African health experts have called for an immediate and coordinated response from pan-African authorities after new cases of the Bundibugyo Ebola virus emerged in Kenya and Nigeria.
The rare Bundibugyo virus, for which there is no approved vaccine or drug, has led to more than 4,600 deaths and 9,552 confirmed infections in the Democratic Republic of Congo (DRC) since an outbreak was first declared on 15 May.
A total of four African countries have now been affected by the virus, with Uganda ending an outbreak in August that caused 20 infections and two deaths. France also contained one imported case from the DRC in June.
Kenya confirmed its ninth Ebola case last week sending alarm bells across the country’s public health, economic and social sectors, while Nigeria confirmed one case.
Misaki Wayengera, former chair of Uganda’s ministry of health scientific advisory committee on epidemics, says the new cases show that efforts to contain the outbreak in DRC have been overwhelmed.
“These cases popping up in Nairobi and Nigeria should serve to wake up the African Union and the East African Community, to make a deliberate effort to put out the fire in the DRC,” he told SciDev.Net.
Wayengera says the complex security landscape of eastern DRC, characterized by decades of armed conflict, difficult terrain and mistrust towards international actors, severely hindered early containment efforts. He urged the African Union and East African Community to work with Kinshasa to prevent further cross-border transmission.
The persisting neglect of the Eastern DRC creates not only a haven for rebel and terror, but also, disease outbreaks of epidemic potential.”
Misaki Wayengera, former chair of Uganda’s ministry of health scientific advisory committee
“By bridging security, epidemiology and basic human needs together, we can create an actionable strategy for stabilizing high-risk cross-border regions,” he added.
‘Don’t panic’
Githinji Gitahi, group CEO of Amref Health Africa said the current situation called “cross-border coordination, not alarm”.
He said the nine Kenyan cases were in one cluster, with no evidence of community spread, no new cases and 14 negative samples in the previous 24 hours. He stressed that Ebola is not transmitted through the air like COVID-19, but through contact with the bodily fluids of a sick or deceased person, or contaminated materials, adding: “I do not expect COVID-style nationwide lockdowns or major trade disruption.”
The World Health Organization (WHO) also stressed the need for coordinated preparedness and response measures. It advised against any restriction of travel to, or trade with, affected countries.
In Nigeria, a woman who had recently travelled to Uganda has “improved remarkably” after receiving treatment for Ebola Bundibugyo at a private health facility in Abuja, according to the Nigeria Centre for Disease Control and Prevention (NCDC).
In its 24 October situation report, the NCDC said 53 contacts linked to the confirmed case had been identified and were being followed up. The report recorded no positive tests among contacts at that point.
Nigeria’s health ministry said genomic analysis by the NCDC and the Institute of Genomics and Global Health at Redeemer’s University found that the virus detected in Nigeria was genetically related to that identified in a case in Kenya. Health minister Muhammad Ali Pate said further investigations were needed to establish whether the cases were epidemiologically linked.
Kenyans in quarantine
Kenya’s director general for health, Patrick Amoth said authorities had moved swiftly to trace contacts of Kenya’s index case, the first infected in early October. The Kenyan national, who had been returning from DRC, travelled through Entebbe in Uganda where he took a flight to Nairobi, Amoth said at a WHO press briefing on 22 October. The patient received medical treatment but died two days later.
Eight other people are currently under isolation and receiving treatment at hospitals in Nairobi, with 120 people in quarantine, Amoth said, adding that Kenya has requested 10,000 vaccine doses to protect health workers.
While there is no approved vaccine specifically for the Bundibugyo Ebola species, the Ervebo vaccine, effective against the Zaire strain, is being widely used in DRC, while clinical trials are underway for vaccines against Bundibugyo.
On 23 October, WHO reported that the TUMAINI phase 2/3 vaccine trial had begun in Bunia, in the DRC, with the first participants enrolled. The trial is intended to generate evidence on vaccine candidates against Bundibugyo virus disease, including Ervebo.
Surveillance and vaccines
Africa CDC says it is working closely with the ministries of health and national public health institutions in DRC, Kenya and Nigeria to strengthen coordination, surveillance, preparedness and response efforts across the region.
Saran Koly, Africa CDC’s director of communications, told SciDev.Net: “In Nigeria, we deployed a multidisciplinary technical team to Abuja on 21 October, within hours of the confirmation of the country’s first case.”
She said the team was supporting Nigerian health agencies with surveillance, infection prevention and control, emergency operations, and public engagement.
Africa CDC has also provided laboratory supplies for 500 PCR tests and is facilitating access to 10,000 vaccine doses in collaboration with US pharma company Gilead Sciences, she said.
At the continental level, director-general Jean Kaseya has convened an extraordinary meeting of African Ministers of Health for Wednesday (28 October).
Resources strained
However, Mohga Kamal-Yanni, a senior policy advisor to The People’s Medicine Alliance and senior health policy consultant to UNAIDS, warns that at-risk countries do not have enough resources to respond to the infection or to take necessary prevention measures such as decentralised labs run by trained and protected staff, contact tracing, and community information and engagement.
“All that needs immediate release of funds to finance, and technical support including from Africa CDC and WHO,” she told SciDev.Net.
She says public information and community engagement, essential for prevention and response, have been lacking, with misinformation fuelling delayed diagnosis and attacks on health centres in DRC.
Diagnostics needed
Despite Ebola being discovered in the 1970s, there is no specific medicine to treat it, Kamal-Yanni noted. Rapid diagnostic tests are also lacking.
Alessandro Marcello, head of molecular virology at the International Centre for Genetic Engineering and Biotechnology, in Trieste, Italy, has developed a simple, rapid and affordable test for the Bundibugyo Ebola virus, based on RT-LAMP technology. The test is in the early stages of testing.
“Our aim is to make testing more accessible, particularly in settings where sophisticated laboratory equipment is not available,” Marcello told SciDev.Net.
“Early testing is essential to identify cases, prevent further transmission and bring an outbreak under control,” he added.
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