Nearly 300 people who have tested positive for Ebola in the Democratic Republic of the Congo cannot currently be traced, Africa’s leading public health official has warned.
Dr Jean Kaseya, director general of the Africa Centers for Disease Control and Prevention (CDC), said on Thursday that the worsening humanitarian crisis and ongoing conflict in affected areas have left more than 1 million people living in camps that health teams are unable to reach.
His warning came as new projections from the World Health Organization’s Africa regional office, published in the Lancet Infectious Diseases journal, estimated that the outbreak could reach about 8,210 cases and 1,420 deaths by mid-September.
The modelling also indicated a 70% likelihood that the outbreak could spread to neighbouring South Sudan in the coming weeks.
So far, the DRC has recorded 1,118 confirmed cases and 291 deaths, while neighbouring Uganda has reported 20 cases and two deaths.
France said on Wednesday that a doctor who had been working in the DRC tested positive after returning home. The medical charity Alima, which employs the doctor, said it was “working to understand how the contamination may have occurred”.
Based on the reported figures for recoveries, active treatment and deaths, officials estimate that 297 people who tested positive are currently unaccounted for.
“This is a concern that we have. Where are these people?” Kaseya said.
DRC authorities said on Thursday that anyone who had been in affected provinces would need to wait 21 days before they could travel onwards.
The outbreak, caused by the Bundibugyo strain of the virus, is the largest on record for five weeks after declaration. At the same stage, the west Africa outbreak of 2014 to 2016, which infected more than 28,000 people and killed more than 11,000, had 239 cases and 160 deaths.
Computer models were used by the WHO to simulate three trajectories – low, central or high transmissibility.
There are signs that the DRC’s response is working to slow transmission, the authors said, and current figures are most in line with the central scenario, predicting between 6,636 and 10,287 cases by 16 September.
The worst-case scenario projects 66,000 confirmed cases by September.
Kaseya said 30% of new cases are among known contacts of confirmed cases, indicating “huge, huge community transmission”. Authorities intend to recruit 20,000 community health workers from the local area to boost contact tracing efforts, he said.
Bed occupancy in Ebola treatment centres is at 95% and “we didn’t reach the peak yet”, he added.
He said camps in which displaced people were living “have cases, and because we don’t have access to these camps, we cannot have the contact tracing. We cannot have a photo of what’s happening there. We cannot stop this outbreak, without resolving the humanitarian issue.”
Africa CDC and the WHO had earlier said $518m (£392m) of health spending would be needed to tackle the outbreak. When humanitarian needs are added, the total rises to $1.4bn, Kaseya said.
Only about 13% of $910m pledged to the response by international governments and organisations has so far been supplied, he said.
The first trial of drugs that may be able to treat the Bundibugyo virus is due to begin in the DRC next week, while a trial of an antiviral given to contacts to prevent them developing the disease will begin a week later.
