One Health 14 (2022) 100379 Available online 15 March 2022 2352-7714/© 2022 Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Recurrent Ebola outbreaks in the eastern Democratic Republic of the Congo: A wake-up call to scale up the integrated disease surveillance and response strategy Olivier Kambere Kavulikirwa a, * , Franck Katembo Sikakulya b, c a Faculty of Veterinary Medicine, Universit´ e Catholique du Graben de Butembo, Democratic Republic of the Congo b Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda c Faculty of Medicine, Universit´ e Catholique du Graben de Butembo, Democratic Republic of the Congo. A R T I C L E INFO Keywords: Ebola outbreak IDSR IHR (2005) One health Early warning Emergency preparedness Health security ABSTRACT Ebola virus disease (EVD) is a dangerous viral zoonotic hemorrhagic fever caused by a deadly pathogenic flo- virus. Frugivorous bats are recognized as being the natural reservoir, playing a pivotal role in the epidemiological dynamics. Since its discovery in 1976, the disease has been shown to be endemic in the Democratic Republic of the Congo (DRC). So far, thirteen outbreaks have occurred, and EVD has been prioritized in the national sur- veillance system. Additionally, EVD is targeted by the Integrated Disease Surveillance and Response (IDSR) strategy in DRC. The IDSR strategy is a collaborative, comprehensive and innovative surveillance approach developed and adopted by WHO's African region member states (WHO/Afro) to strengthen their surveillance capacity at all levels for early detection, response and recovery from priority diseases and public health events. We provide an overview of the IDSR strategy and the issues that can prevent its expected outcome (early detection for timely response) in eastern DRC where there are still delays in EVD outbreaks detection and weaknesses in response capacity and health crisis recovery. Therefore, this paper highlights the advantages linked to the implementation of the IDSR and calls for an urgent need to scale up its materialization against the recurrent Ebola outbreaks in eastern DRC. Consequently, the paper advocates for rapidly addressing the obstacles hindering its operationalization and adapting the approach to the local context using implementation science. 1. Introduction Infection caused by Ebola Virus is a fatal disease in both human and non-human primates populations [1]. Belonging to the genus Filovirus, the species of this group have different virulence and the Zaire Ebola virus is known to be the most fatal [2]. So far, bats (Suborder Micro- chiroptera) are known to be putative reservoir hosts of the flovirus, playing a crucial role in the epidemiology of the Ebola Virus Disease (EVD) [3,4]. An Ebola outbreak often starts from a single case of zoo- notic transmission which is followed by a human-to-human transmission through either direct contact with a patient or deceased or contact with body fuids from an Ebola-infected person [5–7]. The disease is a huge threat to both public health as well as wildlife conservation, suggesting a need for effective control efforts for better health security for humans and nonhuman primates [8]. Also, Ebola Virus epidemics cause tremendous social and economic consequences to affected communities. For instance, it has been reported that huge mental health challenges result from the Ebola Virus Disease, the emotional reaction of communities fearing the virus, and the loss of revenue and high cost of preventive measures and patient care [5,6,9,10]. Likewise, Ebola Virus Disease crises have negative consequences on the health systems of affected countries with fragile health systems [11]. During outbreaks, there are challenges on the supply chain, poor pro- vision, and utilization of health services, and many other issues reducing the availability and accessibility of health services [12]. Due to its epidemiological patterns, the huge burden on public health systems and the need for a huge amount of resources for sanitary responses, EVD is a Abbreviations: IDSR, Integrated Disease Surveillance end Response; EVD, Ebola Virus Disease; IHR (2005), International Health regulations (2005); CBS, Com- munity-based surveillance; HMIS, Health Management and Information System. * Corresponding author. E-mail address: olivierkavulikirwa@ucraben.ac.cd (O.K. Kavulikirwa). Contents lists available at ScienceDirect One Health journal homepage: www.elsevier.com/locate/onehlt https://doi.org/10.1016/j.onehlt.2022.100379 Received 8 December 2021; Received in revised form 10 March 2022; Accepted 10 March 2022