Kenya's Ebola alert: why early symptoms look like malaria, and the lab test that tells them apart

Kenya's Ministry of Health has warned that "Ebola symptoms can look like malaria", the Kenyan news site Capital FM reported on 19 October. In the first days both diseases bring fever and headache, and the World Health Organization (WHO) says the two are hard to separate by examining a patient. A laboratory test settles it.

The alert came with Kenya's total at eight cases, after a 49-year-old hospital patient attendant tested positive. The ministry said early symptoms appear two to 21 days after infection and include fever, tiredness, weakness, muscle pain, headache and sore throat. Later symptoms can include vomiting, diarrhoea, stomach pain and impaired kidney or liver function, and bleeding can occur in later stages.

Malaria begins in much the same way. WHO lists fever, headache and chills as its most common early symptoms, usually starting within 10 to 15 days of a bite from an infected mosquito. Malaria mostly spreads through the bites of some infected female Anopheles mosquitoes. Ebola's incubation period of 2 to 21 days is wider and takes in the malaria window.

Early in an illness, a fever works like a smoke alarm: it says something is burning, not what. WHO's Ebola fact sheet says it can be difficult to tell Ebola from malaria and typhoid fever by symptoms alone, because the early symptoms are similar. The US Centers for Disease Control and Prevention (CDC) says healthcare providers can confuse Ebola with more common infections, and names malaria, influenza, typhoid fever, meningococcal disease and bacterial infections such as pneumonia.

Some difference shows with time. The CDC describes an early "dry" stage of fever, aches, severe headache, weakness and sore throat. "Wet" symptoms, it says, can begin after four to five days of illness: unexplained bleeding, nausea, abdominal pain, diarrhoea and vomiting.

The decisive step is a test. WHO recommends that every suspected case of malaria be confirmed with a parasite-based test, either microscopy or a rapid diagnostic test. For Ebola, WHO lists reverse transcriptase polymerase chain reaction (RT-PCR), which detects the virus's genetic material in a sample, along with antibody-capture ELISA, antigen-capture tests and virus isolation in cell culture.

Kenya's outbreak is of Bundibugyo virus, one of the Ebola viruses. In its outbreak notice of 16 May 2026, WHO said past Bundibugyo outbreaks in Uganda and the Democratic Republic of Congo (DRC), in 2007 and 2012, had case fatality rates of approximately 30% to 50%, and that no approved vaccines or specific treatments existed. The notice calls telling the disease from malaria and other fevers challenging, with PCR or antigen and antibody tests used for confirmation.

The test has to match the virus. WHO added the first molecular test for Bundibugyo virus to its Emergency Use Listing on 2 July 2026, a real-time RT-PCR kit made by Shanghai ZJ Bio-Tech. The Altona RealStar Filovirus Screen RT-PCR Kit 1.0 followed on 29 July. WHO Director-General Tedros Adhanom Ghebreyesus said, as quoted by the Kenyan daily The Standard: "Timely and accurate diagnosis is the cornerstone of every effective outbreak response."

WHO says people cannot transmit Ebola before they have symptoms, and stay infectious as long as their blood contains the virus. Infection comes through direct contact with the blood or body fluids of a person who is sick with, or has died from, Ebola, or with objects contaminated by those fluids. Health workers are often infected when infection control precautions are not strictly followed.

Malaria remains a heavy burden in Africa. WHO puts 95% of the world's malaria cases (265 million) and 95% of its deaths (579,000) in its African Region in 2024. Kenya's national malaria incidence fell from 104 to 72 cases per 1,000 people between 2023 and 2025, the Kenya News Agency, the official state news agency, reported in February from a consultative session between the Ministry of Health and the African Leaders Malaria Alliance.

The ministry's advice in its Ebola alert is for anyone who feels unwell to seek medical care promptly and not to ignore signs of illness or delay seeking care. WHO's malaria fact sheet adds that early treatment of mild malaria can stop the infection from becoming severe, and that people with severe symptoms should get emergency care right away.