Ebola hits an eighth DR Congo province

Nord-Ubangi became the eighth province of the Democratic Republic of the Congo (DR Congo) with Bundibugyo cases on 18 October, when the Institut National de Recherche Biomédicale (INRB), DR Congo's national laboratory, confirmed two infections, one fatal, in Wapinda health zone, the district unit of DR Congo's health system⁠¹. Media reports citing officials, relayed by ECDC, place the cases in a mining area bordering Bas-Uele⁠². That points to an overland route from the Uele provinces, away from the river line that carried the virus to Sud-Ubangi. Nord-Ubangi also borders the Central African Republic.

DR Congo had 9,552 confirmed cases and 4,602 deaths with data to 18 October, ECDC reports⁠³. WHO's counts show growth easing: about 90 confirmed cases a day from late August to 23 September, and about 65 a day from then to 6 October⁠⁴. Set against ECDC's 18 October total, WHO's 6 October count implies about 69 a day, so the pace has held in the high 60s since early October.

Of 372 deaths since WHO's previous bulletin with a recorded place of death, 264, or 71%, happened in communities, outside any treatment centre⁠⁵. Contact follow-up stood at 76.9% with data to 18 October, below WHO's 85% target, so almost one contact in four went unchecked⁠⁶.

An efficacy trial of vaccines built against Bundibugyo itself is now registered as NCT07842107, with one listed site, Bunia in Ituri, and none in North Kivu, which Médecins Sans Frontières said in late September supplied nearly 40% of new cases⁠⁷. Sponsored by the University of Antwerp with INRB, it plans to enrol 3,620 contacts of cases and give every one a candidate vaccine, on day 1 or day 29, with a typhoid shot as the comparator. The record, last updated on 5 October, gave an estimated start of 20 October and no recruitment yet. The doses of Ervebo, a licensed vaccine against the Zaire species, already given to frontline workers target a different virus.

Genomes from 686 patients, in a preprint posted on medRxiv on 9 October and not yet peer-reviewed, date the outbreak's start to late February, about eleven weeks before the 15 May declaration⁠⁸. The Congolese-led team found "no evidence of mutations associated with rapidly growing lineages". On that reading, the jumps to Kenya and Nigeria came from travel and care-seeking, with no sign of a fitter virus.