Health authorities in Kenya and Nigeria are investigating whether their first confirmed Ebola patients crossed paths at Uganda's Entebbe International Airport on October 3, as Switzerland disputes Uganda's account of the Nigerian woman's travel history.3,6
Nigeria reported its first Ebola case in more than a decade on Tuesday, making it the fourth African country affected by an outbreak that began in the Democratic Republic of Congo in May and that health officials have described as the fastest-spreading on record. The patient, a woman, arrived in the capital, Abuja, via Addis Ababa on October 5, according to Odianosen Ehiakhamen of the Nigeria Centre for Disease Control.2,5,6
Ehiakhamen said she began feeling unwell two days later and sought treatment at a private hospital in Abuja on October 11 with malaria-like symptoms. Officials tested her for Ebola on October 19, after learning she had recently traveled to Uganda, and the positive result was confirmed on Tuesday. Health Minister Muhammad Ali Pate said: "Today we are confirming that there has been one imported case of Ebola virus disease in the Federal Capital Territory." Pate told public broadcaster NTA that she was in isolation and receiving treatment.2,3
Ayoade Alakija, a Nigerian physician who co-chairs a G7 committee for investment in global health, said: "My concern, now that this has spread from East Africa to West Africa, is that we now have a pan-African event, as opposed to a few at-risk countries." Alakija also noted that it had taken 12 days from the time the woman fell sick until she was tested, potentially exposing many other people. "Abuja is one of Africa's main cities … with air and road connections daily, multiple, across the world. It's a very different prospect – and that's what worries me — the amount of time it took."2
Wessam Mankoula, head of emergency preparedness and response at the Africa Centers for Disease Control and Prevention, said on Thursday that the first confirmed patients in Kenya and Nigeria had both passed through Entebbe on October 3. Health officials say the two may have crossed paths, but it has not been established whether they encountered each other or whether any transmission occurred at the airport. Investigators are examining whether they were at the airport at the same time.3,6
Uganda's health ministry says preliminary findings indicate the Nigerian woman traveled to eastern Congo for business, then passed through Uganda without symptoms and returned to Nigeria. 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." Nigerian authorities have not confirmed that she visited Congo.3,2
On Friday, Switzerland's Federal Department of Foreign Affairs disputed that account in a statement to Reuters. "She and her husband did not travel to the Democratic Republic of the Congo," the department said. On Thursday, the Swiss government had told Reuters that she was believed to have contracted Ebola while traveling with her husband in Uganda, an assessment that has not been independently confirmed. DW reported that Swiss authorities identify her as a Swiss national of Ugandan origin who is married to a Swiss diplomat based in Abuja, while the New York Post described her as a Ugandan woman.3,6,2
The World Health Organization and Africa CDC said on Thursday that they had not received confirmed information that she had traveled to Congo, and Mankoula said there was no validated information of such travel. Pavel Ursu, the WHO representative in Nigeria, said the information given to the organization included no travel outside Uganda. Patrick Otim, a WHO emergency response manager, said the source of her infection was still unknown. Ugandan authorities rejected the suggestion that she was infected in the country. Government spokesman Alan Kasujja told AFP it was "preposterous" to link Uganda to the case simply because she had holidayed there.6,3
In Kenya, the first confirmed patient died in Nairobi on October 5 after traveling from Congo through Uganda, and health officials have established that this patient also passed through Entebbe on October 3. Al Jazeera reported that Kenya's Ministry of Health had since reported eight more cases, and that Patrick Amoth, the ministry's director-general, said officials had traced all 135 contacts of the first case. DW, citing Kenya's Daily Nation, reported separately that officials are still searching for a Ugandan national identified as a contact of the deceased patient, who was using a South Sudanese telephone number. Amoth told the newspaper: "We know him (the Ugandan) by name and passport number and from his phone but we are not able to reach him."3,6
Mohamed Janabi, the WHO's regional director for Africa, told an online media briefing on Thursday: "We are facing a more complex outbreak landscape." Kenya, Congo and Nigeria all have active or recent cases of the Bundibugyo strain, while Uganda, which had cases earlier in the year, has since been declared Ebola-free. Congo's health authorities say the outbreak has killed more than 4,000 people since May, while the New York Post put the death toll at 4,646. The Africa CDC has warned of an "extremely serious threat," with the fatality rate in Congo approaching 50 percent.6,2,5
Nigeria is tracing 44 contacts, and Mankoula said more had since been identified without giving a new number. Investigators are examining which Abuja health facilities the woman visited between the onset of her symptoms and her hospitalization 48 hours later, Otim said.3,6
