Ebola Outbreak in Congo Reaches Eighth Province as North Kivu Tightens Travel Rules

Congo's Ebola outbreak has spread to an eighth province, the country's Health Ministry said on Sunday, and authorities in neighboring North Kivu are preparing restrictions on movement and public gatherings to slow the virus. ABC News, citing The Associated Press, described it as the fastest-growing Ebola outbreak on record, one that continues to outpace the response.

The ministry recorded two cases, one of them fatal, in Nord-Ubangi province, which borders the Central African Republic. Both patients were men in their 20s living in the Wapinda health zone, next to Bas-Uele province, where cases had already been reported.

What changes in North Kivu

Congo's state news agency ACP reported Sunday that North Kivu will bar people from entering the province from Ituri for one week, starting Monday. The World Health Organization says substantial transmission continues in North Kivu. Ituri remains the epicenter of the outbreak.

Other measures reported by ACP include:

• A ban on carrying more than two people on a motorcycle.
• A limit of four people in a car.
• A suspension of big public gatherings, including mass sports events, nightclubs and political demonstrations.

Why it matters for people in the affected areas

For residents of North Kivu, the rules affect how they travel, gather and move between provinces. Both the Independent and ABC News note that the outbreak's spread is fueled by mass population movements, which is what the restrictions target. Rebel violence, mistrust and poor working conditions for front line workers also drive the spread, according to the reports.

Conditions near the new cases make the response harder. Recurring armed violence in the Central African Republic has forced thousands of people to flee into Congolese border communities. Access in the region can be difficult because of poor roads and limited communication networks.

The virus responsible is Bundibugyo, and no approved vaccine or treatment exists for it. The WHO says early supportive care saves lives.

What the numbers show

Authorities have recorded at least 9,400 cases, including more than 4,500 deaths, since the outbreak was declared in mid-May. That makes it the deadliest in Congo's history. Ituri accounts for almost three quarters of confirmed cases, and the government's latest data shows 66 health zones affected since the start.

Nord-Ubangi lies between Sud-Ubangi and Bas-Uele, the last two provinces the disease reached along the border with the Central African Republic. That country has not recorded any confirmed cases.

The virus has also crossed national borders. Uganda has since declared itself free of the disease. Kenya recorded a seventh case on Saturday.

What officials and field workers say

Mohamed Yakub Janabi, the WHO's regional director for Africa, told the AP in Beni, eastern Congo, on Friday that pockets of infection are generally declining. But, he said, “geographically it's spreading out.” He said one of the biggest challenges is persuading infected people to seek medical care, and that some deaths occur in communities outside health centers.

Serge Ngalebato, an epidemiologist and field coordinator for the Wamba health zone in Haut-Uele province, told the AP that health workers began periodic home visits because people were too afraid to go to hospital. He said residents initially resisted containment efforts but later grew more understanding and began reporting positive cases. “Ebola is a community disease,” he said, adding that cooperation is essential.

Most cases in his health zone are around mining areas, where the population is constantly on the move, and many deaths were reported there, he said.

What Bundibugyo is

Bundibugyo is a less common Ebola strain than the Zaire species and has caused only two earlier outbreaks. The first, in Uganda's Bundibugyo district in 2007-2008, infected 149 people and killed 37. The second, in Isiro, Congo, in 2012, brought 57 cases and 29 deaths. The Independent reported the fatality rate is estimated at between 30% and 40%.

The virus spreads through contact with the blood or body fluids of an infected person or of someone who has died from the disease. Contaminated objects such as clothing, bedding, needles and medical equipment can also transmit it, as can infected animals including bats and nonhuman primates. Symptoms include fever, headache, muscle pain, weakness, diarrhea, vomiting and stomach pain. Unexplained bleeding or bruising can appear as a late stage of illness.

What happens next

North Kivu's entry ban from Ituri is set to last one week from Monday. Reports did not say whether it will be extended.

Sources: The Independent, ABC News