A fishmonger who died of Ebola this week probably carried the virus from Congo into both Rwanda and Uganda, the World Health Organization 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 declared an international health emergency on Wednesday .
So far, a campaign of vigilance and vaccination encompassing almost 75 million screenings has effectively kept the outbreak confined to northeast Democratic Republic of Congo.
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 Congo.
The Congolese fishmonger vomited there several times on July 11, a few days before she died, and a second fish trader who spent time there died of Ebola in Congo 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 a million people that serves as a regional and international gateway. It’s also where a pastor died of the disease earlier this month.
The American Society of Tropical Medicine and Hygiene said the pastor’s death illustrated “the powder-keg nature of this … outbreak.”
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 galvanizing global support.
But the cases of the pastor and the fishmonger have 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 skepticism 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 Congo) … between rival groups to take land and minerals,” Mr. Agaba said.
Meanwhile one fish-store owner in Mpondwe who had dealt with the fishmonger has locked up his shop and could not be traced, nor could his four attendants or brother. Fellow fish traders were refusing to share his contact information, the ministry said.
So far, tests on traders at the market had however not found any infected with the virus, ministry spokesman Emmanuel Ainebyona said. The team continued to monitor the traders.
Nottingham University’s Prof. Ball said concerted action was needed to end the outbreak, notably increased engagement with affected communities.
Congo’s health ministry said it accepted the WHO committee’s decision but that it hoped it was not prompted by 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 said they saw no reason to close their borders with Congo.
As for the pastor in Goma, Congo’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.