Intended for healthcare professionals


DRC faces new Ebola outbreak, covid-19, and measles all at once

BMJ 2020; 369 doi: (Published 04 June 2020) Cite this as: BMJ 2020;369:m2219
  1. Owen Dyer
  1. Montreal, Canada

The Democratic Republic of Congo (DRC)—on the point of declaring victory in a 22 month Ebola epidemic that has claimed 2268 lives—has detected a new Ebola outbreak on the other side of the country, just as covid-19 begins to gain a foothold, and as the world’s deadliest measles epidemic enters its second year.

The long running Ebola outbreak centred on North Kivu province in the east will be officially over if no new cases appear by 25 June, two 22 day incubation periods after the last active case. But six new cases, including four deaths, have now been announced near Mbandaka in Equateur province, 1000 km to the west.

The new outbreak is the country’s eleventh. Mbandaka was also the site of the ninth. It is not believed to have been caused by visitors from North Kivu. While the natural host remains unknown—bats are leading suspects—most of the country is believed to be within the potential zoonotic transmission zone.

Contact tracing has already begun and teams are leaving North Kivu for Equateur to tackle the new outbreak. The DRC now faces a confluence of threats from three infectious pathogens: Ebola, covid-19, and measles, so far the deadliest of the three.

The country of 89 million people has reported 3495 cases of covid-19, with 75 deaths, making it part of a broader African success story in resisting the virus to date. But health experts worry that the measures holding back the coronavirus are hindering efforts against measles in a country where only a third of children receive a vaccine in their first year.

Measles has killed 6600 people since DRC’s epidemic began in January 2019. Almost all were young children. The epidemic stretches north into the Central African Republic and Chad.

Suspicion of health workers and vaccines has grown in DRC in recent years, and vaccination efforts were already faltering in the first two months of this year for measles and several other diseases. UNICEF warns that the country is also threatened by potential resurgence of polio, chickenpox, yellow fever, hepatitis B, diphtheria, tetanus, whooping cough, and meningitis.

Ten times the size of the UK but with just 2200 km of paved roads and widespread insecurity, DRC has never been easy territory for immunisation campaigns. Keeping vaccines cold is a huge challenge.

But the measures needed to slow covid-19 “are having an impact on the overall measles response, including transporting vaccines, assembling dedicated teams, and launching vaccination campaigns,” said Emmanuel Lampaert, DRC coordinator for Médecins Sans Frontières.

“Every delay and every obstacle increases the risk of the measles epidemic continuing to spread, killing more children,” Lampaert said. “The same happened during the West African Ebola outbreak, when measles vaccination activities were disrupted, leading to a resurgence of the disease.”

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