The Democratic Republic of Congo, affected by a new Ebola epidemic, has recorded 246 suspected cases and 80 deaths potentially linked to this virus. The WHO is raising its alert level this Sunday, May 17, it is now a “Public health emergency of international concern.” Sylvain Blaize, doctor of virology, head of the National Reference Center for viral hemorrhagic fevers (FHV), answers questions from RFI.
RFI: This is a resurgence of the “Bundibugyo” strain of Ebola, a poorly known strain. What is its particularity? Regarding its level of lethality, how deadly is it?
Sylvain Blaize : The “Bundibugyo” strain is one of the species of Ebola virus pathogenic for humans. It is the only one that has been discovered recently, since the discovery of this virus dates back to 2007. There have been two epidemics already recorded, notably in the same region in RDCet ôté en Uganda. The particularity, ultimately, there is none really compared to the other strains of Ebola, except that it is perhaps the least lethal of the pathogenic strains, since we have a lethality of 30 to 50% in the two previous epidemics.
The World Health Organization is raising its alert level this Sunday and considers it a “public health emergency of international concern”. Two cases, including one death, were also confirmed in Uganda while Rwanda and the DRC temporarily closed their borders. South Sudan and Kenya are on alert. What should we do concretely? What barrier measures should be put in place?
Transmission is by contact for these viruses. So, we must obviously avoid any contact with the sick. Unfortunately, there is no vaccine or treatment against this particular strain of Ebola virus, unlike the Zaire strain. The only way to counter this epidemic is to limit contact between sick people and healthy people. The difficulty today is that we are in a conflict zone, with interventions that are difficult. An area where people move around a lot, where there are population movements. The risk of spread is very high. And the late discovery of this epidemic at a time when it is already very widespread, with cases in Uganda too (…) potentially thousands of contacts to monitor.
There is currently no vaccine or therapeutic treatment. How can we manage an epidemic in this context?
I told you, the way to manage this epidemic is to identify all contacts, to follow them, to isolate them as soon as they become ill, since contagion occurs as soon as clinical signs appear. In terms of treatments, there is no specific treatment, but we have treatments that we call symptomatic support, which involve helping the body to get through the process, rehydration, a type of intensive care treatment. But obviously, in the region where the virus is rampant, it is difficult to implement. So, mainly limit contacts between sick people and healthy people.
The 17th Ebola epidemic in the Democratic Republic of Congo. You who worked on the epidemic in Guinea in 2014, what lessons can be learned from these previous epidemics?
The lessons that we can learn are that, indeed, the first thing to do to limit the scale of these epidemics is to detect them as quickly as possible. We saw it in Guinea – the problem is that we are in a bit of the same situation – the virus was detected very late. By the time it was detected in Guinea, it had already spread to Conakry, Liberia. If we discover the virus quickly, we can quickly control its spread, especially in these fairly remote regions. On the other hand, if we detect it late, when people have already moved and the virus is already present in different localities, it is much more complicated. The first thing is to strengthen the methods and means of on-site diagnosis and surveillance in these isolated regions.
The epidemic crossed a new threshold on May 14 with the death in Uganda of a 59-year-old Congolese returning from Ituri. This raises the question of the management of burials, for example, of contact between bodies and families. How can this be organized?
In the event of an epidemic, what the teams in place do is to take care of burials since we know that funerals are moments of great contagiousness since the bodies are very contagious. People who attend funerals are used to touching bodies. There are rites which are associated and which promote transmission. This involves so-called “secure” burials, where people no longer have access to the body. Which poses social problems, since these traditions are important for the populations who are affected. But we really need to limit contact between bodies and have safe burials, it’s something very important for the fight.
The source of infection occurred in Mongwalu, approximately 80 kilometers from the capital of Ituri province. An area that is difficult to access for medical teams. What are, at this stage of the epidemic, the most important needs for doctors on site?
The most urgent needs are to set up treatment centers and diagnostic centers to be able to identify contacts and patients as quickly as possible, as well as for the teams on site to follow up contacts and identify them. This is a lot of epidemiological work that must be done quickly. And then set up temporary treatment centers, as we saw in West Africa at the time, to be able to take care of the sick. There are 33,150 suspected cases. That’s a lot of people to take care of and there are no resources on site. We must strengthen health structures very quickly.
How do we protect health teams on site?
They are protected with personal protective equipment, which aims to prevent any contact between the mucous membranes, the skin of caregivers and the biological fluids of patients. This involves waterproof gowns, waterproof goggles, surgical masks and FFP2 which are more effective than surgical masks. An outfit where there is not a square inch of skin exposed. It’s difficult to get into these outfits, since it’s hot there. When we are in these outfits, we can be in the situation for a maximum of three quarters of an hour. Afterwards, this is no longer possible, the person risks feeling unwell due to dehydration and the heat. It’s very complicated for caregivers to intervene with these outfits.
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