Congo began an Ebola vaccination campaign Monday in a northwest provincial capital in a major effort to stem an outbreak that has already made its way from rural towns into a city of more than 1 million people.
The campaign comes a day after the health ministry announced that a nurse has died from Ebola in Bikoro, the rural northwestern town where the outbreak began and was first announced in early May. The death toll is now 27.
There are 49 hemorrhagic fever cases: 22 confirmed as Ebola, 21 probable and six suspected, according to Health Minister Oly Ilunga.
"We have established surveillance mechanisms and are following all cases and contacts," he said. "The response is well-organized because we have also put in surveillance measures at the entry and exit points of Mbandaka."
In a hopeful sign, two patients who were confirmed as positive for Ebola have recovered, and are returning to their homes though they will be monitored, Ilunga said. They have left the hospital "with a medical certificate attesting that they've recovered and can no longer transmit the disease because they have developed antibodies against Ebola," he said.
Ebola, however, does in many cases remain longer in semen, and therefore can be transmitted through sexual contact for some months after recovery.
Congo's health delegation, including the health minister and representatives of the World Health Organization and the United Nations, have arrived in Mbandaka, the northwestern city of 1.2 million where Ebola has spread, to launch the vaccination campaign Monday.
Dr. Eric Ekutshu, a doctor in the Wangata health zone in Mbandaka, received the vaccine Monday as part of a ceremony presided over by officials.
"I'm glad I have received the vaccine against Ebola," he said. "I ask the others (contacts and nursing staff) to get vaccinated to protect themselves. Everyone must adhere to this vaccination campaign with the goal of protection."
Guillaume Ngoie Mwamba, director of the Expanded Program on Immunization, was the first Congolese to receive the vaccine in Mbandaka.
"This is to give a message of safety and assurance to all of the population exposed to the epidemic," he said.
Two dozen vaccinators, including Congolese and Guineans who administered the vaccine in their country during the 2014-2016 outbreak, are in Mbandaka to start injecting the 540 doses that have arrived, the health minister said.
It will take five days to vaccinate about 100 registered patients, including 73 health care staff, who have had contact with patients and their relatives in the Wangata and Bolenge health zones of Mbandaka, he said.
The vaccination campaign will then move to the other two affected areas, the Bikoro and Iboko health zones.
More than 7,500 doses are available in Congo, WHO said Monday, adding that an additional 8,000 doses will be available in the coming days.
The vaccine, provided by U.S. company Merck, is still in the test stages, but it was effective toward the end of the Ebola epidemic that killed more than 11,300 people in Guinea, Sierra Leone and Liberia from 2014 to 2016. A major challenge will be keeping the vaccines cold in this vast, impoverished, tropical country where infrastructure is poor.
Congo President Joseph Kabila and his Cabinet agreed Saturday to increase funds for the Ebola emergency to more than $4 million. The Cabinet also endorsed the decision to provide free health care in the affected areas and to provide special care to all Ebola victims and their relatives.
The U.S. Agency for International Development has said that it has provided an initial $1 million to combat the Ebola outbreak. The funds are going to WHO in support of its joint strategic response plan with Congo's government.
The spread of Ebola from a rural area to Mbandaka has raised alarm as Ebola can spread more quickly in urban centers. The fever can cause severe internal bleeding that is often fatal.
"It's concerning that we now have cases of Ebola in an urban center, but we're much better placed to deal with this outbreak than we were in 2014," WHO's director-general, Tedros Adhanom Ghebreysus, said at the U.N. health agency's annual meeting in Geneva on Monday. "I am pleased to say that vaccination is starting as we speak today."
Tedros said he is "proud of the way the whole organization has responded to this outbreak, at headquarters, the regional office and the country office."
This is Congo's ninth Ebola outbreak since 1976, when the disease was first identified. The virus is initially transmitted to people from wild animals, including bats and monkeys. It is spread via contact with the bodily fluids of those infected.
While Congo has contained several Ebola outbreaks in the past, all of them were based in remote rural areas. The virus has twice made it to Kinshasa, Congo's capital of 10 million people, but was effectively contained.
There is no specific treatment for Ebola. Symptoms include fever, vomiting, diarrhea, muscle pain and at times internal and external bleeding. The virus can be fatal in up to 90 percent of cases, depending on the strain.
AP writers Carley Petesch and Geir Moulson contributed to this report.