Monday, August 25, 2014

2014 Ebola Outbreak in the Democratic Republic of Congo (Map)

As of August 25, 2014, at least two cases of Ebola have been identified from Équateur Province in the Democratic Republic of Congo by the Ministry of Health from among 8 tested individuals. (link)

 According to the Minister of Health Felix Kabangue Numbi, the Ebola strains identified include Sudan ebolavirus (SUDV) and a Zaire ebolavirus (EBOV)/Sudan ebolavirus cross strain. According to Kabangue Numbi the Zaire and Sudan strains are very similar.

Although there is uncertainty over the strain or strains infecting individuals in this outbreak in the Democratic Republic of Congo, it does not appear to be the same strain that has recently infected more than 2500 people in Nigeria and Western Africa.

According to Kabangue Numbi, as many as 13 people have died from this Ebola outbreak in the Democratic Republic of Congo. The index case was apparently a pregnant woman who died on August 11. The husband of this woman has tested positive and a doctor, nurse, and hygienist who treat this pregnant woman as well as two additional health care workers have died. Other suspected cases in this outbreak include relatives or villagers who attended the woman’s funeral. (link)

Contact tracing has indicated that these cases have been reported from at least three villages, Djera, Lokolia, and Watsikengo, from the Boende territory or administrative zone which is part of the Tshuapa district or subregion of the Équateur Province. (see map below) Currently 11 contacts of these confirmed and suspected cases are in isolation.

Confounding the public health situation in the Boende territory is that up to 75 deaths have been recently reported from the region. According to the World Health Organization most of these individuals have died from “febrile gastroenteritis with haemorrhaging.” (see this FluTrackers thread) Whether any of these deaths beyond the 13 referenced by Kabangue Numbi are reclassified as Ebola deaths remains to be seen.

Friday, August 22, 2014

It is Time for the International Community to Provide More Aid to Ebola-Stricken Nations in Africa

Presently, only four countries, Guinea, Liberia, Nigeria, and Sierra Leone (as depicted in red on the map below) have confirmed cases of Ebola. But the outbreak is rapidly becoming out of control with more than 2400 cases reported. Several weeks ago, on August 3, the director of the Center for Disease Control in the United States, was quoted as saying that Ebola is “out of control” (link) at that time. Today, the World Health Organization (WHO) acknowledged that they have underestimated the extent of this Ebola outbreak in Africa in a situation assessment identifying the many reasons why the current cases are underestimated. (link) The inability of the international health community to understand this outbreak is precisely because it is out of control in the West African nations.

However this outbreak is more than an African problem. There is worldwide concern for this infectious disease. So far, no cases have yet been reported beyond the four African nations. The FluTrackers crew ( has been reporting and tracking suspected Ebola cases from media reports around the world since the outbreak began. To date, at least 36 countries (as highlighted in yellow on the map below) have had suspected cases of Ebola. Unless this outbreak is controlled in Africa, it is a certain to spread to other parts the world. It will only be a matter of time before one of the suspected cases becomes a confirmed case outside of Africa.

In a meeting in early August with the presidents of Guinea, Liberia, and Sierra Leone, Margaret Chan, the Director-General of WHO, stated “this meeting must mark a turning point in the outbreak response.” (link) That didn’t happen. It is now time for Chan and the rest of the international community to provide the much-needed assistance for these countries to combat Ebola locally before it truly becomes an international problem.

Wednesday, August 20, 2014

Searching for the Animal Reservoir(s) of MERS-CoV

The World Organisation for Animal Health (OIE), organized in the 1920s, is an international organization of member countries established to promote global transparency of animal diseases, to collect scientific information relating to international animal disease control, and to develop standards for international trade of animals and animal products. The OIE is also tasked with disseminating information about emerging zoonotic diseases that have the potential for transmission to humans.

Recently, the OIE provided a summary of its current understanding of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Update August 2014 - Questions & Answers on Middle East Respiratory Syndrome Coronavirus (MERS-CoV). This update provides general information about the MERS-CoV, but also has a detailed discussion about potential animal reservoirs for this coronavirus.

Several patterns or mode of human transmission of MERS have been identified by the World Health Organization. Human MERS infections can be transmitted in hospital settings and through close human to human contact. Both of these transmission settings require an infected individual. It is uncertain how the initial MERS cases in these situations became infected. These sporadic or community acquired infections could result from an environmental source or direct or indirect contact with animals.

The OIE points out that there is strong evidence that camels may be an animal host for this coronavirus, but perhaps not the only host. A number of confirmed MERS human cases had contact with camel or exposure to camels or camel products prior to infection. But not all sporadic MERS cases can be linked to camel or camel product exposure. The OIE specifically states “there remains the possibility that other animal species may be involved in the maintenance and transmission of the MERS-CoV”. The OIE concludes that more scientific research is necessary to determine whether other animal species, besides camels, may represent primary or intermediate hosts for MERS-CoV.

Map: Geographic Distribution of Ebola Cases in West Africa, August 2014

The current Ebola outbreak in Africa has now grown to more than 2200 cases from four countries, Guinea, Liberia, Nigeria, and Sierra Leone. (link) The map below shows the geographic distribution of Ebola cases within Guinea, Liberia, and Sierra Leone in West Africa based on recent reports. See map notes.

Tuesday, August 12, 2014

Another reported MERS infection in Saudi Arabia

Yesterday, Saudi Arabia reported a new case of Middle East Respiratory Syndrome (MERS) infection, a 72-year-old male from Riyadh. (link) This is the first MERS infection reported from Saudi Arabia since July 10 (link) and the first MERS cases reported for Riyadh since July 7. (link)

Because the incubation period of MERS is reported to be between 5 and 14 days, and assuming the Saudi Arabia Ministry of Health is reporting all MERS infections in the country, this newly reported case does not seem to be a result of human-to-human transmission but rather an independent infection most likely from a non-human animal source. It is unlikely, but possible, that this individual contracted the coronavirus from an asymptomatic human carrier. There is no reason to believe that this case resulted from a deliberate release of the coronavirus. See The discrepant epidemiology of Middle East respiratory syndrome coronavirus (MERS-CoV) for a hypothesis that MERS infections are a result of a bio-terrorist plot.