Americans in Congo believed to have had exposure to suspected cases| STAT

Several Americans in the Democratic Republic of the Congo have potentially been exposed to suspected Ebola cases amid the latest outbreak, with some facing high-risk exposure, sources have informed STAT. One of these individuals might be showing symptoms.

According to a source, no test results are available for these individuals yet, but the U.S. government is reportedly planning to transport them out of the DRC to a location where they can be safely quarantined and treated if they are confirmed to be infected. It remains uncertain if this location will be in the United States, though there is some consideration of relocating them to an American military base in Germany.

The sources provided this information under the condition of anonymity, as they were not authorized to publicly discuss the situation.

In a statement on Sunday, the Centers for Disease Control and Prevention (CDC) expressed that it is “supporting interagency partners who are actively coordinating the safe withdrawal of a small number of Americans who are directly affected by this outbreak.”

The outbreak has reached significant numbers: 10 confirmed cases, 336 suspected, and 88 deaths in the DRC, including at least four health workers. This outbreak is one of the largest recorded, although it is considerably smaller than the West African outbreak of 2014-2016, which saw over 28,000 cases and 11,000 deaths.

On Sunday, the CDC held an urgent news conference to discuss the outbreak, which the World Health Organization has declared a public health emergency of international concern (PHEIC). However, when questioned about whether any Americans have been exposed to Ebola and the government’s plans to extract them from the DRC, the CDC’s incident manager, Satish Pillai, did not provide answers.

Neither the State Department nor the Department of Health and Human Services has responded to repeated requests from STAT for information about the situation.

“We don’t discuss or comment on individual dispositions,” Pillai stated. “It is a highly dynamic situation, and at this point, what I would say is, we continue to assess [and] we will continue to keep you posted as we learn more.”

Pillai noted that the CDC is assessing the ground needs and is working to deploy experts to assist with the response.

Despite the lack of official answers, STAT has learned that the U.S. government has been contacting health care facilities that have high-containment treatment capabilities to quarantine people with high-risk Ebola exposure and provide care for those who fall ill.

A source informed STAT that the situation is fluid, with numbers changing daily. However, efforts are underway to expedite the extraction of some Americans from the DRC.

These efforts are complicated by the fact that one of the facilities equipped to quarantine individuals suspected of being infected with a high-consequence pathogen like Ebola is currently housing Americans who were on the MV Hondius, a cruise ship recently involved in a hantavirus outbreak.

The Ebola outbreak was declared a PHEIC late Sunday, Geneva time, by WHO Director-General Tedros Adhanom Ghebreyesus. This declaration was made without convening an expert panel, highlighting the seriousness of the situation.

The confirmation of an Ebola outbreak in northeastern DRC was only announced Friday by the DRC’s National Public Health Institute.

Daniel Jernigan, who previously led the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, indicated that the signs suggest an outbreak that may take considerable time to control. The size of this outbreak at its declaration is unusual, hinting at the challenge of tracing all transmission chains.

“There is a lot that we don’t know here, and it has happened very quickly, and the numbers suggest that it’s not going away anytime soon,” Jernigan commented.

The WHO reported on Sunday that the first known suspected case, a health worker, developed symptoms on April 24. It is unlikely that a health worker would be the initial case; more likely, someone infected by a bat or another person brought the virus into a healthcare setting. This implies the outbreak had been ongoing for some time before being identified as Ebola.

Two individuals from the DRC traveled independently to Kampala, Uganda, where one died. Currently, there is no indication of continued transmission in Uganda, according to the WHO.

The outbreak is attributed to the Bundibugyo species of Ebola, marking only the third recorded outbreak involving this species, with the previous two occurring in 2007 and 2012.

Historically, Bundibugyo has been considered less risky than the Zaire and Sudan ebolaviruses due to its infrequency and believed lower fatality rate. There is no licensed vaccine for Bundibugyo, and it is unlikely that there are enough experimental doses available for deployment in this outbreak.

The outbreak originated in Ituri province in northeastern DRC, near the borders of Uganda, South Sudan, and Rwanda. This location was the epicenter of the second-largest Ebola outbreak in history from 2018 to 2020, with 3,470 cases and 2,287 deaths, caused by the Zaire ebolavirus. The ongoing conflict in this region, which complicated the previous response, is likely to be a challenge again. During the 2018-2020 outbreak, cross-border transmission was common due to the regular movement of people in the area.

This story has been updated with a statement from the CDC.