Wife and daughter of Ebola victim in Congo's Goma infected

The wife of the man who died of Ebola in Congo's city of Goma this week has tested positive for the virus, hours after their one-year-old daughter was confirmed to have the disease.

The Ebola co-ordinator for North Kivu province, Dr. Aruna Abedi, confirmed the latest case to The Associated Press.

The two new cases on Thursday are the first involving direct transmission of Ebola inside Goma, a city of more than 2 million people on the Rwandan border.

Congo's Ebola virus outbreak is now in its second year.

This is the first transmission of Ebola inside Goma, a scenario that health experts have long feared. The painstaking work of finding, tracking and vaccinating people who had contact with the man — and the contacts of those contacts — has begun.

The man died on Wednesday after spending several days at home with his large family while showing symptoms. The presidency of Congo, also known as Congo-Kinshasa, said the entire family was at "high risk" and that it was likely other members will be confirmed to have Ebola.

"We're seeing the first active transmission chain in Goma and expect more to come," the International Rescue Committee's Ebola response director, Andre Heller, warned in a statement.

Rare global emergency

This outbreak has killed more than 1,800 people, nearly a third of them children. It is now the second-deadliest Ebola outbreak in history, and last month the World Health Organization declared it a rare global emergency.

Rwanda's state minister for foreign affairs, Olivier Nduhungirehe, confirmed the border closure, a day after WHO officials praised African nations for keeping their borders open. Last week Saudi Arabia stopped issuing visas to people from Congo while citing the Ebola outbreak, shortly before the annual hajj pilgrimage there this month.

Congo's presidency swiftly condemned Rwanda's decision, and local Congolese at the busy border expressed frustration. "I can't understand why they don't just test us instead of closing these borders," said Angel Murhula, who works in Rwanda.

Several hours later Congo's presidency said the border had reopened, while Rwanda's health minister said the "border was never closed and it is not closed," instead calling it a "traffic slowdown." The ministry advised against unnecessary travel to the Goma area.

Transmission beyond borders a risk

WHO has recommended against travel restrictions amid the outbreak but says the risk of regional spread is "very high." Any border closure is likely to push people to avoid formal immigration posts. In June, three people who crossed on an unguarded footpath into Uganda died there before their family members were taken back to Congo for treatment.

The death on Wednesday in Goma "in such a dense population centre underscores the very real risk of further disease transmission, perhaps beyond the country's borders," United Nations agencies said in a joint statement marking a year of the outbreak.

The man in his 40s was a miner returning from an area of northeastern Ituri province, Mongwalu, where no Ebola cases in this outbreak have been recorded, WHO said. He was exposed to the virus along the roughly 490-kilometre route from Komanda to Goma as he took motorcycle taxis over a number of days through the densely populated region at the heart of the outbreak.

The man arrived in Goma on July 13 and started showing symptoms on July 22. He was isolated at an Ebola treatment centre on Tuesday. He had spent five days being treated at home and then went to a health facility, where Ebola was suspected. Symptoms can start to occur between two and 21 days from infection, health experts say.

Health workers attacked

"He may not even have been aware of the exposure that he had," WHO emergencies chief Dr. Michael Ryan said on Wednesday. Symptoms such as fever can be confused with malaria, which is endemic in the region.

Congo's new Ebola response co-ordinator, Jean-Jacques Muyembe, has said there appears to be no link between the case and the previous one in Goma that was announced two-and-a-half weeks ago. That case was a 46-year-old preacher who managed to pass through three health checkpoints on the way from Butembo, one of the communities hardest hit by this outbreak.

The declaration of a global health emergency — the fifth in history — came days after that first Goma case. It has brought a surge of millions of dollars in new pledges by international donors, but some health workers say a new approach is needed to combat misunderstandings in a part of Congo that had never experienced Ebola before.

Health workers responding to the outbreak have been attacked, even killed, in a region where rebel groups are active and the population is wary of outsiders.

There is no licensed treatment for Ebola, which is spread by close contact with bodily fluids of those infected, and survival can depend on seeking treatment as quickly as possible. And yet many people in the region don't believe that the virus is real, health workers have said.

This outbreak is second only to the 2014-16 Ebola outbreak in West Africa that left more than 11,300 people dead.