Kenya’s first recorded Ebola death has raised fears that the ongoing outbreak in the Democratic Republic of the Congo could spread to other countries, after an infected man arriving from the Congo via Uganda passed health screening procedures at Entebbe and Nairobi airports before his infection was detected and he was isolated at a hospital in the Kenyan capital.
The infected man’s journey from the Congo to Nairobi
Kenyan Health Minister Aden Duale said the infected man was an unidentified Kenyan national who had fallen ill about a month earlier in the Democratic Republic of the Congo, where he had lived for 7 years and received treatment. On 2 October, he left the city of Beni by road for the Ugandan capital Kampala, before boarding a flight to Nairobi, where he arrived the following day.
After arriving, one of his relatives and a friend took him to a hospital in Nairobi, where he was isolated and tests showed that he had the virus. The man died last Monday and was buried the following day in accordance with Kenya’s approved protocol for handling Ebola deaths. The death was attributed to the Bundibugyo strain of Ebola, first detected in Uganda in 2007, according to the World Health Organisation.
No vaccine is available for this strain, unlike the Zaire strain that caused the outbreak in West Africa between 2014 and 2016 and for which vaccines have since been developed. By last Thursday, Kenyan health authorities had identified 57 people who may have come into contact with the infected man, including members of his family and health workers.
Screening gaps at Entebbe and Nairobi airports
Passengers arriving from Uganda and Kenya, travelling to either country or transiting through them undergo repeated temperature checks and are required to complete at least two digital forms concerning the possibility that they were exposed to the virus in the Democratic Republic of the Congo. But the man passed through these procedures without his condition being detected. Uganda’s Ministry of Health said the man’s temperature was normal when he was screened at Entebbe airport before his departure.
Kenyan authorities, however, said he may have taken medication that concealed his symptoms during a later screening at Nairobi airport, noting that this possibility was still under investigation. A senior Ugandan health official said the authorities were trying to review the digital form the infected man was expected to have completed at Entebbe airport. Officials are also reviewing surveillance-camera footage in an effort to identify the driver who took the man to the airport.
Ugandan government spokesman Allen Kasujja rejected the attempt to draw his country into the discussion about the case, writing on X: “Take Uganda out of this discussion. We do not have Ebola here.” Uganda had treated 20 people who arrived from the Democratic Republic of the Congo before declaring itself free of the virus last July.
The widening outbreak and obstacles to containing it in the Congo
Wolfgang Preiser, professor of medical virology and head of the department at Stellenbosch University in South Africa, believes the tracing system appears effective, as it was in Uganda. He based his assessment on the speed with which the infected man was diagnosed after arriving in Kenya. The current outbreak began in Ituri province in the north-east of the Democratic Republic of the Congo, and the authorities officially announced it in May.
It later spread to 7 provinces in the north and east of the country, recording at least 4148 deaths among 8300 reported infections. Efforts to contain the outbreak face simultaneous obstacles, including weak infrastructure and the remoteness of affected areas, as well as conflict with armed groups near the Democratic Republic of the Congo’s borders with South Sudan, Uganda and Rwanda.
The response is also being affected by strikes by health workers who have not been paid, the spread of misinformation and cultural practices including family funerals held with open coffins. Médecins Sans Frontières warned last Monday of a “worrying rise” in infections in North Kivu province, which borders Uganda and currently accounts for about 40% of new infections.
Stephanie Hoffmann, coordinator of the organisation’s Ebola treatment centre in the city of Butembo, likened efforts to tackle the outbreak to “fighting a massive fire”. About 2 million people live in Butembo and the surrounding areas. The region has 4 Ebola treatment centres, 2 of which opened recently, while patients are repeatedly transferred between the centres, increasing the risk of transmission.
Preiser said the scale of infections and the speed at which the virus was spreading exceeded the capacity of many health systems. He expected cases to continue to be recorded in other provinces of the Democratic Republic of the Congo and in neighbouring countries until the number of infections began to decline.
Kenya steps up surveillance and contact tracing
The World Health Organisation said last Tuesday that Kenya was working to strengthen epidemiological surveillance through more targeted screening at entry points classified as high risk. It added that the organisation was working with Kenyan authorities on contact tracing and passenger screening, and had delivered about 1,000 Ebola tests and 1,000 sets of personal protective equipment to the Kenyan counties most at risk.
Jean-Bessimwa Nachega, a professor of infectious diseases at Stellenbosch University, said the virus did not respect national borders and that tightening screening procedures at borders was not enough on its own.
He called for the entire public health response system to be strengthened, including training frontline workers, speeding up laboratory diagnosis, ensuring effective isolation and expanding contact-tracing operations.
