The number of confirmed cases in the growing Ebola outbreak in the Democratic Republic of the Congo (DRC) has risen to 676, including 136 deaths, as health officials warn it’s likely to get worse.

Among the dead are two victims who were living in a displacement camp in eastern DRC, which has been plagued by conflict between the government and rebel groups. According to Reuters, the mother and daughter, who died on May 31 and June 1 and later tested positive for Ebola, were living in a camp that’s hosting 30,000 internally displaced people in cramped and unsanitary conditions. 

“We are all really worried that Ebola in these camps will spread extremely quickly and that there will be panic and people will flee all over whether or not they’re contacts, whether or not they’re ill,” Caitlin Brady, country director for the Danish Refugee Council in Congo, told the news agency.

Officials with the World Health Organization (WHO) said the number of affected health zones in DRC is growing.

“Every day, cases are being identified in new health zones. And that reflects really the scale of this outbreak, a scale that is much bigger than what is being detected and the high mobility of the population in this part of the DRC,” Olivier le Polain, PhD, of the WHO said at a press conference today. 

Concern over potential spread to children

UNICEF officials say they’re concerned about the potential impact on children in the country.

“Most cases to date have been among socially and economically active adults, but as the outbreak evolves, we must be prepared for increasing household transmission, which means we may see children affected in the days ahead,” Douglas Noble, MD, UNICEF’s global incident manager for Ebola, said at a press conference today. Noble said previous Ebola outbreaks in the DRC have shown that children make up a significant share of cases.

Noble said the problem is that early symptoms in children—like fever, diarrhea, vomiting, tiredness, and loss of appetite—are hard to differentiate from other diseases that affect kids in the DRC, such as malaria. 

US to provide funding for medical countermeasures

The outbreak is concentrated in three provinces in eastern DRC—Ituri, North Kivu, and South Kivu. It’s the 17th outbreak in the DRC since Ebola was first identified in 1976, and the fourth largest overall. An additional 19 cases have been confirmed in neighboring Uganda, including two deaths. 

Health officials from the DRC and the WHO believe the outbreak, which was initially declared on May 15, began months earlier and was spreading undetected. The outbreak is caused by the rare Bundibugyo Ebola virus, which has no licensed treatments or vaccines. WHO officials have prioritized several vaccine and therapeutic candidates, but it will be several months before clinical trials can even begin.

Most cases to date have been among socially and economically active adults, but as the outbreak evolves, we must be prepared for increasing household transmission, which means we may see children affected in the days ahead.

The US Department of State said today that it’s working with Congress to provide $50 million to the Coalition for Epidemic Preparedness to develop medical countermeasures, including vaccines, for the Bundibugyo strain.

“This funding would support laboratory studies and clinical trials using ethically proven methods, and manufacturing for Bundibugyo medical countermeasure candidates,” the department said in a statement.