Kenya prepared for Ebola. It still slipped through — a warning of wider cross-border spread

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Kenya had spent months preparing for Ebola, one of the world’s deadliest viral diseases, screening hundreds of thousands of travelers and training nearly 5,000 health workers in case it crossed the borders.

A man who had been ill for weeks and was later confirmed to have Ebola left eastern Democratic Republic of Congo (DRC), crossed by road into neighboring Uganda and flew to Nairobi, passing airport health screening in both countries without being flagged.

A relative and a friend drove him directly from the airport to the Nairobi Hospital, a private hospital in the Kenyan capital. By the time he arrived on October 3, he had a fever, chills, severe fatigue, muscle pain and bleeding beneath his skin, according to Kenya’s Ministry of Health . Doctors isolated him and tests later confirmed Bundibugyo virus, a form of Ebola. He died days later on Monday, and health officials have been trying to identify anyone who may have been exposed.

His journey shows how quickly an outbreak centered in the DRC can become a wider regional problem. The outbreak is now the largest Ebola outbreak ever recorded in the country. As of Wednesday, the World Health Organization (WHO) had recorded 8,728 confirmed cases and 4,205 deaths in the DRC. Cases have been recorded across seven provinces. WHO says transmission remains intense and assesses the risk to countries sharing land borders with the DRC as high.

Kenya races to trace all contacts after first Ebola death

The DRC is not the only country affected. Uganda recorded 20 cases before its health ministry declared the country Ebola-free on July 28, while France recorded a travel-related case with no additional cases reported. Kenya is now the fourth country to confirm Bundibugyo virus.

Oyewale Tomori, a former WHO regional virologist for Africa, told CNN that the Kenya case warns that more infections could cross borders while transmission remains high in the DRC.

“Africa is an open field divided into countries by poorly manned porous borders,” he said. “The Kenya case is a warning of more cases in the future.”

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The Kenyan man, who had lived in the DRC for seven years, moved through three countries in about two days.

On October 2, he traveled by road through Beni in eastern DRC’s North Kivu province to Kampala, Uganda’s capital, before flying to Nairobi the next day, according to Kenya’s Ministry of Health and WHO . Authorities have not said what screening, if any, he underwent at the DRC-Uganda land border.

WHO says it is unclear when he developed Ebola symptoms during the trip. The agency says his month-long illness suggests he was probably sick with something else at first and possibly later contracted Ebola while seeking care.

Uganda had temporarily restricted non-essential travel across its border with the DRC after most of its cases were imported from the country.

Uganda’s health ministry said the man spent fewer than 24 hours in the country and had a normal temperature when screened before departing Entebbe International Airport, near Kampala. The ministry said it was intensifying cross-border surveillance and information sharing following the case.

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In Nairobi, Kenya’s health ministry says he underwent “normal public health screening” at Jomo Kenyatta International Airport. The ministry’s account indicates he was not flagged as a suspected Ebola case during the screening.

Kenya Airports Authority told CNN that Port Health Services, part of the Ministry of Health, handles passenger screening.

CNN has asked health authorities in Uganda and Kenya what checks he underwent and whether his recent travel from the DRC should have prompted further assessment.

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Ebola outbreak in Democratic Republic of Congo becomes deadliest in country’s history

The challenge goes beyond airports and official border crossings. The International Organization for Migration (IOM) told CNN that movement between Ebola-affected parts of eastern DRC and neighboring countries remains high, with people regularly crossing for work, trade and family reasons. Not all of that movement happens through official border posts.

IOM said some people use informal routes that are much harder to monitor, so airport and land-border screening will not catch every infected traveler, especially before symptoms appear. It said countries also need to watch for cases in communities, test quickly, trace contacts and share information across borders – just like the response in Kenya – so imported cases are found early and further spread can be contained.

Tomori was skeptical that border screening alone could do much, comparing weaknesses in the system to “using a football goalpost net to catch a mosquito.”

Christian Happi, a professor of molecular biology and genomics at Redeemer’s University in Nigeria, whose laboratory helped confirm Nigeria’s first Ebola case in 2014, said temperature checks can miss an infected traveler who is not running a fever at that moment.

“If you don’t have a fever at the time you are passing the health post at the airport, how is the health care worker going to detect it?” he asked.

WHO’s current guidance for the DRC calls for exit screening at airports, ports and ground crossings, including at least a questionnaire about possible exposure and a temperature check. The agency says “suspected, probable and confirmed” cases, as well as contacts assessed as exposed, should not travel internationally except for medical evacuation.

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Happi argues that authorities should go further and require people flying from the DRC to show a negative Ebola test before boarding.

“Anybody without a negative Ebola test should not board a flight,” he said. He also said countries need the capacity to test travelers much more quickly at airports.

His proposal goes beyond WHO guidance, which does not call for negative Ebola tests for every traveler leaving an affected area. WHO also advises against broader travel or trade restrictions involving affected countries.

CNN has asked WHO and the Africa Centres for Disease Control and Prevention (Africa CDC) how likely the outbreak is to spread further across borders and what countries should do as cases continue in the DRC.

That is why the response doesn’t stop at the border: when screening misses a case, speed becomes critical.

In Kenya, health officials are now trying to identify anyone who may have been exposed and prevent further transmission. They have also intensified screening at Nairobi’s Jomo Kenyatta International Airport.

Preliminary tests on a separate 20-year-old patient who had traveled from the DRC through Uganda came back negative for Ebola on Thursday, according to Kenyan authorities.

Rapid detection is particularly important because there is no licensed vaccine or approved specific treatment for this form of Ebola, although possible vaccines and treatments are being tested .

Happi pointed to Nigeria’s experience during the 2014 West Africa Ebola epidemic, when an imported case in Lagos, one of Africa’s largest cities, led to 20 cases and eight deaths before transmission was stopped.

He said rapid detection and close coordination were key to containing the outbreak.

For Happi, Nigeria’s experience is the lesson for countries now watching the DRC outbreak.

“It won’t be easy to detect everybody crossing borders,” he said. “It is how quickly countries detect and then how quickly they can contain imported cases.”

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肯尼亚曾花费数月时间准备应对埃博拉病毒，这种病毒是世界上最致命的病毒性疾病之一。肯尼亚对数十万旅客进行了筛查，并培训了近 5000 名医务人员，以防病毒越境传播。

一名患病数周后被确诊感染埃博拉病毒的男子离开刚果民主共和国东部，经陆路进入邻国乌干达，然后乘飞机前往内罗毕，在两国机场均顺利通过健康检查，未被发现。

一位亲戚和一位朋友开车将他从机场直接送往内罗毕医院，这是一家位于肯尼亚首都的私立医院。据肯尼亚卫生部称，他于10月3日抵达时，已出现发烧、畏寒、极度疲劳、肌肉疼痛和皮下出血等症状。医生将他隔离，随后的检测证实他感染了邦迪布焦病毒，一种埃博拉病毒。几天后的周一，他不幸去世。卫生官员一直在努力追踪所有可能接触过病毒的人员。

他的经历表明，以刚果民主共和国为中心的疫情爆发会如何迅速演变成更广泛的区域性问题。此次疫情是该国有史以来记录到的最大规模的埃博拉疫情。截至周三，世界卫生组织（世卫组织）已记录到刚果民主共和国8728例确诊病例和4205例死亡病例。病例分布在七个省份。世卫组织表示，病毒传播仍然十分活跃，并评估认为与刚果民主共和国接壤的国家面临的风险很高。

肯尼亚在首例埃博拉死亡病例后，正紧急追踪所有接触者。

刚果民主共和国并非唯一受影响的国家。乌干达在卫生部于7月28日宣布该国已无埃博拉病例之前，曾记录了20例病例；法国则记录了一例与旅行相关的病例，之后未报告其他病例。肯尼亚现在是第四个确诊布迪布焦病毒的国家。

世界卫生组织非洲区域病毒学家奥耶瓦莱·托莫里告诉美国有线电视新闻网，肯尼亚的病例警告说，随着刚果民​​主共和国的传播仍然很高，可能会有更多感染病例跨越国界。

他说：“非洲就像一片开阔的田野，被人为疏忽、管控不力的边境线分割成一个个国家。肯尼亚的案例预示着未来可能会有更多类似的案例。”

杨光/新华社/盖蒂图片社

这位在刚果民主共和国生活了七年的肯尼亚男子，在两天左右的时间里穿越了三个国家。

据肯尼亚卫生部和世界卫生组织称，10月2日，他经刚果民主共和国东部北基伍省贝尼镇陆路前往乌干达首都坎帕拉，次日乘飞机抵达内罗毕。当局尚未透露他在刚果民主共和国-乌干达陆地边境是否接受了筛查，以及筛查内容。

世界卫生组织表示，目前尚不清楚他是在旅行期间何时出现埃博拉症状的。该机构称，他长达一个月的病程表明，他最初可能患的是其他疾病，之后可能在就医过程中感染了埃博拉病毒。

乌干达的大部分病例都是从刚果民主共和国输入的，因此该国暂时限制了与刚果民主共和国接壤的非必要旅行。

乌干达卫生部表示，该男子在乌干达停留时间不足24小时，在离开坎帕拉附近的恩德培国际机场前接受体温检测时体温正常。卫生部表示，鉴于此病例，正在加强跨境监测和信息共享。

巴德鲁·卡通巴/法新社/盖蒂图片社

肯尼亚卫生部表示，这名男子在内罗毕乔莫·肯雅塔国际机场接受了“常规公共卫生筛查”。卫生部的说法表明，他在筛查过程中并未被列为疑似埃博拉病例。

肯尼亚机场管理局告诉 CNN，隶属于卫生部的港口卫生服务部门负责旅客筛查。

CNN已向乌干达和肯尼亚的卫生部门询问他接受了哪些检查，以及他最近从刚果民主共和国的旅行是否应该引起进一步评估。

Benediction Murhabazi/AFP/Getty Images

刚果民主共和国爆发埃博拉疫情，成为该国历史上最致命的疫情。

挑战远不止机场和官方边境口岸。国际移民组织（IOM）告诉CNN，刚果民主共和国东部受埃博拉疫情影响地区与邻国之间的流动依然频繁，人们经常为了工作、贸易和探亲等原因跨境流动。并非所有这些流动都通过官方边境口岸进行。

国际移民组织表示，有些人使用非正规途径入境，这些途径更难监控，因此机场和陆路边境筛查无法发现所有感染者，尤其是在症状出现之前。该组织还表示，各国需要密切关注社区病例，迅速进行检测，追踪密切接触者，并跨境共享信息——就像肯尼亚采取的应对措施一样——以便及早发现输入性病例，控制疫情进一步蔓延。

托莫里怀疑仅靠边境筛查能起到多大作用，他将系统中的缺陷比作“用足球门网来捕捉蚊子”。

尼日利亚救赎者大学分子生物学和基因组学教授克里斯蒂安·哈皮表示，体温检查可能会漏掉当时没有发烧的感染旅客。他的实验室曾帮助确认尼日利亚在 2014 年的首例埃博拉病例。

他问道：“如果你在经过机场卫生站时没有发烧，医务人员怎么能发现你发烧了呢？”

世界卫生组织目前针对刚果民主共和国的指导意见要求在机场、港口和陆路口岸进行离境筛查，至少包括填写一份关于可能接触史的问卷和测量体温。该机构表示，“疑似病例、可能病例和确诊病例”以及被评估为接触者的密切接触者，除医疗转运外，不应进行国际旅行。

Daniel Buuma/Getty Images

哈皮认为，当局应该更进一步，要求从刚果民主共和国乘飞机的人在登机前出示埃博拉病毒检测阴性证明。

“任何没有埃博拉病毒检测阴性证明的人都不应该登机，”他说。他还表示，各国需要具备在机场更快地检测旅客的能力。

他的提议超出了世卫组织的指导方针，世卫组织并未要求所有离开疫区的旅客都必须进行埃博拉病毒检测且结果为阴性。世卫组织还建议不要对疫区国家实施更广泛的旅行或贸易限制。

CNN 已向世界卫生组织和非洲疾病控制与预防中心（非洲疾控中心）询问，疫情在刚果民主共和国持续出现病例的情况下，进一步蔓延到其他国家的可能性有多大，以及各国应该采取哪些措施。

这就是为什么应对措施不会止步于边境：当筛查漏诊时，速度就变得至关重要。

在肯尼亚，卫生官员正在努力追踪所有可能接触过病毒的人员，以防止病毒进一步传播。他们还加强了内罗毕乔莫·肯雅塔国际机场的筛查力度。

据肯尼亚当局称，周四对另一名从刚果民主共和国经乌干达入境的 20 岁患者的初步检测结果显示，其埃博拉病毒检测呈阴性。

快速检测尤为重要，因为目前尚无针对这种埃博拉病毒的许可疫苗或批准的特定治疗方法，尽管可能的疫苗和治疗方法正在测试中。

哈皮指出，尼日利亚在 2014 年西非埃博拉疫情期间有过这样的经历：当时，非洲最大的城市之一拉各斯出现了一例输入性病例，导致 20 例病例和 8 例死亡，之后病毒传播才被阻止。

他表示，快速检测和密切协调是控制疫情的关键。

哈皮认为，尼日利亚的经验可以给正在关注刚果民主共和国疫情的国家带来教训。

他说：“要检测出所有跨境人员并不容易。关键在于各国发现输入病例的速度，以及能够迅速控制住病例的速度。”