FILE - This Tuesday, April, 16, 2019 file photo taken in Congo shows an Ebola health worker at a treatment center in Beni, Eastern Congo. Uganda's health ministry said late Tuesday, June 11, 2019 that a 5-year-old Congolese boy who crossed into Uganda has tested positive for Ebola in what is the first cross-border case of the deadly virus since an outbreak started in neighboring Congo last year. (AP Photo/Al-hadji Kudra Maliro, File)
An Ebola health worker at a treatment center in Beni, eastern Congo © AP

A five-year-old boy has died from Ebola in Uganda and two more people have been infected in the first known cases of the virus crossing a border since the outbreak began in eastern Congo last year.

Health experts on Wednesday were racing to discover how the boy’s relatives entered Uganda on June 9 and with whom they might have come into contact. Uganda’s health ministry said the five-year-old, who died on Tuesday night, had come into contact with at least eight people. 

Ebola, which kills up to 90 per cent of those infected, is transmitted through bodily fluids, making carers particularly vulnerable to infection. 

Jeremy Farrar, director of Wellcome, a UK health charity, said that the epidemic, the second worst in history, had reached “a truly frightening phase”.

Its spread from Uganda was “tragic but unfortunately not surprising,” he said, calling for a step-up in the response. 

Since the first case last August, nearly 1,400 people out of some 2,000 infected have died in eastern Congo, a thickly forested mining zone and one of the most turbulent regions in the world.

Efforts to contain the spread have been hampered by chronic violence and suspicion of outsiders. Half or more of Ebola deaths have occurred in people who never sought help at a health clinic, suggesting that efforts to track the spread of the virus and isolate those contaminated are failing. 

Map of ebola in DRC and Uganda

Seth Berkley, a medical epidemiologist and chief executive of the Gavi global vaccines alliance, said: “Let us be clear. It’s getting worse. The numbers are going up, not down.”

Eastern Congo borders Rwanda and South Sudan as well as Uganda. Experts had previously warned that if the virus crossed into a neighbouring country it would represent a dramatic escalation of the crisis.

The World Health Organisation is preparing to convene an expert committee that could declare the Ebola outbreak a global health emergency, something it has stopped short of doing on two previous occasions. 

Mark Eccleston-Turner, a global health lawyer at Keele University, said it was essential that the WHO now took that step. “A declaration acts as a clarion call to the international community that this is an outbreak that requires further attention.”

While Mr Eccleston-Turner called the spread to Uganda “incredibly disappointing”, he added: “The expertise that Uganda has and the fact that this has been discovered quite quickly gives hope that this can be snuffed out.”

Ebola outbreak chart

Earlier this month, the WHO reported that 2,000 people had been infected, with two-thirds of them dying. It took seven months for the outbreak to reach 1,000 cases, but just three to hit the 2,000 mark.

Mr Berkley of Gavi said the disease’s spread had been slowed by a vaccine developed by US pharma giant Merck that was being used in Congo and neighbouring countries, though more could have been achieved if health workers had had access to all the communities affected. 

“If you had to pick the worst place in the world for this to happen, this would be it,” he said, referring to eastern Congo’s endemic violence and the lack of trust in a central government based in Kinshasa, some 1,000 miles away. 

The strategy in Congo has been to create vaccine “rings” around outbreaks to prevent the virus passing to other communities. In neighbouring countries, including Uganda, frontline health workers had been vaccinated to protect them from infection. The vaccine is thought to be 100 per cent effective after 10 days.

Some 150,000 doses have already been used. A WHO expert advisory group recently dropped the permitted dosage to eke out remaining supplies.

Uganda’s health ministry said the boy’s mother, who is Congolese but married to a Ugandan and living in the Kasese district of Uganda, had travelled back to Congo to nurse her sick father, who subsequently died of Ebola. On returning to Uganda, the boy had started coughing up blood and vomiting and was taken to Kagando hospital where health workers immediately suspected Ebola. 

A sample of his blood tested positive for the virus and on Wednesday two of the boy’s relatives, thought to be his younger brother and grandmother, were also confirmed to have contracted the disease.

In 2014, an epidemic in west Africa — mainly in Guinea, Liberia and Sierra Leone — killed more than 11,000 people. Apart from that, no previous outbreak has killed more than 300.

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