Ebola Outbreak Now Spans Three African Regions After Nigeria Case, With Congo Cases Near 10,000

Since Congo declared the Bundibugyo Ebola outbreak in May, the virus has crossed into a fifth country, and as of today, Oct. 22, the Africa Centres for Disease Control and Prevention is calling it the most geographically widespread Ebola outbreak in history.

Dr. Jean Kaseya, the agency's director-general, said the outbreak affects several countries across three regions of Africa. "Ebola is crossing borders," he said Wednesday. "Our response must move faster, with stronger coordination, greater solidarity and decisive political leadership."

Congo's numbers keep climbing

The European Centre for Disease Prevention and Control, citing Congolese data through Oct. 18, counts 9,552 confirmed cases and 4,602 deaths as of Oct. 19. An AP tally puts total infections above 9,700, with nearly half of the patients dead. A later Congolese situation report cited by Xinhua put the count at 9,637 confirmed cases and 4,646 deaths as of Oct. 19.

The ECDC counted 97 new confirmed cases and 41 deaths since its previous update. North Kivu accounted for 48 of those cases, Ituri for 42 and Haut-Uélé for seven.

Ituri remains the worst-hit province, with 6,960 cases and 3,217 deaths. North Kivu has 2,084 cases and 1,176 deaths. In all, 66 of Congo's 178 health zones across eight provinces are affected.

Only 76.9% of identified contacts are under follow-up. In parts of North Kivu, health authorities say the disease is out of control. Most recorded deaths there are happening in the community, and contact tracing cannot keep pace.

Nigeria's case and the dispute over where it started

Nigerian authorities confirmed a case in Abuja on Oct. 20. The patient is a woman who had recently traveled through Uganda. She developed symptoms Oct. 7 and went to a private hospital in Abuja four days later. She was treated there for several days before the diagnosis was confirmed.

The woman is isolated and receiving care. Nigerian authorities have identified 44 contacts, most of them health-care workers, according to CBC.

Where she caught the virus is unsettled. Uganda's Ministry of Health says she traveled to eastern Congo for business and then passed through Uganda in early October without symptoms. It stresses that transiting Uganda does not establish she was infected there, and says investigations are continuing. Uganda had reported 20 cases and two deaths before being declared Ebola-free; Xinhua reports that declaration came on Aug. 27, after a 42-day monitoring period without new infections. The World Health Organization says it has not been told whether the woman went to Congo.

Dr. Ayoade Alakija, a Nigerian physician who co-chairs a G7 committee on global health investment, pointed to the delay. She said it took 12 days from the onset of illness to an Ebola test. "Abuja is one of Africa's main cities ... with air and road connections daily, multiple, across the world," she said. "It's a very different prospect, and that's what worries me."

Nigeria has more than 230 million people. Nigerian health officials told health facilities nationwide to stay on high alert and to identify and isolate suspected cases quickly. "There is no need for panic," they said.

Kenya, France and the border problem

Kenya has reported nine cases, all tied to a man who had lived in Congo and traveled to Kenya via Uganda on Oct. 3. He died. The ECDC lists the cluster as close relatives, three health-care workers and a patient attendant. Kenya's Health Ministry Director-General said the latest ECDC-listed case was a patient attendant rather than a health-care worker.

France confirmed a case in June in a doctor who had returned from Congo. That person recovered and was discharged July 4, according to the WHO. A Congo-based health-care worker who tested positive Sept. 29 was evacuated to Leiden University Medical Center in the Netherlands.

The AP identifies weak surveillance at entry points as a recurring problem. Most initial cases in other countries were confirmed long after the travelers arrived from Ebola-active areas and started showing symptoms. In Congo, the spread is fueled by mass population movement, rebel violence, mistrust and poor working conditions for front-line workers. The affected provinces border Uganda, South Sudan, Rwanda and the Central African Republic. Local people cross those borders often with little oversight.

No approved vaccine or treatment

There is no approved vaccine or treatment for Bundibugyo virus. Congolese officials have been giving vaccines cleared for the Zaire strain.

The outbreak is also pushing people away from basic care. Health officials told Reuters that women and children in eastern Congo are avoiding clinics, afraid of catching Ebola or of being deliberately infected. In Ituri, deaths during childbirth rose 70% from May to July.

"They think the medicines we give them contain the Ebola virus," a nurse in Butembo told Reuters. UNICEF emergency expert Raoul Kamadjeu said vaccination rates have plummeted and warned of measles. "The longer an epidemic persists, the greater the risks," he said.

What comes next

Africa CDC called a crisis meeting of African heads of state on Wednesday, Oct. 21, to strengthen the response. Kaseya said his agency has begun mobilizing support to Nigeria while intensifying its work in Congo and Kenya and keeping heightened vigilance in Uganda.

The open questions are specific. Nigeria still has to trace 44 contacts from a patient who was hospitalized for days before testing, and investigators have not established where she was infected.

The Ebola count in Congo, at 9,552 confirmed as of Oct. 19 per the ECDC, is adding close to 100 confirmed cases per update and is approaching 10,000.