Uganda says it has no active Ebola cases, but infections in Kenya and Nigeria are prompting fresh scrutiny

The first confirmed Ebola patients in Kenya and Nigeria may have crossed paths at Uganda's Entebbe International Airport, according to African health officials, as new information from Switzerland contradicts Uganda's account of the Nigerian patient's travel history.

Uganda, a country reporting no active Ebola infections, has become a focus of investigations into cases thousands of kilometers apart.

Uganda insists that it has no confirmed active cases of the deadly virus. Yet health authorities in Kenya and Nigeria are investigating Ebola infections involving people whose travel histories or contacts are connected to the East African nation.

Both patients passed through Entebbe International Airport on October 3, according to Wessam Mankoula, head of emergency preparedness and response at the Africa Centers for Disease Control and Prevention (Africa CDC).

Health officials say the two may have crossed paths, although it has not been established whether they encountered each other or whether any transmission occurred at the airport.

The differing accounts have raised questions about whether Uganda was simply a transit point for infected travelers. Or could infections be going undetected along some of Africa's busiest cross-border routes? 

The latest developments come after Switzerland disputed claims that the Nigerian patient had visited the Democratic Republic of Congo (DRC), where an Ebola outbreak is underway.

Did the two Ebola patients cross paths in Uganda?

Nigerian Health Minister Muhammad Ali Pate confirmed an Ebola case in the capital, Abuja, involving a woman who had recently traveled to East Africa, including Uganda.

"Today we are confirming that there has been one imported case of Ebola virus disease in the Federal Capital Territory," Pate said.

The woman developed symptoms on October 7 and visited a private health facility on October 11. Further laboratory testing confirmed Ebola, and she was subsequently isolated for treatment.

Pate said the patient was stable and health officials had identified 44 contacts, including health care workers, caregivers, patients and people who may have encountered her during her travels.

But the woman's journey has become central to the investigation.

Speaking on Thursday, Mankoula said the first confirmed patients in Kenya and Nigeria were both known to have traveled through Entebbe International Airport on October 3. Investigators are examining whether the two patients were at the airport at the same time and whether their movements overlapped.

Switzerland contradicts Uganda's account

Uganda's Health Ministry says preliminary findings indicate that the Nigerian patient traveled to eastern DRCfor business before passing through Uganda without symptoms and returning to Nigeria.

"Travel through Uganda does not establish that infection occurred here. The location of exposure remains under investigation," the ministry said in an October 20 statement.

But, on Friday, Switzerland's Federal Department of Foreign Affairs directly disputed the account.

"She and her husband did not travel to the Democratic Republic of the Congo," the department said in a statement to Reuters news agency.

The woman, identified by Swiss authorities as a Swiss national of Ugandan origin, is married to a Swiss diplomat based in Abuja. 

Ebola cases have now been detected in multiple African countriesImage: Afolabi Sotunde/AP Photo/picture alliance

On Thursday, the Swiss government told Reuters that she was believed to have contracted Ebola while traveling with her husband in Uganda, although that assessment has not been independently confirmed.

The World Health Organization (WHO) and the Africa CDC also said Thursday that they had not received confirmed information establishing that the woman had traveled to the DRC.

The conflicting accounts raise fresh questions about where the woman was exposed to the virus and how accurately her movements were initially reconstructed. They do not, however, establish that she contracted Ebola in Uganda.

Uganda maintains that it has no confirmed active Ebola cases and says it is awaiting more detailed information from Nigeria about the woman's movements.

Kenya's missing contact complicates investigation

In Kenya, Uganda has emerged in a separate investigation involving the country's first confirmed Ebola patient, who died in the Kenyan capital, Nairobi, on October 5. The patient had traveled from the Democratic Republic of Congo through Uganda before reaching Kenya.

Health officials have now established that the patient passed through Entebbe International Airport on October 3, the same day as the woman subsequently diagnosed in Nigeria. Kenyan authorities have since reported additional infections linked to the initial case.

But one aspect of the investigation remains unresolved.

According to Kenya's Daily Nation, health officials are searching for a Ugandan national identified as a contact of the deceased patient.

"We know him (the Ugandan) by name and passport number and from his phone but we are not able to reach him," Kenya's director-general for health, Patrick Amoth, told the newspaper.

The Daily Nation reported that the man was using a South Sudanese telephone number, complicating efforts to establish his whereabouts.

Being an untraced contact does not mean that he is infected. However, locating potentially exposed individuals is essential to preventing further transmission.

Can border screening stop Ebola?

Uganda shares a lengthy border with the Democratic Republic of Congo, where Ebola outbreaks have repeatedly challenged health authorities.

Cross-border trade, population movements and international travel make it difficult to establish where someone was exposed to the virus. 

Congo's Ebola crisis: Fear, mistrust and a growing outbreak

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Ebola symptoms typically develop two to 21 days after infection. According to the WHO, people infected with Ebola are not considered infectious until symptoms appear.

Even well-functioning border surveillance systems cannot identify every infected traveler.

The discovery that both patients traveled through the same international airport on the same day illustrates the complexity of tracing potential exposures across multiple countries. It also highlights the importance of reconstructing travel histories and identifying close contacts.

Uganda says it is strengthening screening and public health controls at points of entry. Nigeria has intensified contact tracing and infection prevention measures.

The challenge is ensuring that authorities across different countries can exchange accurate information quickly enough to identify potential exposures.

Anxiety grows in Nigeria

In Abuja, the confirmed infection has revived memories of previous Ebola outbreaks. Resident Peace Kolawole expressed concern about the consequences of another outbreak. "So here is my hand sanitizer, so I'm actually very concerned about it," she told DW.

Others fear that Nigeria's health care system may struggle to respond while many citizens face economic hardship. "Because now people are not even worried about sickness anymore, people are worried about surviving," Abuja resident Jonathan Steven told DW.

Nigeria's health authorities say the patient is receiving medical care and contact tracing is continuing.

What remains unanswered?

Uganda's position between the DRC and other regional destinations offers one explanation for its appearance in both investigations.

But the latest findings have added two significant questions: Did the patients from Kenya and Nigeria come into contact at Entebbe International Airport on October 3? And where did the Nigerian woman contract the virus if, as Switzerland insists, she never traveled to DR Congo? 

Did Ebola start spreading before officials even knew?

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The conflicting accounts from Uganda and Switzerland have made establishing the Nigerian patient's travel history an urgent part of the investigation. The WHO and Africa CDC have yet to confirm the disputed DR Congo travel history.

Uganda's declaration of zero confirmed active cases does not establish that all infections have been ruled out. Equally, the travel histories do not prove an undetected outbreak.

For Kenya and Nigeria, the immediate priority is containing confirmed infections. For Uganda, the challenge is demonstrating that its surveillance systems are effective and reassuring both its citizens and neighboring countries.

The Africa CDC will convene an "extraordinary virtual meeting" of national health officials on October 28 as the continent's latest Ebola outbreak continues to spread.

Edited by: Keith Walker