Ebola Outbreak Outpaces Containment as Bundibugyo Strain Spreads Across Africa and Beyond

A woman who returned to Nigeria from Uganda began developing symptoms on Oct. 7. This week she became Nigeria's case in a growing count: the country is now the fourth outside Congo to report Ebola, in an outbreak that health officials say is moving faster than the effort to contain it.

The outbreak began in Congo in May, when the rare Bundibugyo virus was first detected after spreading unnoticed for months, according to the World Health Organization. There is no approved vaccine or treatment for it. More than 9,700 people have been infected and nearly half have died. That makes it the deadliest Ebola outbreak in Congo's history and the fastest-growing in the world.

Five countries have now reported cases linked to the outbreak: Congo, Uganda, Kenya, France and Nigeria. Three have active cases. Uganda declared itself Ebola-free in July after 20 cases, and it has denied that the woman in Nigeria caught the virus there. The WHO said it has not been told whether she traveled to Congo. Kenya has reported nine cases, all traced to a man who traveled from Congo through Uganda. France confirmed a case in June in a doctor returning from Congo, the only reported case outside Africa. The doctor recovered and was discharged on July 4, the WHO said.

A recurring weakness is surveillance at entry points. Most of the first cases in new countries were confirmed long after the people had arrived from areas where Ebola is active and had begun showing symptoms.

Inside Congo, conditions favor the virus. Officials point to mass population movement, rebel violence, mistrust of authorities, and poor working conditions for front-line workers. The provinces reporting cases border Uganda, South Sudan, Rwanda and the Central African Republic, and local people cross those borders often for work and personal reasons, with little or no official oversight. Ebola spreads through direct contact with the bodily fluids of an infected person, including blood and vomit, or through contaminated materials such as bedding and clothing. In parts of Congo, including North Kivu, health authorities say the disease is out of control. Most recorded deaths there occur in the community, and contact tracing cannot keep up.

The Africa Centers for Disease Control and Prevention called a crisis meeting of African heads of state on Wednesday. "Ebola is crossing borders," said its director general, Dr. Jean Kaseya, urging faster response, stronger coordination and decisive political leadership. He added that the continent has the expertise and capacity to stop the outbreak if it mobilizes them together. The WHO advised all countries in the region to maintain a high level of readiness. Its guidance for travelers and transport authorities advises against general travel or trade bans, but the recommendations are not binding, so national measures vary from country to country. Dr. Mohamed Yakub Janabi, the WHO's regional director for Africa, told reporters Thursday that the test is no longer confined to one place and demands regional vigilance.

Money is a second front. Earlier this month, Africa CDC and Congolese officials raised concerns that $700 million in Ebola aid is unaccounted for. They asked the organizations working on the ground, including U.N. agencies, international charities and local aid groups, to give more information about their finances. The disclosure revives old questions about transparency in Congo. Earlier outbreaks were marked by allegations of corruption and mismanagement, which experts say fed community mistrust and made it harder to stop the spread.

What to watch next: whether the heads-of-state meeting produces coordinated funding and border measures, and how the cases in Nigeria, Kenya and Uganda develop.