Prior to 2014 Ebola outbreaks were usually small and in remote areas and thus controlled relatively easily once recognised. The outbreak in 2014, however, occurred in urban areas and caused nearly 30,000 cases and over 13,000 deaths. In addition, the World Bank estimated that the West Africa epidemic cost the three affected countries $2.2 billion in lost gross domestic product in 2015. Ebola is again spreading in urban areas, this time in the Democratic Republic of the Congo. Since September, the incidence of Ebola has more than doubled and the outbreak is now the second largest one to date. The virus has spread to 11 DRC health zones, and the WHO has deemed the risk of further national and regional spread to be very high. The majority of people with recently diagnosed Ebola were not on existing lists of contacts of people with the disease. This concerningly indicates unrecognized transmission in the community. Control efforts are being hampered by civil unrest, armed conflict, inadequate infection prevention and control in healthcare settings and community resistance. No cases have been reported in neighbouring countries to date but if the outbreak continues the risk of spread is high particularly to Uganda and also Rwanda and South Sudan. Heightened surveillance has been implemented in Burundi, Rwanda, South Sudan, and Uganda. Unlike previous outbreaks vaccination is being trialed with over 53,000 people being vaccinated in affected areas. In addition, experimental treatments are being used.
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