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Ebola Part

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The number of suspected cases of Ebola has risen to 29 from nine in less than a week in an isolated part of Democratic Republic of Congo, where three people have died from the disease since April 22, the World Health Organization said on Thursday.

The WHO was criticised for responding too slowly to an outbreak in West Africa in 2014 that left more than 11,000 people dead, and Dr. Peter Salama, the executive director of the organisation’s health emergencies programme, said at a briefing that it was essential to “never, ever underestimate Ebola” and to “make sure we have a no-regrets approach to this outbreak.”

Assessing the risk

The risk from the outbreak is “high at the national level,” the WHO said, because the disease was so severe and was spreading in a remote area in north-eastern Congo with “suboptimal surveillance” and limited access to health care.

“Risk at the regional level is moderate due to the proximity of international borders and the recent influx of refugees from Central African Republic,” the organisation said, but it nonetheless described the global risk as low because the area is so remote.

About a week ago, in addition to the nine suspected cases, 125 patients who had come into close contact with the disease were being monitored. Now about 400 patients are being followed, even as nine new cases were reported on Thursday, according to the WHO.

The Ebola virus causes fever, bleeding, vomiting and diarrhoea, and it spreads easily by contact with bodily fluids. The death rate is high, often surpassing 50%, particularly with the Zaire strain, which has been confirmed in two cases in this outbreak.

The outbreak was reported in a densely forested part of Bas-Uele Province, near the border with the Central African Republic. Cases have occurred in four separate parts of a region called the Likati health zone.

Aid groups and the WHO have struggled to reach the affected area, which has no paved roads.

The first known case occurred on April 22, when a 39-year-old man who had fever, vomiting, diarrhoea and bleeding died on the way to a hospital in the Likati zone. The person caring for him and a motorcyclist who transported him also died.

The first six months of the response to the outbreak are expected to cost the WHO and aid groups $10 million, Dr. Salama said at the briefing. He said telecommunications networks would have to be established and airstrips repaired so that aid workers can provide the necessary medical care.

repaired so that aid workers can provide the necessary medical care.

Experimental drugs

The WHO, aid groups and the Congolese government are discussing the possibility of using an experimental Ebola vaccine, made by the American pharmaceutical company Merck, that proved effective in Guinea.

The response would involve a “ring vaccination,” in which contacts of patients, contacts of contacts, and health workers would be vaccinated. There would be no mass public vaccination. The vaccine has not yet been licenced, and its use would require permission on several fronts. Nonetheless, Dr. Salama said that if permission were granted, the vaccine could be made available in a week or so. Other experimental antiviral drugs may also be considered.

The Ebola virus is considered endemic in the Democratic Republic of Congo, where eight outbreaks, the largest involving about 300 patients, have been recorded since 1976.

The country “has considerable experience and capacity in confronting these outbreaks,” Dr. Daniel Bausch, an Ebola expert at the WHO, said in an email. He added, “I think there is a very good probability that control can be rapidly achieved.”

Dr. Salama said that aid workers had reached a town in the Likati zone, which was as close as they had been able to come to the epicentere of the outbreak. He said aid groups were setting up centeres for treatment and isolation, and mobile labs. The first aid group to arrive was the Alliance for International Medical Action, which was already in the region, responding to cholera.

In a telephone interview from Conakry, Guinea, the group’s executive director, Matthew Cleary, said that seven people who were believed to have contracted Ebola had been taken to a district hospital in the Likati zone that was not equipped to deal with the virus.

“It’s urgent to get them into a proper isolation centre,” Mr. Cleary said, adding that the group is preparing to build a treatment unit. It will include windows that allow families to see patients, a response to past outbreaks in which people sometimes shunned sealed-up isolation units into which patients seemed to disappear.

Brienne Prusak, a spokeswoman for Doctors Without Borders, said on Wednesday that the group had sent a team of about 20 doctors, nurses and other experts to the Likati zone, and that it was still trying to figure out how to reach the epicentre.

“Transport is extremely difficult in the area, and helicopter flights may be the only way to get there,” she said by email. “We considered motorbikes but are now thinking of helicopters because we need to get so many materials there. “We’re expecting to get to the epicentre by the weekend.”

The Centers for Disease Control and Prevention in the United States is also sending an Ebola expert, Dr. Pierre Rollin, to Congo, along with epidemiologists, a spokeswoman said.

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