17 August, 2012). Accessed 20 August, 2012. Available at: http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/3661-ebola-outbreak-in-uganda-as-of-17-august-2012.html

4. Arthur R R. Ebola in Africa - Discoveries in the past decade. Euro Surveill. 2002; 7(3):pii=342. [Accessed 20 August, 2012]. Available at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=342

5. Health Protection Agency. Locations of cases/outbreaks Marburg and Ebola haemorrhagic fevers. [Accessed 20 August, 2012]. Available at: http://www.hpa.org.uk/web/HPAweb&HPAweb_C&HP

AwebImage/HPAweb_C/1259152446024

6. World Health Organization. Global Alert and Response. End of Ebola Outbreak in Democratic Republic of Congo. [Accessed 20, August, 2012]. Available at: http://www.who.int/csr/don/2009_02_17/en/index.html

7. Health Protection Agency. Ebola. [Accessed 20 August, 2012]. Available at: http://www.hpa.org.uk/Topics/InfectiousDiseases/

InfectionsAZ/Ebola/

8. Beeching NJ, Fletcher TE, Hill DR, Thomson GL. Travellers and viral haemorrhagic fevers: what are the risks? Int J Anti Micro Agents 36:S26-S35, 2010.

 

Links

Health Protection Agency: Ebola

World Health Organization: Factsheet Ebola