The risk to public health has been raised to “very high” in the Democratic Republic of Congo by the World Health Organization, after a case of Ebola was confirmed in a major city.
The first definite case of the deadly virus in the city Mbandaka, which has a population of around 1.5million, was described as a “major, major game-changer in the outbreak,” by WHO deputy director-general of emergency preparedness and response, Dr Peter Salama.
The fear now is that the disease, which has been linked to the deaths of as many as 25 people so far this year, could spread much faster in a city than in remote, rural areas, where most cases had been reported to date.
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The WHO also raised the risk level to “high” from “moderate” in the region, adding: “The confirmed case in Mbandaka, a large urban centre located on major national and international river, road and domestic air routes increases the risk of spread within the Democratic Republic of the Congo and to neighbouring countries.”
The first Ebola case of this outbreak was announced last week in the city of Bikoro, 93 miles from Mbandaka, where there were a further three suspected cases.
A WHO statement said there had been 21 suspected, 20 probable and three confirmed cases of Ebola between 4 April and 15 May, according to reports by the Associated Press.
The ultimate fear now is if the virus, which can be fatal in up to 90 per cent of cases, were to spread to Kinshasa, a city that is home to almost 10 million people, many of whom live in slums with poor sanitation. It is an hour’s flight from Mbandaka
Mr Salama had told reporters on Thursday: “We’re certainly not trying to cause any panic in the national or international community.
“What we’re saying though is that urban Ebola is very different phenomenon to rural Ebola because we know that people in urban areas can have far more contacts so that means that urban Ebola can result in an exponential increase in cases in a way that rural Ebola struggles to do.”
Health teams are now monitoring more than 500 people who may have come in contact with infected individuals.
They say they are now better prepared to deal with the outbreak, compared to when a major outbreak killed more than 11,000 people across west Africa between 2014 to 2016, with more than 28,000 confirmed, probable and suspected cases.
A vaccine, which was tested during the previous outbreak, will be sent out and given to those who may have come into contact with the disease.
The organisation has already sent 4,300 doses to Kinshasa and is now sending 7,540 more doses to the region, claiming this should be enough to treat 50 rings of 150 people.
Life after Ebola: a community rebuilds in Sierra Leone
Life after Ebola: a community rebuilds in Sierra Leone
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‘During Ebola, they quarantined areas. My husband was at Kailahun and couldn’t cross the boundary, so we were separated. They taught us how to wash our hands and we were all washing our hands every day; even my children were washing their hands.’ Haja is the mother of three surviving children, two of her children died from diarrhoea
WaterAid
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‘This is the finished toilet that we have built in our compound, I am very happy to have my own toilet and I will be proud to use it’
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3/27
‘All the parents came together and built a school in the village, we have just opened the school. The children are at assembly with no uniforms. I am the teacher at the school so I took this photo to show how we have been working hard for our children to be educated’
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4/27
‘Here is my son, Sessay (left), with his friends. I was happy to snap them. I have given birth to six children, but only three are still alive. The first one I lost was three years ago, and the second was two years ago. Four months ago I lost Senior Lahai. He was six months old and was affected by a runny stomach and a rising body temperature’
WaterAid
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5/27
‘Four months ago I lost Senior Lahai. He was six months old and was affected by a runny stomach and a rising body temperature. He was really, really sick, he wasn’t even taking breast milk, and he died. My heart was broken. My baby used to be strong. He was able to sit by himself and was just starting to practise to crawl and reach for things. He laughed a lot when I played with him, I’d clap and dance. I have a happy moment when he started sitting by himself and learning to crawl. Those are the happy moments that makes a mother most happy. The moment I remember most about Lahai was when he was breastfeeding and was playing with my neck and chin with his hand. I look to the future and hope that such things won’t happen again, and that God will give me children that stay with me’
WaterAid
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6/27
‘My step brother Ibrahim is building our toilet with loamy soil because we don’t have cement. WaterAid taught us about good sanitation and I want to show that we are now building our own toilets so that we will not go to the bush or use the stream as a toilet that is why I took this photo’
WaterAid
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7/27
Washing in the stream: ‘When we came here the water system was very bad. I know that when I drink dirty water I get sick. We are getting diarrhoea because we are drinking that type of water. If I am sick I am not able to earn money because I am not able to go to work, and I have to stay at home, which is very difficult for me’
WaterAid
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8/27
‘These are the contractors that came to build the water well, and they are mixing the stones and the cement to build the cover of the well’
WaterAid
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9/27
‘I started tree climbing when I was living with my grandmother and she was trying to get some palm kernels and process them to make the oil that we use. I didn’t like doing the processing part so I decided to climb the trees to do the harvest instead. Tree climbing is very difficult. At times you can be confronted by a snake, as you are going up you just see one and it will hiss at you. If you are not strong you are going to fall out of the tree, and could die! I am just doing it for necessity sake. I don’t want to do this job really, but at the moment I have no other means of making money, so I have no choice but to do this to manage my family’
WaterAid
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10/27
‘They killed my uncle during the war. I was not in this village during the war; I was in Guinea. Just after the war, my mother asked me to come back home. There were no houses when I returned; it had all been destroyed’
WaterAid
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11/27
‘This is my son Bockarie. He reminds me of his mother, who is not presently here with me, and he resembles me. Recently my son was very sick and we had to take him to the clinic to get treatment. Even getting to the clinic costs money. I didn’t have any money, so I had to borrow money from the community people so I could take him to the hospital. Having very good drinking water would ease the issues with having to take people to the hospital because of illness, and the problem of finding the money to manage that’
WaterAid
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12/27
‘Sidique is 21 years old, he is my daughter’s husband and is drinking from the stream we use to fetch water. Our forefathers created this village, and the water was good. They covered it with a concrete box to keep it safe, but all of that fell down during the war, and afterwards no one could repair it. The water is not good here now and I have worms as a result. It will be very good to have clean water; it would give us a long life. If you have good drinking water, then your life is safe, but if you don’t then your life is not secure. Having good drinking water would ease the issues with having to take people to the hospital because of illness, and the problem of finding the money to manage that’
WaterAid
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13/27
‘We the women of this village are experiencing the problems with lack of water and we pray that things will change. The rain washes everything, including faeces into the water. The children get diarrhoea from the water. With clean water, I would be clean and would not suffer from sickness’
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14/27
‘This is my brother’s wife, she is holding both her daughter and my granddaughter’
WaterAid
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15/27
Matu is the life and soul of the village of Tombohuaun. She is a traditional birth attendant and plays an important role within the women’s society. Matu suffers from poor health; she has stomach problems caused by the dirty water
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16/27
‘My name is Amadou Kokoyeh, but I am more familiar with Kokoyeh [Bush Chicken]. The name Kokoyeh was given to me by father’s older brother. It’s meant to be a bird that is in the bush and mostly eats other people’s groundnuts when they plant them.”
WaterAid
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17/27
‘This is my father helping to dig the water well, so that we will have clean water to drink. I am happy because we are going to have a well in my village. I don’t think the water we currently collect from the muddy spring is good for drinking because it is exposed, and leaves and other things fall in it. I also get water down there with my mum, and sometimes I go with the other kids. Sometimes when I drink it, I have a stomach pain, and it also brings me headache. I have got sick from that, and I was taken to the health centre’
WaterAid
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18/27
‘This is my family – my mother, father and younger brother. When I’m not with them this picture will make me feel closer to them’
WaterAid
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19/27
‘Moserie Yajah was lying down in the grass, and asked me to get a shot of him. At the moment, every day people ask me to get a photo of them. I feel very happy when people ask for a picture. What I love most to get a shot of is people that are well dressed, sitting in a chair or in a very comfortable area that I can snap’
WaterAid
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20/27
‘We were going down to Matu’s place, and my friends and brother decided to cover themselves with that fishing net, and asked me to take a shot of them. The fishing net was taken from Ginnah’s mother (Massah) and I think the picture is really good. I like the photo mainly because they are standing close to the wash yard, where people go to heat their water and wash. I love it because they are all my brothers, and we look out for each other’
WaterAid
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21/27
‘I love this picture. I took this photo of Bockarie when he was drinking water. The water was collected from the muddy spring where everyone collects water. I don’t think it is good for drinking because it is exposed, and leaves and other things fall in it. I also get water down there with my mum, and sometimes I go with the other kids. Sometimes when I drink it, I have a stomach pain, and it also brings me headache. I have got sick from that, and I was taken to the health centre. If it rains, we harvest rainwater’
WaterAid
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22/27
‘This is my cousin Papay; we are very close – he lives nearby and we spend lots of time together. In this picture he is messing around. On his head is what our fathers make to catch fish in small streams. We then eat some fish and they sell the rest. It is important for our survival’
WaterAid
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23/27
‘The community people helping to build the water well, I was glad about this, that is why I took this photo.’ Kempah is a youth leader and mechanic from Tombohuaun
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24/27
‘These children are our next of kin, my children and their friends. They are wonderful children’
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25/27
‘Here, my father, brothers and aunt are separating cocoa fruit from pods. By selling cocoa, my family earns enough to pay my school fees’
WaterAid
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26/27
‘We have now built a small school in our village. This is inside the class for my children’s first day in school. I took this picture to show them in the future so they will know that I want them to be educated and also free from diseases’
WaterAid
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27/27
‘This is my Aunt Mamie Ansumana. She is 40 and is a farmer. She loves going to the farm and likes to smile. She looked after me when my children died. The dirty water caused the death of two of my children; I don’t want anything to happen to the others. She took me from the room where Senior Lahai died to her own room. I slept in her room for some time. I want to thank to her because she is still taking care of us’
WaterAid
The WHO’s “ring vaccination method” involves treating those who may have contacted those feared to be infected, their contacts and frontline health workers.
Last time, thousands died from the disease in countries including Liberia, Sierra Leone and Guinea and Nigeria.
Those infected included a number of British health workers including nurse Pauline Rafferty, who made a full recovery.
The virus can cause symptoms including vomiting, diarrhoea, muscle pain, headache, bleeding and a high temperature and can be fatal.
There is currently no licensed treatment for the disease, which is spread through contact with an infected person who has symptoms, through their bodily fluids and through handling raw or undercooked bushmeat.
A WHO emergency committee will meet tonight to decide if the outbreak is a “public health emergency of international concern” and how best to deal with it.
The global risk remains “low”.
The Foreign Office has advised “against all but essential travel to the Equateur province” where the outbreak was announced and urged people to check the WHO website for the latest updates.
The NHS issued advice following the previous outbreak which includes to “avoid physical contact with anyone who has possible symptoms of an infection” and washing hands frequently with soap or failing that, rubbing them with alcohol.
It also advises not handling dead animals or raw meat, not eating bushmeat and making sure fruit and vegetables are washed and peeled before eating.
The Centers for Disease Control and Prevention in America has echoed the NHS advice and added that any travellers who experience symptoms or who have had contact with someone who has over the past 21 days should seek medical help immediately.
Agencies contributed to this report.
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