While the world rightly focused on the growing number of Ebola cases emerging from Africa’s west coast this summer, the virus made another appearance in the heart of the continent: in the Democratic Republic of Congo (DRC), where Ebola was first identified in the 1970s. That outbreak—which was of another strain of Ebola Zaire—spread to just 69 people, however, and a report in the New England Journal of Medicine, has some answers as to why.
The DRC outbreak began with a pregnant woman who butchered and ate a dead monkey her husband had found in the Inkanamongo village, near a remote, forested area in the equatorial province. Presumably, the monkey was infected with Ebola; the woman became ill on July 26 and died on August 11. A local doctor and three health workers who performed a Cesarean section to remove the fetus before burial were also infected and died of Ebola.
Nearly two dozen others who were infected had direct contact with the woman, and most of them had helped care for her after she became sick. Forty nine of the 69 people who either had confirmed or suspected infection died. The number of cases was kept to a minimum, say the study authors, for five reasons, which could help inform how to contain the epidemic in the west.
PHOTOS: See How a Photographer is Covering Ebola’s Deadly Spread
Members of a Liberian Red Cross burial team, under contract from the Liberian Ministry of Health, remove the body of suspected Ebola victim Lorpu David, 30, on Sept. 18, 2014, in the Gurley street community in central Monrovia, Liberia.Daniel Berehulak—The New York Times/ReduxMembers of a Liberian Red Cross burial team, remove the body of woman, 75, a suspected Ebola victim on Sept. 18, 2014 in Monrovia, Liberia. Daniel Berehulak—The New York Times/ReduxA burial team collects the body of a 75-year-old woman in a neighborhood called PHP in Monrovia, Liberia, Sept. 18, 2014. Daniel Berehulak—The New York Times/ReduxA resident of the West Point neighborhood covers his nose as a burial team leaves with a body in Monrovia, Liberia, Sept. 17, 2014. Daniel Berehulak—The New York Times/ReduxMembers of a burial team from the Liberian Red Cross remove the body of a man, a suspected Ebola victim, from a home in Matadi on Sept. 17, 2014 in Monrovia, Liberia.
Daniel Berehulak—The New York Times/ReduxA member of a Liberian Red Cross burial team is disinfected, with chlorine sprayed on by a colleague, after having removed the body of a man, a suspected Ebola victim, on Sept. 6, 2014 in Monrovia, Liberia.
Daniel Berehulak—The New York Times/Reportage by Getty ImagesResidents look on as the body of a man suspected of dying from Ebola lies in a busy street after it was reportedly dragged there to draw the attention of burial teams. For several days, his family had asked for the body to be picked up, to no avail. Monrovia, Liberia, Sept. 15, 2014. Daniel Berehulak—The New York Times/ReduxFriends and relatives weep as a burial team removes the body of a 75-year-old woman. Her neighbors insisted she had died of a stroke. Monrovia, Liberia, Sept. 18, 2014.Daniel Berehulak—The New York Times/ReduxEric Gweah, 25, grieves as he watches members of a Red Cross burial team carry the body his father, Ofori Gweah, 62, a suspected Ebola victim, in a riverside area called Rock Spring Valley in central Monrovia, Liberia, Sept. 18, 2014. Ofori Gweah had endured Ebolaís telltale symptoms for six days, his family took him to treatment centers twice, only to be turned back. So many Ebola victims are dying at home due to a severe shortage of treatment centers in Monrovia, and many of the ill are infecting family members, neighbors and others in a ballooning circle of contagion. (Daniel Berehulak/The New York Times)Daniel Berehulak—The New York Times/ReduxResidents discuss an Ebola awareness campaign in Monrovia, Liberia, Aug. 30, 2014. Daniel Berehulak—The New York Times/ReduxResidents of the West Point neighborhood attend church after a 10-day quarantine was lifted in Monrovia, Liberia, Aug. 31, 2014. Daniel Berehulak—The New York Times/ReduxJames Dorbor, 8, suspected to have Ebola, lays on the ground as his father Edward tried to get the boy to drink coconut water. They waited for James to be admitted into the JFK Ebola treatment center on Sept. 5, 2014 in Monrovia, Liberia. Daniel Berehulak—The New York Times/Reportage by Getty ImagesEdward Dorbor reacts after believing that his son, James Dorbor, 8, had died. However, the boy survived for a few additional hours before dying at the JFK Ebola treatment center on Sept. 5, 2014 in Monrovia, Liberia. Daniel Berehulak—The New York Times/Reportage by Getty ImagesMedical staff rush into the treatment facility, carrying James Dorbor, 8, suspected of having Ebola. Since the health workers weren't wearing the appropriate protection against Ebola, they positioned James' body in a way to limit exposure to the deadly virus. Monrovia, Liberia, Sept. 5, 2014. Daniel Berehulak—The New York Times/ReduxA relative grieves as members of a Liberian Red Cross burial team dress themselves in full protective clothing prior to removing the body of suspected Ebola victim, Ofori Gweah, 62, on Sept. 18, 2014 in central Monrovia, Liberia.Daniel Berehulak—The New York Times/ReduxMedical staff spray down a small plastic bag containing the blood sample of Hawa Konneh, 9, a suspected Ebola victim, as she lays on the dirt wrapped in a shawl in front of the Doctors Without Borders (MSF) Ebola treatment center, as her mother, Masogbe, sits near to her prior to Hawa's passing away on Sept. 4, 2014 in Monrovia, Liberia. Daniel Berehulak—The New York Times/Reportage by Getty ImagesMarvin Gweah, 28, is overcome by emotion as members of a Liberian Red Cross burial team carry away the body of his father, Ofori Gweah, 62, a suspected Ebola victim, on Sept. 18, 2014 in central Monrovia, Liberia. Daniel Berehulak—The New York Times/Reportage by Getty Images
1. While both regions practice similar cultural rituals surrounding burial, including touching the bodies of the dead, some behaviors in the equatorial DRC differ from those in West Africa, and thus help to limit spread of the virus from person to person.
2. The strain circulating in DRC is also genetically different from that in Guinea, Sierra Leone and Liberia, and may have a different disease trajectory.
3. The remote and relatively isolated locations of villages in DRC helped to contain the virus and prevent it from spreading as quickly as it does in large, mobile populations.
4. The DRC may have a stronger health response to Ebola given its longer history with the virus. Since it first appeared there in 1976, the Congo has weathered six outbreaks and may have more experience in responding quickly and educating its citizens about how to control infection.
5. Finally, because the virus has circulated among the people in DRC, they may have more immunity to it, and could be in a better position to fight off infection.
The DRC outbreak provides a stark contrast to the way Ebola has erupted in West Africa; it shows how an experienced and prepared community might be one of the most important ways to help stop spread of a deadly disease. Similar strategies have helped to contain the epidemic in Nigeria and Senegal, which neighbor the most heavily affected countries in West Africa but are close to declaring their outbreaks over.
