Bundibugyo Ebola Outbreak: Why Diagnosis and Treatment Remain So Difficult

On May 15 this year, an Ebola outbreak caused by the rare Bundibugyo virus was declared in the Democratic Republic of the Congo (DRC) and Uganda. The virus species is named after the Ugandan region where it was first recorded in 2007.

In the two previously known Bundibugyo virus outbreaks in these countries, case-fatality rates ranged from 30% to 50%. By September 23, the number of infected people in the DRC had reached 7,890, with about 3,799 deaths — a mortality rate of approximately 48%.

There are no approved vaccines or treatments specifically for this type of Ebola virus. Two of Bundibugyo virus’s four vaccine candidates are currently in clinical trials. Several drugs are also being tested for people who may have been exposed to the virus but have not yet developed symptoms.

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Richard Kojan, an intensive-care physician with the Alliance for International Medical Action (ALIMA) in Paris, is working on the front lines of the response in the DRC.

Healthcare workers face significant challenges because Bundibugyo virus infection can cause symptoms similar to those of the more deadly Zaire strain, including fatigue, headache, fever, bleeding, severe diarrhea and vomiting. Many people arrive at treatment centers with circulatory shock and eventually die from multiple-organ failure.

Kojan has more than 20 years of medical experience. After graduating from the University of Kinshasa as a specialist in intensive care and anesthesiology, he began working as an anesthesiologist in public and private hospitals in 2002. He joined ALIMA in 2010.

What are the challenges of controlling the Ebola outbreak?

Many viruses in the Filoviridae family, including Ebola virus, have no vaccines. Health systems in low-income countries such as the DRC are often ill-prepared for outbreaks, which can delay detection and allow the virus to spread while laboratory testing is underway.

Limited resources can also mean that healthcare workers lack adequate training in infection prevention and control, including patient isolation, or do not have essential medical equipment. These challenges contribute to high mortality rates, particularly during the early stages of an epidemic.

Why is Ebola diagnosis often delayed?

Ebola is not always the first condition healthcare workers consider when someone develops symptoms. Fatigue, for example, is an early symptom, but many people in the region work extremely hard and may already feel tired. Seeing these symptoms does not immediately lead everyone to suspect Ebola.

Better diagnosis could have limited this Ebola outbreak

Ebola symptoms also resemble those of other tropical diseases, including malaria. Even when people seek treatment quickly, healthcare workers must rule out other illnesses before considering Ebola. During this delay, the virus continues multiplying in the body.

What is happening on the front lines of the Ebola outbreak?

Many people arrive at treatment facilities with metabolic disorders, electrolyte imbalances caused by fluid loss, unstable blood pressure, reduced blood flow to vital organs, shock and difficulty breathing.

Healthcare professionals must urgently correct electrolyte imbalances with intravenous potassium and treat respiratory problems with oxygen. Antibiotics are used to prevent bacterial infections, which are a major complication of Ebola, while epinephrine is used to combat shock.

Treatment is complicated because Ebola patients are kept in separate rooms in an area of the hospital known as the red zone. Medical professionals must wear full personal protective equipment (PPE) to enter, and putting it on takes time. PPE also makes it difficult to monitor patients continuously and intervene quickly when their condition changes.

Wearing PPE causes profuse sweating, making it difficult to remain in the red zone for more than 30 minutes. After 20 minutes, Kojan begins to feel sick. Yet the treatment facilities are full of patients, making it impossible to spend only 30 minutes inside and still help everyone who needs care.

What is CUBE, and how could it affect Ebola treatment?