Questions are mounting over the effectiveness of regional Ebola surveillance after a Kenyan businessman travelled through the Democratic Republic of Congo (DR Congo) and Uganda while ill before being diagnosed in Nairobi, where he later died.
The 40-year-old man, who had lived in DR Congo for seven years, became Kenya’s first confirmed Ebola patient after arriving at Nairobi Hospital in a critical condition. He died on October 5, just two days after his admission.
Health authorities confirmed that he had contracted the Bundibugyo strain of Ebola, which is also responsible for the outbreak in DR Congo.
A reconstruction of his movements by the Africa Centres for Disease Control and Prevention has highlighted possible missed opportunities to identify the infection during his journey, which spanned several weeks and multiple health facilities.
Africa CDC emergency director Dr Wessam Mankoula said the man had travelled extensively across DR Congo for business before developing symptoms around September 15.
His first reported medical visit resulted in a prescription for antibiotics and discharge. On September 17, he was admitted to Tongo Etandi Health Centre in Bondo with fever and a rash, but the illness was diagnosed as a skin infection.
He was discharged on September 19 without an Ebola test being conducted.
The following day, he travelled to Kisangani, where he spent more than 10 days seeking medical care. Details of the hospitals he visited and the treatment he received remain unclear.
On October 1, he travelled by air to Beni in North Kivu province before proceeding to Kasindi, a major border town. He crossed into Uganda later that day, travelling to Kampala and subsequently to Entebbe International Airport.
Despite his worsening condition, the businessman boarded a flight to Nairobi on October 3.
Ugandan officials said he had a normal temperature during airport screening. Kenyan authorities also did not identify him as a suspected Ebola case when he arrived at Jomo Kenyatta International Airport.
His condition had deteriorated significantly by the time he reached Nairobi Hospital, where he presented with fever, chills, muscle pain, a sore throat and bleeding. Laboratory tests confirmed the infection, prompting his isolation.
He died two days later and was buried under strict safety measures to minimise the risk of transmission.
The case has drawn attention to the challenges facing authorities who rely on temperature screening and travellers’ declarations to identify potentially infectious passengers.
A person may not have a fever at the time of screening, even if they are incubating an infection or have symptoms that fluctuate.
Kenya’s Ministry of Health says 66 people who may have had contact with the patient have been identified. Officials expect the figure to rise as investigations extend to people who interacted with him in Uganda and DR Congo.
The ministry has also reported screening more than 652,000 travellers and training nearly 5,000 healthcare workers in Ebola preparedness. Five health facilities have been designated to handle cases.
The World Health Organization says Ebola can take between two and 21 days to produce symptoms following exposure. Transmission occurs through direct contact with the bodily fluids of symptomatic infected people or contaminated materials.
This makes the identification and monitoring of contacts critical, particularly when an infected person has travelled extensively before diagnosis.
Dr Mankoula has urged travellers who develop possible Ebola symptoms to seek medical attention early and disclose their symptoms and travel history to health professionals.
The WHO has cautioned that stigma and misinformation remain significant barriers to containing outbreaks, with fear of discrimination potentially discouraging people from seeking treatment.
The Kenyan case underscores the need for countries in the region to strengthen cross-border coordination, improve the assessment of symptomatic travellers and ensure that health facilities consider Ebola when evaluating patients arriving from affected areas.
