Ebola watch: Dodgy travellers, contacts raise infection risk

A health official screens a traveller for Ebola at the Busia One Stop post on the Kenya-Uganda border on October 12, 2026. [AFP]

It has emerged that passengers are concealing travel histories and contacts, attempting to evade quarantine, further complicating the fight against Ebola.

Also, the travellers are suppressing fever with paracetamol, testing the limits of East Africa’s fight against Ebola.

These practices have exposed how individual behaviour can undermine surveillance systems designed to stop the virus crossing borders.

In Kenya, health officials had to deploy CCTV cameras to monitor relatives of the index patient in quarantine, while security teams helped trace contacts in Nairobi who were difficult to locate.

“We had a problem with one of the isolation facilities. You know the index patient came from a close-knit community; they ate together, shared a room. They were always together. We were even forced to use CCTV cameras to monitor them. It was difficult at first, but we were successful,” said Director-General for Health Dr Patrick Amoth.

The experience exposed the risks of close contact among people who may have been exposed to Ebola, particularly where facilities lack the space needed to separate individuals effectively.

Contacts also tried to beat the system, including one who switched to a South Sudanese telephone number in an apparent attempt to evade detection. Health officials said telephone tracing helped establish the whereabouts of contacts, particularly during the initial days of the exercise.

Such omissions can leave health officials without the information needed to identify high-risk travellers, locate their contacts and determine whether they require further examination or monitoring.

The search illustrated the difficulties of tracking contacts whose movements cross national borders and whose identities or telephone details complicate tracing.

Amoth said security agencies were brought in to help locate contacts in Nairobi, where the scale and complexity of the city made the exercise more demanding.

“The other challenge was also doing contact tracing in an urban metropolis like Nairobi. We had to use our security forces to triangulate the calls of the contacts. That is how we got most of them until the last one,” he said.

The case demonstrated how one unaccounted-for contact can prolong an investigation, forcing health teams to establish where the person travelled, whom they encountered and whether further monitoring is necessary.

In his briefing to African regional health officials, Amoth said Kenya had listed 135 contacts linked to the index patient and was working to account for all of them. He subsequently reported that all contacts had been traced, with 120 people under quarantine at the time of the briefing.

He said eight people linked to the index case were receiving care in designated isolation facilities at Kenyatta National Hospital and Nairobi Hospital.

“Further, we have one person in isolation at the Moi Teaching and Referral Hospital, a contact who was on the same flight with the index case, and another two who are relatives of the index case currently isolated at Makaror Sub-County Hospital in Wajir County,” Amoth added.

Dr Patrick Otim, the World Health Organisation’s Programme Area Manager for Emergency Response, said travellers passing through border points must honestly disclose their movements, health history and possible exposure to Ebola during the preceding 21 days.

“Essential travellers, that is people moving through the border points, long-distance drivers and people seeking healthcare,” are among those who require screening, he said.

The screening process begins with declaration forms through which travellers provide information about where they have been, their activities and possible exposure to the virus. However, some travellers fail to sign the forms, while others provide incomplete information or conceal visits to areas affected by Ebola, including the Democratic Republic of Congo (DRC).

Amoth acknowledged that some quarantine facilities were not designed for a disease requiring such stringent infection prevention measures.

Ideally, each person under quarantine should have a separate room, toilet and bathroom, without contact with other people. But that standard was not being met at one facility, forcing officials to recalibrate quarantine arrangements and reassess monitoring periods.

“One of the challenges that we have had to deal with is prevention control measures at one of the facilities,” he said.

The problem highlights an important distinction: while some contacts may deliberately evade instructions, compliance is also shaped by whether authorities can provide safe and appropriate quarantine conditions.

The WHO has identified another way travellers can undermine screening: taking medication to suppress a fever before arriving at a checkpoint.

Dr Marie Roseline Belizaire, WHO Africa’s Regional Emergency Director, said border screening teams collect temperature readings and information about travellers’ movements and contacts during the preceding 21 days.

“When the temperature is high, which indicates the person has a fever, the person is not allowed to travel,” she said.

Under the International Health Regulations, points of entry should have the capacity to isolate suspected cases and arrange for rapid teams to collect samples for testing.

However, Belizaire warned that some travellers with fever take paracetamol before travelling, making it harder for screening teams to identify them through temperature checks.

“We have had cases of people who, when they are travelling and when they have fever, take paracetamol so the system cannot detect the temperature. Those are some of the cases,” she said.

The practice exposes a limitation of temperature screening: a normal reading cannot, on its own, rule out Ebola. Travellers may be incubating the virus without symptoms, while medication can temporarily reduce fever.

Temperature checks must therefore be combined with honest travel declarations, exposure assessments and follow-up of people who may have been in contact with an infected person.

The challenge extends beyond Kenya. The index patient travelled from the DRC through Uganda before boarding a flight from Entebbe to Nairobi, illustrating how an outbreak in one country can create surveillance demands across several jurisdictions.

Otim said Uganda had no active cases at the time of his briefing, despite receiving imported cases originating in the DRC.

“We agree there is a porous border between DRC and Uganda. Most of them crossed from Ituri through Arua in Northern Uganda or down in the western part and then they travelled to Kampala to seek treatment,” he said.

Uganda has established screening points at designated border crossings, but the length of its border with the DRC makes it difficult to monitor every possible route.

“There is a very long porous border between DRC and Uganda and it is almost impossible to put people at all those points,” Otim said.

Informal crossings can allow travellers to bypass official screening, while people who conceal symptoms or travel histories may move through formal checkpoints without triggering further assessment.

WHO Regional Director for Africa Dr Mohamed Janabi said strong surveillance and community participation were essential to containing the outbreak and protecting neighbouring countries.

“We also know that success is strong when surveillance is strong and the community is involved,” he said.

Janabi said the WHO was maintaining close contact with the DRC, Kenya, Uganda and Nigeria to protect high-risk areas and neighbouring countries. He urged governments to share information promptly.

“We urge countries to be transparent and share information on time, so that we can curb Ebola on time,” he said.

Janabi also cited more than 300 health workers infected and 48 deaths among health workers in the outbreak figures presented during his briefing, underscoring the consequences of delayed detection and continued transmission.

Kenya’s response has involved tracing contacts, isolating people requiring care and assessing those under quarantine to determine when they can safely be released.

Amoth said patients in isolation were receiving monoclonal antibodies and intravenous remdesivir under the treatment approach being used at the time of his briefing. He reported that they were stable and responding to treatment, although one patient required supplemental oxygen after a drop in oxygen saturation.

Kenya had also requested 10,000 vaccine doses for healthcare workers from the WHO and the Africa Centres for Disease Control and Prevention.

But medical interventions and laboratory capacity cannot fully compensate for delayed disclosure, incomplete travel histories or contacts who cannot be located promptly.

Every concealed journey creates additional work for contact tracers. Every person who evades monitoring may require teams to reconstruct their movements and identify further contacts. And every traveller who relies on a temperature check alone may pass through screening without revealing a relevant exposure.