Rwanda briefly closed its border with Congo over the virus outbreak in the city of more than 2 million as the painstaking work of finding, tracking and vaccinating people who had contact with the man — and the contacts of those contacts — began.
The man died on Wednesday after spending several days at home with his large family while showing symptoms. Congo's presidency said the entire family was at "high risk" and in quarantine. The Ebola coordinator for North Kivu province, Dr. Aruna Abedi, confirmed the wife's case to The Associated Press hours after that of the child.
"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.
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, citing the Ebola outbreak, shortly before the annual hajj pilgrimage there this month.
Congo's presidency condemned Rwanda's decision, and Congolese at the busy frontier 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. A Rwanda health ministry statement called the events a "traffic slowdown" as surveillance for Ebola was reinforced. The ministry advised against unnecessary travel to the Goma area.
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 official crossings equipped with hand-washing stations and where people are checked for signs of fever or other Ebola symptoms. 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 Wednesday in Goma "in such a dense population center 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 300-mile-long (490-kilometer) route from the city of Komanda to Goma as he took motor 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 center on Tuesday. He had spent five days being treated at home before going to a health facility, where Ebola was suspected. Symptoms can start to occur between two and 21 days from infection, health experts say.
"He may not even have been aware of the exposure that he had," WHO emergencies chief Dr. Michael Ryan said Wednesday. Symptoms such as fever can be confused with malaria, which is endemic in the region.
Congo's new Ebola response coordinator, Jean-Jacques Muyembe, has said there appears to be no link between the case and a previous one in Goma 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.
Ssuuna reported from Kigali, Rwanda. Associated Press writer Al-Hadji Kudra Maliro contributed.
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