WHO updates Ebola recommendations as South Sudan, 8 other countries face high regional risk

The World Health Organization has updated its temporary recommendations for containing an outbreak of Bundibugyo virus disease in the Democratic Republic of Congo, warning that the regional risk remains high for nine countries bordering or near affected areas.

The WHO Emergency Committee met Aug. 18 to reassess the outbreak under the International Health Regulations. As of Aug. 14, the WHO assessed the risk as “very high” in Congo, where community transmission is occurring.

The regional risk was assessed as “high” for Angola, Burundi, Central African Republic, Republic of Congo, Rwanda, South Sudan, Tanzania, Uganda and Zambia.

Bundibugyo virus disease is caused by Bundibugyo virus, a member of the Orthoebolavirus genus. Unlike Ebola virus disease, there are currently no approved vaccines or therapeutics specifically for Bundibugyo virus disease, although clinical trials are underway, the WHO said.

For Congo, the WHO is calling for expanded emergency coordination, surveillance, laboratory testing, infection prevention and control, contact tracing, case management and safe and dignified burials.

Authorities are also being urged to establish security corridors to allow health workers and humanitarian responders to safely reach affected communities, including displaced-person camps.

The WHO recommended daily notification of suspected, probable and confirmed cases and called for contacts of confirmed and probable cases to be monitored for 21 days after their last known exposure.

The agency also urged Congo to strengthen community-based surveillance and rapidly investigate alerts, including unexplained clusters of illness or deaths.

For countries bordering areas with community transmission, including South Sudan, the WHO recommended strengthening surveillance at border crossings and preparing rapid response teams, laboratories and isolation facilities.

Countries are also being urged to pre-position personal protective equipment, sample collection kits, case investigation materials and safe-burial supplies at high-risk border areas and points of entry.

The WHO recommended that travelers arriving from areas with community transmission receive information about symptoms and precautions and that countries maintain mechanisms for identifying and following contacts who cross borders.

However, the WHO said suspension of flights or waterways from affected countries and blanket denial of entry to travelers and conveyances from those countries are not recommended.

The WHO called for greater involvement of community leaders, health workers, religious leaders, traditional healers, survivors and other trusted local actors to improve public understanding and acceptance of outbreak-control measures.

Authorities are encouraged to provide food, water, communication, financial and psychosocial support where movement restrictions are imposed to help affected communities comply with public health measures.

The recommendations also call for postponing mass gatherings in areas with ongoing community transmission and conducting risk assessments for events elsewhere.

The WHO said health authorities should maintain essential health services, including malaria diagnosis and treatment and maternal and child health services, while strengthening infection prevention measures in health facilities.

For countries without community transmission, the WHO assessed the risk as low but urged governments to prepare to detect, assess and manage travelers with unexplained fever arriving from affected areas.

The agency said countries should not suspend international travel solely because of the outbreak but should maintain surveillance, rapid notification and contact-tracing systems to prevent further spread.

The recommendations will be reviewed and updated as the epidemiological situation and scientific evidence evolve.