Vaccinations against the latest outbreak of the deadly Ebola virus in the Democratic Republic of Congo (DRC) began on Wednesday in North Kivu Province, according to the World Health Organization (WHO).
An experimental vaccine is being used after it proved successful during its first wide-scale usage during the recent outbreak in Equateur Province.
An analysis of genetic sequencing showed that while the outbreak in North Kivu Province is new, it is the same Zaire strain of virus.
The country's 10th outbreak was announced on August 1 by the Ministry of Public Health. So far, at least nine people have died. In total, there have been 18 confirmed cases, 27 probable cases and 46 suspected ones.
Security situation remains a concern
The current outbreak is further complicated by the presence of multiple armed groups in North Kivu Province, which shares a border with Uganda and Rwanda.
Health workers in the region are currently relying on the support of the United Nations peacekeeping force known as MONUSCOto carry out their work.
"The security situation in North Kivu is likely to be a major constraint in addressing this current Ebola outbreak," WHO spokesman Tarik Jasarevic told DW. "Obviously our concern is the access — are we going to be really able to get to all places where we need to go once we start the epidemiological work on investigating where the virus may have gone, where people who may have been infected are? We are trying to see what security measures we will have to follow so we can do our job."
For decades, eastern Congo has suffered from on-and-off war and remains beset by ongoing conflicts over land and ethnicity.
Since late 2014, approximately 1,000 civilians have been killed by both local and state forces in the area around the city of Beni, where a number of health workers are currently based.
No mass vaccination
The volatile security situation also has the potential to impact the method of vaccination used by WHO to try and contain the outbreak.
As with the previous outbreak, health workers plan on using the ring vaccination method, which targets only those who are most likely to be infected — effectively creating 'rings' around people who are already infected with the virus. So far, more than 900 people who have been in contact with those infected have been identified. However, WHO is prepared to adapt its vaccination strategy if necessary.
"We may also have to vaccinate the whole village because of the security constraints," Jasarevic said. "We don't really have the time to spend long hours identifying precise people. But it is really important to note that this is not going to be mass vaccination. The Ebola vaccine is meant to protect people who are at high risk."
The vaccine needs to be kept at extremely cold temperatures, which adds to the challenge of distribution in hot, central African countries.
The importance of educating communities
As with previous outbreaks, keeping local communities informed about developments and safety measures is a key component of WHO's work in the region.
"We are working really hard to explain to the population what needs to be done," Jasarevic said. "We obviously need people who speak the language and know the context, so we are working with partners like UNICEF to put in place those community engagement measures."
This includes making sure people take sick family members to a health facility rather than keep them at home where they pose a risk to others. Alerting them to the importance of safe burials is also a priority.
The disease, which includes symptoms such as fever, vomiting and diarrhea, is spread through direct contact with body fluids.
Uganda on high alert
The health ministry in neighboring Uganda has issued an alert, asking health workers in the region to be remain vigilant and intensify their surveillance.
The risk is considered higher than usual as the fragile security situation in affected areas of the DRC is encouraging the movement of refugees across the border. The city of Beni, where many WHO workers are based, lies approximately 100 kilometers (62 miles) from the border with Uganda.
"We are screening all people coming in from DRC, of course, in order to ensure that people in our country are safe from the disease," Uganda's Deputy Minister of Health, Sarah Opendi, told DW.
However, Opendi is optimistic that Uganda will be able to handle the latest outbreak as it has done in the past.
"There's a lot of cooperation from the public so there's no cause for alarm because over the years we have developed a rapid response on the ground," she said. "We strongly believe that [the DRC] will be able to contain the situation within a short time and we will not have many more new cases."
Uganda has sent a team of 20 doctors to districts along the DRC border, where they will continue to monitor the situation until the outbreak is confirmed to be over.
The country has suffered five Ebola outbreaks in its history — the last being in 2012 which killed 17 people.