Ebola outbreak spreads across Africa as Nigeria reports case in woman back from Uganda

Outbreak in Congo and spread across Africa

The Ebola outbreak caused by the Bundibugyo strain began in Congo in May and has since spread to other African countries. More than 9,700 people have been infected, and nearly half of whom have died, according to AP, which calls it Congo's deadliest Ebola outbreak on record and the world's fastest-growing. Africa CDC figures put the number killed in Africa at about 4,700. Cases have been reported in Congo, Uganda, Kenya, France and Nigeria, and poor surveillance at entry points has been a recurring problem. France confirmed in June that a doctor returning from Congo had been infected, the first and only case outside Africa, and the patient recovered.

Jean Kaseya, director general of the Africa Centers for Disease Control and Prevention, said on Wednesday, 21 October, that the response had to move faster.

Ebola is crossing borders. Our response must move faster, with stronger coordination, greater solidarity and decisive political leadership.

The Nigerian case and the Entebbe question

Nigeria's health minister Ali Pate confirmed the case on Tuesday, 20 October, after laboratory testing. The patient is a 42-year-old Ugandan-born woman who lives in Abuja and is married to a Swiss diplomat based there. She returned to Nigeria on 3 October after about two and a half weeks in Uganda, started showing symptoms on 7 October, and tested positive on 20 October after treatment at two private facilities. WHO says she is in isolation and improving, but officials have not yet established where she was infected. Africa CDC says both she and the Kenyan patient passed through Entebbe airport on 3 October, and investigators are checking whether they could have been exposed through shared equipment or other contact.

Wessam Mankoula, head of emergency preparedness and response at Africa CDC, put it this way on Thursday:

One of the issues we are currently investigating has been some sort of interaction between the two cases at the airport.

Mankoula stressed that no link has been established.

Kenya, Uganda and the source of infection

Kenya has confirmed nine infections, including one death. The Kenyan man travelled from Congo through Uganda and reached Nairobi on 3 October, and he later died, Kenya's first recorded Ebola death in the current outbreak. Uganda, which declared itself Ebola-free in July after 20 cases, rejects the idea that the Nigerian woman was infected there. Government spokesman Alan Kasujja told AFP that linking Uganda to the case simply because she had holidayed there was "preposterous". WHO and Africa CDC said they had not received confirmed information that she had travelled to Congo, and a Swiss government statement says she is believed to have caught the disease while in Uganda. Patrick Otim, a WHO emergency response manager, said:

The source of exposure is still not known. The travel history of the patient is still being pieced together.

Swiss embassy staff in Abuja

The Swiss foreign ministry (EDA) confirmed that the infected woman is the wife of an employee at the Swiss embassy in Abuja. Her husband travelled with her to Uganda and is in isolation, though he has not developed symptoms. The other 25 embassy staff, eight Swiss nationals and 17 local employees, are well and, after consultation with the health ministry and WHO, need no isolation. The embassy remains open, and the EDA says all necessary health and safety measures have been taken. Whether the woman will be flown back to Switzerland for treatment has not been decided.

US travel rules tighten

The CDC issued a memo on Thursday, 22 October, adding a new entry requirement for travellers bound for the United States. From 3 November, every airline passenger flying to the US must file a digital or paper attestation confirming they spent none of the 21 days before travel in Congo. The May restriction on passengers who had been in Congo during the preceding three weeks was extended to US citizens in July. Earlier this year, the CDC also barred foreign nationals who had been in Uganda or South Sudan during the previous three weeks. The agency will hold briefing calls with US and foreign airlines on Friday, 23 October, to explain compliance, and it says no cases tied to this outbreak have been recorded on US soil.