The World Health Organization (WHO) said today that the Democratic Republic of Congo (DRC) Ebola virus outbreak has grown to 32 cases, three of them in health workers, as more responders arrive on the scene and as funding help comes from the United Kingdom.

Meanwhile, in the United States, news yesterday of the exit of one of the country's top global health officials, coming on the heels of President Trump's proposed rescission of earlier Ebola response funds, has deepened concerns about the nation's preparedness for an epidemic such as Ebola.

Outbreak developments

In an update today, the WHO said that, as of yesterday, a total of 32 Ebola cases have been reported, including 2 confirmed, 18 probable, and 12 suspected. Eighteen deaths are among the cases.

All of the illnesses are in the Bikoro health zone in the DRC's Equateur province and are from the area covered by the Ikoko-Impenge health facility, about 19 miles from Bikoro's central health zone office. Bikoro is home to about 163,000 people and has 3 hospitals and 19 health centers, but most of them have limited service.

Of 21 cases, 17 had epidemiologic links to other patients, the WHO said. It added that, of eight previous Ebola outbreaks in the DRC, four occurred in Equateur province, though the new outbreak is the first to strike the Bikoro health zone. Home to about 163,000 people, Bikoro has 3 hospitals and 19 health centers, but most of them have limited service.

The WHO said it considers the risk within the DRC as high because of the nature of the disease and the lack of information about the scope of the outbreak. For the region, it said the risk is moderate because of the hot spot's location near the Congo River, which connects it to the capitals of the Republic of Congo and the Central African Republic.

Yesterday, the DRC's health ministry reported that 12 members of its expert team had arrived in Mbandka, the capital of Equateur province, to investigate the outbreak, identify contacts, and assess resources, according to a press release translated and posted by FluTrackers, an infectious disease news message board. The ministry said the multidisciplinary team will be supported by lab technicians who will move mobile labs from the National Institute for Biomedical Research (INRB) to the area.

The team also brought rapid diagnostic tests and laser thermometers, and health protection kits and medications were already in place in Mbandaka, the release said.

In a related development, Doctors Without Borders (MSF) said yesterday that an emergency team is working with the DRC's health ministry and other international groups to assess and support a rapid response to the outbreak. It added that its team is based in the Bikoro health zone and in Kinshasa.

Julien Raickman, head of MSF's DRC mission, said in the statement that MSF has worked alongside Congolese official in the past to care for patients and help control outbreaks. "At the moment, there is an experienced MSF team in Bikoro, made up of medics, water and sanitation experts, health promoters, logisticians, and an epidemiologist,” Raickman said. “The team is working with the national authorities and other international organizations to assess the situation and to ensure that the outbreak is contained."

Yesterday, a WHO Ebola expert aired serious concerns about the DRC's latest Ebola outbreak, given signs that it may have been underway for weeks or months and that several locations may be involved, Stat reported.

Pierre Formenty, DVM, MPH, also told Stat that though the outbreak is in a remote location, it is on a lake port that raises the worrying possibility of infected people traveling by boat via the Congo and Ubangi rivers to the large cities of Kinshasa, Brazzaville in the Republic of Congo, or Bangui in the Central African Republic. He added that the WHO is in talks with the DRC and Republic of Congo governments to set up a way to control boat traffic on the Congo River to identify any sick travelers.

Wellcome Trust, UK announce funds

Wellcome Trust said today that it is making an initial $2.7 million (£2 million) pledge to support a rapid response to the DRC's Ebola outbreak, and the UK's Department for International Development (DFID) said it is releasing $1.35 million (£1 million) from a joint research initiative on epidemic preparedness that it operates with Wellcome Trust to support the rapid response.

In its statement, Wellcome Trust said the funding will help the DRC and WHO conduct critical research.

Jeremy Farrar, MD, PhD, Wellcome's director, said, the group made the funds available immediately. "It's vital the global response to this outbreak is swift. We know from previous outbreaks that the DRC are ready to act, but they need global support to ensure this outbreak is contained effectively," he added.

The funds from Wellcome Trust and DFID come on top of $1 million that the WHO has already released from its emergency contingency fund.

US global health leadership changes raise worries

Yesterday, a day after news of the DRC's Ebola outbreak emerged, the Trump administration announced the departure of Rear Admiral Tim Ziemer, head of global health security on the White House's National Security Council (NSC), the Huffington Post reported.

John Bolton, President Trump's new national security advisor, has eliminated the office Ziemer led, and staff members have been placed in other NSC departments, according to the report. Last month, homeland security advisor Tom Bossert, who was also involved in global health security, resigned the day after Bolton started as national security advisor.

Robert Palladino, NSC spokesperson, told the Huffington Post that Ziemer left "on the warmest of terms."

Global health experts and former government officials contacted by the Huffington Post said Ziemer has been "one of the most quietly effective leaders in public health" and that expertise like his is critical for avoiding large outbreaks.

Ron Klain, who led the Ebola response under President Obama, told the paper that proposing rescission of Ebola funding on the day the new DRC outbreak was announced was misguided and that forcing out two officials in charge of epidemic response at the White House is even worse. "Doing it all at the same time shows a reckless disregard for the dangers we face," he said.

See also:

May 10 WHO outbreak update

May 8 CIDRAP News story "DRC confirms 2 Ebola infections, probes suspected cases"

May 8 FluTrackers post

May 9 MSF statement

May 9 Stat story

May 10 Wellcome Trust press release

May 10 DFID press release

May 10 Huffington Post story