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A 40-year-old Kenyan businessman travelled through the Democratic Republic of Congo (DR Congo) and Uganda while ill with Ebola before the infection was identified at a hospital in Nairobi. He died two days after his diagnosis, on 5 October.
The case raised questions about screening at medical facilities and border crossings during the outbreak. BBC reported that Africa CDC, the continent’s public health agency, reconstructed the man’s movements over nearly six weeks and identified several points where his infection might have been detected.
More than 4,000 people have died from Ebola in DR Congo this year, making the outbreak the second deadliest known to date. The man’s identity has not been made public.
Medical visits in DR Congo
The businessman had lived in DR Congo for seven years and travelled to three provinces for work. It is not known when or where he contracted the virus. By early October, Ebola cases had been recorded in all three provinces he visited, according to the World Health Organization (WHO).
He spent much of late August and early September in Bas-Uélé province, visiting towns including Buta, Aketi and Likati. The WHO confirmed a case in Buta in August, before his visit, but there is no evidence that he caught the virus there.
His symptoms began around 15 September. After receiving antibiotics, he was sent home. Two days later, he was admitted to Tongo Etandi Health Centre in Bondo, where he stayed until 19 September. Despite having a fever and rash, he was diagnosed with a skin infection.
He was not tested for Ebola during his travels. His symptoms could have been consistent with the early stages of the disease, but also with other infections common in the region, including malaria.
On 20 September, he flew to Kisangani, where he spent more than 10 days seeking medical care. It is not known which clinics or hospitals treated him or what medication he received. Kisangani is the capital of Tshopo province, which had recorded 51 Ebola cases.
Travel through Uganda to Nairobi
On 1 October, he took a domestic flight to Beni, in North Kivu province, and then travelled to Kasindi, a busy border town. North Kivu had recorded 1,755 infections and more than 1,000 deaths. He crossed into Uganda later that day.
Uganda had restricted movement across its border with DR Congo after the outbreak began in May. Although the country has experience managing Ebola outbreaks and was declared free of the disease in August, the border runs for hundreds of kilometres through remote areas. It is not known whether the man passed an official health checkpoint.
He travelled by road to Kampala and then to Entebbe International Airport, where he boarded a flight to Nairobi on 3 October. Ugandan officials said his temperature was normal during airport screening. Africa CDC emergency director Dr Wessam Mankoula said investigators were examining whether medication had lowered his temperature; he may also not have had a fever at the time.
He was not flagged as a suspected Ebola patient at Jomo Kenyatta International Airport in Nairobi. A relative collected him and drove him to Nairobi Hospital. By then, he had a fever, chills, muscle pain, a sore throat and bleeding. Laboratory tests confirmed infection with the Bundibugyo species of Ebola, the same species responsible for the outbreak in DR Congo.
The patient was isolated as his condition worsened and died on 5 October. He was buried the following day under strict infection-control measures. Kenya’s government said it had identified 66 people who may have had contact with him after his arrival; the WHO said that number was likely to grow as tracing continued in Uganda and DR Congo.
Kenya’s health ministry said more than 652,000 travellers had been screened and nearly 5,000 healthcare workers trained to respond to Ebola. Five facilities had been designated to handle cases. Questions have also been raised about quarantine arrangements and the patient’s treatment at Nairobi Hospital.
Ebola spreads through direct contact with the bodily fluids of an infected person who has developed symptoms, or with contaminated materials. The incubation period is two to 21 days, so an exposed person may not become ill for several weeks.
Mankoula urged travellers with possible Ebola symptoms to report them and seek medical care early. The WHO has warned that stigma, fear and misinformation can discourage people from seeking help, while health workers in DR Congo have faced attacks from people who deny that Ebola exists.
