Uganda ordered citizens returning from the Democratic Republic of Congo to quarantine for 21 days on Sunday, stepping up precautions against Ebola while investigators examine whether the first patients confirmed in Nigeria and Kenya crossed paths at a Ugandan airport.1,3,4
Health Minister Chris Baryomunsi announced the measure at a news conference in Kampala. Returning Ugandans with a history of travel to the Democratic Republic of Congo will have to pay for their quarantine, the Ministry of Health said. Officials have also strengthened checks at Entebbe International Airport and land crossings, and all incoming travelers must complete forms recording how they can be contacted.1
Uganda declared its Bundibugyo Ebola outbreak over on July 28, after recording 20 infections and two deaths, according to the Health Ministry, and the country says it has no active infections. NPR reported that Uganda was declared Ebola-free in August.1,3
Nigeria is the fourth African country to record a case in the current outbreak, and the first in West Africa. Swiss authorities have said that a Ugandan-born woman married to a Swiss diplomat was believed to have contracted Ebola during a visit to Uganda in September. Nigeria confirmed her infection on October 20, after she had traveled to Abuja, the capital. Nigerian health authorities described her as the wife of a diplomat based in Abuja, while Breitbart described her as the spouse of an employee at the Swiss embassy in Uganda.1,3,5
Nigerian Health Minister Muhammad Ali Pate confirmed the case in the Federal Capital Territory. "Today we are confirming that there has been one imported case of Ebola virus disease in the Federal Capital Territory," Pate said. He said the patient was stable and that 44 contacts had been identified, including health care workers, caregivers, patients and people who may have encountered her during her travels. Breitbart reported that she was first wrongly diagnosed with malaria, and that Swiss authorities said she was hospitalized and responding to treatment.3,4,5
Uganda's Health Ministry said preliminary findings indicated that the Nigerian patient had traveled to eastern Congo for business before passing through Uganda without symptoms. In an October 20 statement, the ministry said, "Travel through Uganda does not establish that infection occurred here. The location of exposure remains under investigation." At Sunday's briefing, Baryomunsi challenged the conclusion that she was infected in Uganda, saying relatives who had previously visited the DRC had met the woman in a Kampala suburb. He questioned whether that route of exposure had been ruled out. "We should speak science, not politics," he said.1,4
Switzerland's Federal Department of Foreign Affairs disputed the account that the woman had visited the DRC. "She and her husband did not travel to the Democratic Republic of the Congo," the department said in a statement to Reuters. The Swiss government told Reuters on Thursday that she was believed to have contracted Ebola while traveling with her husband in Uganda, an assessment that has not been independently confirmed. Its statement said the infection "may have occurred during a trip to Uganda approximately two weeks ago" and that her husband was in isolation and had shown no symptoms.4,5
The World Health Organization said on Thursday that the information it had received did not show the woman herself had traveled to the DRC. The Africa Centers for Disease Control and Prevention also said it had not received confirmed information establishing that travel. Uganda says it is awaiting more detailed information from Nigeria about her movements, and Nigerian and Ugandan officials are investigating her movements and possible source of infection.1,4
The inquiry has also turned to a Kenyan man who traveled from the DRC through Uganda before flying to Nairobi on October 3. He died two days later, and Kenya has since reported a second Ebola death. Eight other cases have been confirmed in Kenya since the first. Kenya's director-general for health, Patrick Amoth, said officials were searching for a Ugandan national identified as a contact of the deceased patient. "We know him (the Ugandan) by name and passport number and from his phone but we are not able to reach him," Amoth told Kenya's Daily Nation, which reported that the man was using a South Sudanese telephone number.1,3,4
Both patients passed through Entebbe International Airport on October 3, according to Wessam Mankoula, head of emergency preparedness and response at the Africa Centers for Disease Control and Prevention. Mankoula said the center was probing whether there had been "some sort of interaction between the two cases at the airport." Ugandan officials said on Sunday that security footage showed no physical interaction between them. Nigerian authorities said genetic testing found closely related viruses in the two cases, but no direct link had been established. Baryomunsi said 60 people traced in Uganda after possible contact with the Kenyan patient had finished 21 days of monitoring and been discharged.1,3,4
In the DRC, where the outbreak began in May, the WHO had recorded 9,704 cases and 4,687 deaths by October 20. NPR put the figures at about 9,700 infections and at least 4,600 deaths, while Breitbart cited 9,066 cases and 4,381 deaths as of mid-October. The outbreak has reached eight Congolese provinces. The Bundibugyo strain behind it has no approved vaccine or specific treatment. Ebola spreads through direct contact with the bodily fluids of infected people, and symptoms can take up to 21 days to appear, according to the WHO. In its October 23 update, the WHO urged stronger monitoring and cooperation across borders, while advising against restrictions on travel or trade with affected countries.1,3,5
Africa CDC Director-General Jean Kaseya urged the countries involved to avoid disputes and finger-pointing and to be forthcoming with information. "What we know is that the lady came from Uganda, but what we don't know is whether it is a transmission from Uganda, Kampala, or a transmission that came from another place," Kaseya said in an interview. "What we want is collaboration from this lady. She has to tell us, to disclose to the authorities; I need this information, Nigeria needs this information because we need also to support Uganda."5
