Ebola spreads to west Africa

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Countries must be on high alert to deal with the spread of the Ebola outbreak after Nigeria reported the first case in west Africa, the World Health Organization has warned. 

Nigerian authorities are investigating 44 identified contacts of the person, whose infection with the Bundibugyo virus was confirmed on Tuesday — more than two weeks after she arrived in the country. 

Nigeria is the fifth country to report a case in the months-long outbreak, which was first detected in the Democratic Republic of Congo in May and has become the worst in the country’s history. Scientists are urgently trying to develop a vaccine for the Bundibugyo pathogen, for which there is no approved jab. 

According to Nigerian officials, the patient on their soil is a Ugandan who travelled from the country’s Entebbe International Airport to the Nigerian capital Abuja. She flew via Addis Ababa on Ethiopian Airlines, which operates Africa’s largest aviation network and connects more than 145 cities across Africa and the world. 

Nigerian officials are investigating her movements and where she originally contracted the disease. Uganda, which was declared free of Ebola in August after an initial outbreak, said the patient had transited through the country. 

The complexity of trying to trace all the people with whom the woman might have been in contact with in Nigeria is causing alarm. 

“The genie is out of the bottle,” said Dr Ayoade Alakija, a WHO special envoy for Covid, who is based in Nigeria. 

While the Ebola outbreak was mostly contained within poor, relatively isolated parts of DR Congo, the world had been complacent, she said. 

“If we now have Ebola that has crossed from east to west Africa via Ethiopia, we have an Africa-wide situation,” she added. 

The WHO Africa office on Wednesday urged all countries in the region “to sustain a high level of readiness” as the outbreak “continues to evolve”. This includes nine cases reported in Kenya in recent weeks that are linked to an imported infection.

It called for measures including heightened monitoring at points of entry, the setting up of rapid response and clinical teams and the pre-positioning of essential supplies.

The Nigeria Centre for Disease Control and Prevention had activated its incident management in response to the case in the country, the WHO said. 

The patient’s symptoms began on October 7, four days after arriving in Nigeria, and she sought care at a private health facility in Abuja on October 11, the WHO said. On October 20, tests confirmed the presence of the Bundibugyo virus. 

For public-health officials, Ebola gaining a grip in Nigeria — Africa’s most populous nation — is an alarming prospect. The country’s peripatetic elites and traders have connections across Africa and the globe.

But in 2014, when a patient with the disease arrived from Liberia during the worst outbreak of Ebola, the country proved efficient at stamping it out. In a rare national effort, federal and state institutions, international NGOs and civil society pulled together to quash the outbreak.

“These are very different scenarios. It was one person, one healthcare facility and some people very bravely gave their lives to stop it going into wider Lagos,” said Dr Alakija. “The scenario we have here is someone undetected for more than two weeks.”

DR Congo authorities have reported more than 9,500 Ebola cases and more than 4,600 deaths, according to data up to October 18. The pathogen has spread far beyond the initial outbreak area of Ituri in the country’s north-east, which borders Uganda. 

Uganda reported 20 cases after the May 15 declaration of the outbreak in DR Congo but later said it had managed to contain further spread. France reported one case, from a doctor who had been doing humanitarian work in DR Congo and who later recovered.

Efforts to curb the Ebola outbreak in DR Congo have been hampered by the rugged terrain and community suspicions of authorities in the conflict-wracked region where it appeared. 

Map by Andrew Francisco