From the article Weaver posted:

The new vaccine has some flaws, experts said. It appears to work only against one of the two most common strains of the Ebola virus, and it may not give long-lasting protection. Some of those who get it report side effects like joint pain and headaches.
...
The Lancet study was done in 11,841 residents of Guinea last year. Among the 5,837 people who got the vaccine, none came down with Ebola 10 or more days later. There were 23 Ebola cases among the thousands of others not immediately vaccinated.

So here we go again, an outbreak in DRC just hitting the news now. Normally I would say that a small outbreak in a remote area of DRC would be horrible but manageable, the last two there were contained fairly quickly and although the remoteness of the areas made accessing the zones difficult, it also meant the spread was more easily contained. When I started reviewing this outbreak around two weeks ago I was relatively confident it would be the same, however it seems the virus traveled to a major regional centre (Mbandaka) a city of more the a million crammed into a small area beside a port on the Congo river. It seems to have traveled via attendees at a funeral for what may be assumed to be a early unidentified case. This spread to an urban area, especially an urban area astride a major international river highway is much more problematic. It may be that a combination of risk awareness, early intervention, thorough contract tracing and as a last resort ring vaccination of probable contacts will stop the further transmission to other areas. As the article below states the WHO has decided this not yet a Public Health Emergency of International Concern, but this possibility exists that this will occur. I hope we have moved past the hysteria of the 2013/15 West African outbreak, although I am even less confident about this.
http://www.bbc.com/news/world-africa-44164027

https://www.theguardian.com/world/2018/ ... f-mbandaka

The Guardian now reporting more confirmed cases in Mbandaka which which is accurate to my knowledge.
Why the sudden upsurge in confirmed rather than presumed cases is that testing facilities are now operational, testing is one of the more dangerous occupations along with burial and so testing only happens when advanced equipment/well trained staff available, there is likely to be a spike in confirmed cases due to the availability of safe testing that does not necessarily indicate an actual increase in cases. The article also says that 300 confirmed indirect and direct contacts have been identified, which I expect to be an under estimate if it includes indirect. The 'ring vaccination' method which will be initiated soon, is where presumed cases and clear direct contacts are given the still experimental vaccine in addition to limiting movement and further contact to contain the spread. The vaccine seems to be effective but is only available in small amounts, the most effective measures are still hygiene, safe burial and education with rapid and effective contact tracing being the key. The initial few thousand vaccines arriving will probably be used immediately on contacts and health care teams, it is not clear how a major urban population will react to restricted access to the vaccine under an emergent outbreak situation as has only been live tested during the end of an extended outbreak.

More disturbing news from Mbandaka in the DRC, a number of patients infected or presumed infected have left or been removed from Ebola Treatment Units (ETU) Currently reported as three although I expect that number to be be revised up, BBC reports two were taken to a religious ceremony where it is expected they came in contact with many people while at the most infectious final stage immediately prior to death: http://www.bbc.com/news/world-africa-44229346
This is disturbing because DRC has had a good history of containing outbreaks by using community engagement rather than force to ensure isolation of infected individuals, I hope this not a sign that the community mistrust of health officials which had such a disastrous impact in the 2013-2015 outbreak in West Africa not taking hold in the DRC.
I understand that people may react to these events by suggesting forcible isolation as the next step, this would however probably make matters worse as it would make people reluctant to seek assessment and treatment and make identifying cases early pretty much impossible. We know that voluntary compliance with isolation and contact tracing the most effective means to limit transmission and with a vaccine available to treat contacts the identifying of contacts early is critical.

Harrowing.

And another outbreak reported in DRC, just a week after the last one confirmed over. This time in the east of the country near the border with Uganda, this probably unrelated outbreak has just been announced by the DRC Dept of Health, with 4 laboratory confirmed cases, this in the context of a hemorrhagic fever outbreak that had killed at least 30 people in the region. Hemorrhagic fever in this area could be Yellow Fever, Marburg virus or something else, it seems that at least some of these cases are EVD, 2 of the samples tested were negative.
EVD is endemic to this region, so a second outbreak in such a short period may just be an artifact due to better surveillance and testing, rather than an increase in outbreaks of the disease itself. Or it could actually be that this disease is becoming more common as humans encroach on territories where the vector (presumed to be fruit bats) is more commonly affected, or a combination of both these factors. The most positive note is that the response including surveillance, contact tracing and ring vaccination seems to have been effective in the May/June outbreak in the west of the country, and the DRC Dept of Health in conjunction with international partners is becoming even better at responding to outbreaks like this, the vaccine a new and apparently very useful tool. However the vaccine remains approved only for emergencies and is available in very small quantities, it is unclear how effective and how long a duration it is effective for. Data from the 2013/2015 outbreak in West Africa also indicates the virus can remain active in infected individuals for far longer than the 28 days we had always assumed.

The vaccine rVSV-ZEBOV is also only considered effective for the ZAIRE strain of the virus, and although DRC is the country formally known as Zaire this doesn't necessarily mean it is this strain.