A fishmonger who died of Ebola this week probably carried the virus from the Democratic Republic of the Congo into both Rwanda and Uganda, the World Health Organisation said, as health workers struggled to track down people she could have infected.
The woman is one of almost 1,700 victims of the highly contagious disease during an 11-month epidemic that the WHO, reflecting growing concerns that it might spread, on Wednesday declared an international health emergency.
So far, a campaign of vigilance and vaccination encompassing almost 75 million screenings has effectively kept the outbreak confined to northeast DRC.
Three victims died in Uganda last month without spreading Ebola further there, while Rwanda has never had a recorded case.
But Mpondwe, a Ugandan border market, has become a focal point for possible contagion beyond the DRC.
The Congolese fishmonger vomited there several times on July 11th, a few days before she died, and a second fish trader who spent time there died of Ebola in the DRC on Tuesday, the WHO said. It cited a Ugandan health ministry report.
Twelve people have been identified as at high risk of catching Ebola from the fishmonger.
But local official Wilson Agaba said authorities had been slow to send gloves and chlorine solution to medics in the market area, and some residents were refusing to help trace the fishmonger's contacts for fear of testing positive for Ebola and being isolated.
The health ministry suspected that, while infected, the fishmonger also went to Gisenyi in Rwanda on business, and to Goma, a Congolese border city of more than one million that serves as a regional and international gateway and where a pastor died of the disease this month.
The American Society of Tropical Medicine and Hygiene said the pastor’s death illustrated “the powder-keg nature of this ... outbreak”.
‘Worrying signs’
Jonathan Ball, a professor of molecular virology at Britain's University of Nottingham, said the latest cases showed current efforts were not effective enough to halt the epidemic, which "is showing no signs of letting up".
Rwanda is intensifying screening at ports of entry and recommends avoiding unnecessary travel to Ebola-affected areas, its government said via the WHO.
Since the outbreak was declared last August, the WHO’s advisory committee of health experts has three times declined to declare an emergency – a rare designation aimed at galvanising global support.
But the cases of the pastor and the fishmonger pushed it to act. “The committee is concerned that a year into the outbreak, there are worrying signs of possible extension of the epidemic,” it said in Wednesday’s report.
Health workers fronting the vaccination campaign have at times faced scepticism or hostility from at-risk communities. “Some Ugandans and Congolese at the border told us that they believe Ebola is witchcraft while others say Ebola is a political tool used [in the DRC] ...between rival groups to take land and minerals,” Mr Agaba said.
Unpredictable
Meanwhile one fish store owner in Mpondwe who the fishmonger had dealt with had locked up his shop and could not be traced, nor could his four attendants or brother, and fellow traders were refusing to share his phone contact, the ministry said.
So far, tests on traders at the market had however not found any infected with the virus, said ministry spokesman Emmanuel Ainebyona. The team continued to monitor the traders.
Nottingham University’s Ball said concerted action was needed to end the outbreak, notably increased engagement with affected communities.
The DRC’s health ministry said it accepted the WHO committee’s decision but hoped it was not due to pressure from humanitarian groups looking to raise funds “despite the potential negative and unpredictable consequences for the communities affected, who rely very much on cross-border trade to survive”.
The committee urged countries not to use the designation to justify trade or travel restrictions. Officials from the Rwandan and South Sudanese governments told Reuters they saw no reason to close their borders with Congo.
As for the pastor in Goma, the DRC's health minister Oly Ilunga said everyone in the city who had come into contact with him had been identified and that efforts continued in the cities of Beni and Butembo to locate any other contacts. – Reuters