Ebola outbreak in Congo formally ends

An outbreak of the deadly Ebola virus in the heart of Congo has formally ended about four months after it began spreading through several remote villages and towns.

The central African nation’s Ministry of Health on Tuesday said that Congo is now free of the disease, 42 days after the last case was diagnosed in early June. There were 53 confirmed and probable cases identified and 29 people died from the virus. 

The outbreak began in an isolated village in the Equateur Province in April before spreading to the town of Bikoro and the city of Mbandaka. Mbandaka sits on the Congo River, the main thoroughfare between several major cities.

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Had the virus spread along the river, officials worried about a catastrophic outbreak that might have reached the scale of the 2014-2015 epidemic that struck three West African nations.

“We were very concerned at the beginning when we had cases in Mbandaka. Mbandaka is a very big city with a population of close to 2 million,” Ibrahima Socé Fall, the World Health Organization’s (WHO) regional emergencies director in central Africa, said in an interview from Brazzaville, in the neighboring Republic of Congo. “Mbandaka is close to the Congo River, and you can see the traffic on the Congo River.”

Public health officials raced to the province after Congo’s health ministry formally notified the WHO of the outbreak in early May.

Several groups administered a new experimental vaccine to front-line health workers and to those who had come into contact with Ebola patients, a practice known as ring vaccination. About 3,300 people received the vaccine, and though researchers will have to continue to monitor their progress, none of those who received the vaccine got sick.

The vaccine had been tested toward the tail end of the outbreak that struck Liberia, Guinea and Sierra Leone three years ago. A team of about 50 Guinean epidemiologists deployed to Congo to help administer the vaccine. 

In interviews with public health officials over the last month, many lavished praise on both the Congolese health ministry and the WHO, which had come under scrutiny for its lackluster response to the previous outbreak in West Africa. 

“There is a lot of partners coming from different countries, and WHO is coordinating that so we don’t duplicate,” Pierre Rollin, the top Ebola expert at the Centers for Disease Control and Prevention (CDC), said in an interview before he deployed to Congo.

The WHO has dramatically reshuffled its bureaucracy, both in Geneva and in Africa, in order to better respond to an outbreak before it spreads too widely.

“We had a number of commissions calling for WHO to be more operational. We realized the expectation from developing countries was higher than what WHO could actually do,” Fall said. “We were more able to do rapid response.”

About a dozen members of a CDC team based in Kinshasa, the capital of Congo, deployed to Mbandaka, Bikoro and the tiny village of Itipo to assist with contact tracing, lab testing and coordination. 

The region is so remote that the teams had to fly on United Nations planes to Mbandaka before taking helicopters to more far-flung villages. The CDC teams slept in tents in the oppressive humidity, and responders worked out of temporary facilities or community buildings that had been seconded as treatment or laboratory facilities.

“These are very rural locations where sometimes it can take a couple hours to find a contact by a single path,” Ben Dahl, who led the CDC response, said in an interview from Kinshasa. 

The WHO’s new Contingency Fund for Emergencies, created in the wake of the West African epidemic, spent about $4 million to respond to the outbreak. The U.S. Agency for International Development spent about $5.3 million, and governments in Italy, Germany, Norway, Canada, Japan and the World Bank chipped in millions more.

Public health officials said they had prepared neighboring countries for the possibility of a more widespread outbreak. Officials in the Republic of Congo, the Central African Republic, Rwanda and Burundi received training and funds to bolster their public health systems.

The WHO said it will conduct an after-action report to assess the strength of its own response, a process likely to take weeks or months.