A five-year-old boy vomiting blood became the first cross-border victim of Ebola in the current outbreak on Wednesday, while two more people in Uganda tested positive for the highly contagious disease that has killed nearly 1,400 in Congo.
The boy, part of a Congolese family who crossed into Uganda earlier in the week, died overnight, the World Health Organization said. Ugandan authorities said the two new cases are his three-year-old brother and 50-year-old grandmother, who have been isolated at a hospital near the Congo (also known as Congo-Kinshasa) border. Uganda now has three confirmed Ebola cases.
Authorities are trying to determine how the family, exposed to the virus via a sick relative in Congo, managed to cross a border where health officials have been screening millions of travellers for months.
This has become the second-deadliest Ebola outbreak in history since the first cases were declared in August. A WHO expert committee has been alerted for a possible meeting on whether to declare a global health emergency now that the outbreak has crossed the border, a spokesperson said.
Fatal in up to 90% of cases
Congo's health ministry said a dozen members of the boy's family had showed symptoms of Ebola and were put in isolation. But six managed to leave while awaiting transfer to an Ebola treatment centre. They crossed into Uganda, where authorities had been alerted. The boy received treatment and relatives were isolated. Two of them developed symptoms and were tested.
Experts have long feared Ebola could spread to neighbouring countries because of rebel attacks and community resistance hampering virus containment work in eastern Congo, one of the world's most turbulent regions. The virus can spread quickly via close contact with bodily fluids of those infected and can be fatal in up to 90 per cent of cases.
Ugandan health teams "are not panicking," Henry Mwebesa, a physician and the national director of health services, told The Associated Press. He cited the East African nation's experience battling previous outbreaks of Ebola and other hemorrhagic fevers.
"We have all the contingencies to contain this case," Mwebesa said. "It is not going to go beyond" the patient's family.
Ebola vaccine being widely used
The Congolese family likely did not pass through official border points, where health workers screen all travellers for a high temperature and isolate those who show signs of illness.
The child's mother, who is married to a Ugandan, "knows where to pass. She does not have to go through the official border points," Mwebesa said from Kasese, a district near the border where the family was being treated.
At the border area where the family is thought to have crossed, surveillance teams patrolled the Ugandan side on Wednesday. Many Congolese cross on footpaths away from official border posts, however, and some paths remained unguarded. Some people wade through the shallow Lubiriha River instead of using a bridge, to avoid being stopped by border officials.
Uganda is more stable than eastern Congo, and for the first time an experimental but effective Ebola vaccine is being widely used, with more than 130,000 doses distributed. Uganda has vaccinated nearly 4,700 health workers, and WHO is shipping in another 3,500 vaccine doses this week for health workers and close contacts of those infected.
'A truly frightening phase'
But Ebola has been especially feared in Uganda, where multiple outbreaks have occurred over the years. An outbreak in the north in 2000 infected 425 people and killed more than half of them.
The WHO expert committee has twice decided that the current outbreak, while of "deep concern," is not yet a global health emergency.
But international spread is one of the major criteria the United Nations agency considers before such a declaration. Millions of travellers along Congo's border with Uganda and Rwanda have been screened for Ebola since the outbreak began. WHO has advised against travel restrictions.
The news of a first cross-border case is "tragic but unfortunately not surprising," said Dr. Jeremy Farrar with the Wellcome Trust, which is funding vaccine research in this outbreak. While Uganda is well-prepared with established surveillance, "we can expect and should plan for more cases in [Congo] and neighbouring countries. This epidemic is in a truly frightening phase and shows no sign of stopping anytime soon."