On Sunday (17 May), the World Health Organization (WHO) declared the Ebola disease caused by the Bundibugyo virus (BDBV) a public health emergency of international concern.
This is despite cases of the disease being detected only in the Democratic Republic of Congo and Uganda so far.
The Director-General of WHO, Dr Tedros Adhanom Ghebreyesus, determined it as a global health emergency after consulting officials in the two affected countries.
On Tuesday (19 May), Congo reported that the toll of the disease has risen sharply since Saturday (15 May) — from 65 deaths and 246 suspected cases to 131 deaths and 513 suspected cases, according to Time Magazine.
Ebola disease is caused by viruses that belong to the Orthoebolavirus genus, which are believed to originate from fruit bats of the Pteropodidae family.
Experts have identified six strains of Orthoebolaviruses to date, three of which are known to cause large outbreaks — Ebola virus, Sudan virus, and BDBV.
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The BDBV, which is behind the ongoing outbreak in Congo and Uganda, has a 30% fatality rate and is the most recently discovered type, having been identified in 2007.
While there are vaccines and medicine for Ebola virus disease, there is currently no approved vaccine or treatment for other Ebola diseases, including the Bundibugyo virus disease (BVD). Candidate products are still in development.
The current outbreak was discovered after the WHO received an alert on 5 May regarding an unknown illness with high mortality in Ituri Province, Congo, that caused the death of four health workers within four days.
Following an investigation, the outbreak was confirmed to be the BVD on 15 May.
On the same day, Congo officially declared its 17th Ebola Disease outbreak.
According to the WHO, the symptoms of Ebola disease can start showing anywhere between two to 21 days after infection.
These can include fatigue, malaise, muscle pain, headache and sore throat.
Later, patients can also experience vomiting, diarrhoea, abdominal pain rash, and impaired kidney and liver functions.
Some may also develop internal and external bleeding, including blood in vomit and faeces, and bleeding from the nose, gums and vagina.
The disease can also affect the central nervous system and cause confusion, irritability and aggression.
Humans can contract the Orthoebolavirus from the blood, secretions, organs or other bodily fluids of infected animals, including fruit bats, porcupines, forest antelopes, and non-human primates.
It can also be transmitted from person to person when broken skin or mucous membranes come in contact with blood and bodily fluids of a person with Ebola disease, whether directly or through contaminated objects and surfaces.
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Notably, people can only transmit the disease when they show symptoms and can infect as long as their blood contains the virus.
Because of these factors, many healthcare workers have been infected while treating patients with Ebola disease.
Even the bodies of those who have already died of Ebola disease can contribute to its spread when their burial ceremonies involve direct contact with the corpses.
The WHO listed three grounds as to why it declared Ebola disease a public health emergency of international concern.
Firstly, it said the event is extraordinary, citing reasons such as observing unusual clusters of community deaths pointing to the BVD having been reported across several health zones in Ituri.
At least four deaths among clinic staff have also raised “concerns regarding healthcare-associated transmission, gaps in infection prevention and control measures, and the potential for amplification within health facilities”.
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Presently, officials are uncertain about the real number of infected individuals and areas affected by the disease.
There is also limited understanding as to how the existing cases are related.
Furthermore, the increasing number of suspected cases and deaths in Ituri suggests a potentially larger outbreak than what is currently known.
Source: UNICEF
Secondly, the international spread of Ebola disease has been documented, with two confirmed cases in Uganda in individuals who have travelled in Congo.
Finally, the WHO said international coordination and cooperation are required to understand the extent of the outbreak, and control the disease’s spread through surveillance, prevention and response efforts.
It stressed that conditions such as “high population mobility, the urban or semi-urban nature of the current hotspot and the large network of informal healthcare facilities” all contribute to the risk of spread of the disease.
This has been observed during the previous Ebola virus disease epidemic in Congo in 2018 to 2019, but unlike the previous Ebola-zaire strain involved, there are currently no approved vaccines or treatments for the BDBV.
The WHO has issued advice to State Parties — countries which adhere to the World Heritage Convention — on what to do, whether they have documented BVD cases, share a land border with countries with BVD cases, and other State Parties.
At present, Singapore falls in the “other” category, as there have been no reports regarding Ebola cases across the island.
Neighbouring Malaysia also has no current Ebola cases, its health ministry said, according to a Free Malaysia Today report on Wednesday (20 May).
Countries that have no current BVD cases nor share a land border with affected countries are advised not to close their borders nor restrict travel and trade.
“Such measures are usually implemented out of fear and have no basis in science,” the WHO stated, adding that these only push people to use unmonitored border crossings.
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However, low-risk State Parties are still advised to take precautions, including providing the public, including travellers to BVD-affected areas, with information regarding the disease.
Countries are also advised to prepare to facilitate the evacuation and repatriation of nationals who have been exposed to BVD.
However, the WHO also said screening is still not needed at airports or other ports of entry for passengers returning to low-risk countries from areas at risk.
In response to the global health emergency declaration, Singapore’s Communicable Diseases Agency (CDA) said on 19 May that it is closely monitoring the outbreak.
While there are no direct flights from Congo and Uganda to Singapore, and the number of travellers from these countries is low, it has also ramped up measures to prevent the importation of Ebola disease to the country.
Additionally, measures for the early detection and management of Ebola disease have been put in place.
The CDA now requires medical practitioners and laboratories to notify it immediately of all confirmed and suspected cases of Ebola disease.
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Incoming travellers are also required to declare their health status and travel history, and “will be subject to medical assessments at points of entry if they present with symptoms compatible with Ebola and have travelled to the affected areas”.
Starting 19 May, health advisories on the Ebola outbreak will also be displayed at all points of entry for incoming and outbound travellers.
Additionally, the CDA said it will adjust public health measures should the situation change.
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The CDA advises those travelling to Congo or Uganda to monitor the Ebola outbreak closely.
To reduce the risk of infection, they are urged to take precautionary measures such as practicing good personal hygiene.
Contact with people who are unwell, particularly those showing symptoms of Ebola disease, including their blood or bodily fluids, should be avoided.
Travellers are also advised to avoid visiting healthcare facilities, unless necessary, and participating in funerals or burial ceremonies that involve direct contact with the deceased.
Additionally, they are cautioned against making contact with animals, particularly bats and primates, and eating, cooking, or handling any meat from unknown sources.
Those who detect symptoms of Ebola disease should seek medical attention immediately and inform their doctors of their recent travel history, itinerary and any potential exposure.
Also read: What’s the Hantavirus & why have 2 S’poreans been quarantined in connection to it?
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