Although the declaration of an `end to Ebola transmission' in Guinea today is a huge and long awaited milestone - it doesn't mean the threat in West Africa is over - but 42 days without registering a new case is a hopeful sign.
We've already seen instances of the virus re-emerging weeks or even months after transmission was halted (see New Ebola Case Confirmed In Liberia After 17 Weeks).
The virus likely remains in the environment, and could easily be reintroduced through the consumption of infected bush meat. And we've strong evidence that some Ebola survivors can carry (and shed) the virus for months after they have recovered, providing yet another route for resurgence.
- In ECDC On Ebola Persistence & Rapid Risk Assessment, we looked at the unexpected relapse of Scottish nurse Pauline Cafferkey, nine months after her recovery from the the virus
- In WHO: Study Shows Ebola Virus Fragments May Be Detectable In Semen For > 9 Months, we saw additional evidence of the long-term presence of the Ebolavirus in male semen, and last May (see MMWR & WHO On Risks Of Sexual Transmission Of Ebola) we saw evidence of the sexual transmission of the virus.
All of which makes `getting to zero, and staying there’ a daunting task.
Additionally, there are thousands of survivors who continue to suffer from a variety of serious sequelae, and the social stigma of having been infected. Their recovery, and the region's, will be a long process.
This from WHO.
Geneva, 29 December 2015 - Today the World Health Organization (WHO) declares the end of Ebola virus transmission in the Republic of Guinea. Forty-two days have passed since the last person confirmed to have Ebola virus disease tested negative for the second time. Guinea now enters a 90-day period of heightened surveillance to ensure that any new cases are identified quickly before they can spread to other people.
“WHO commends the Government of Guinea and its people on the significant achievement of ending its Ebola outbreak. We must render homage to the Government and people of Guinea who, in adversity, have shown extraordinary leadership in fighting the epidemic,” says Dr Mohamed Belhocine, WHO Representative in Guinea. “WHO and its partners will continue to support Guinea during the next 90 days of heightened surveillance and in its early efforts to restart and strengthen essential health services throughout 2016.”
A milestone for the Ebola outbreak
The end of Ebola transmission in Guinea marks an important milestone in the Ebola outbreak in West Africa. The original chain of transmission started two years ago in Gueckedou, Guinea in late December 2013 and drove the outbreak which spread to neighbouring Liberia and Sierra Leone and, ultimately, by land and air travel to seven other countries.
“This is the first time that all three countries – Guinea, Liberia and Sierra Leone – have stopped the original chains of transmission that were responsible for starting this devastating outbreak two years ago,” says Dr Matshidiso Moeti, WHO Regional Director for Africa. “I commend the governments, communities and partners for their determination in confronting this epidemic to get to this milestone. As we work towards building resilient health care systems, we need to stay vigilant to ensure that we rapidly stop any new flares that may come up in 2016.”
In addition to the original chain of transmission, there have been 10 new small Ebola outbreaks (or ‘flares’) between March and November 2015. These appear to have been due to the re-emergence of a persistent virus from the survivor population.
Among the challenges survivors have faced is that after recovering from Ebola virus disease and clearing the virus from their bloodstream, the virus may persist in the semen of some male survivors for as long as 9-12 months.
WHO and its partners are working with the Governments of Liberia, Sierra Leone and Guinea to help ensure that survivors have access to medical and psychosocial care, screening for persistent virus, as well as counselling and education to help them reintegrate into family and community life, reduce stigma and minimize the risk of Ebola virus transmission.
Sustained support to Guinea, Liberia and Sierra Leone
“The coming months will be absolutely critical,” says Dr Bruce Aylward, Special Representative of the Director-General for the Ebola Response, WHO. “This is the period when the countries need to be sure that they are fully prepared to prevent, detect and respond to any new cases.
“The time-limited persistence of virus in survivors which may give rise to new Ebola flares in 2016 makes it imperative that partners continue to support these countries. WHO will maintain surveillance and outbreak response teams in the three countries through 2016.”
At the same time, 2016 will see the three most-affected countries implementing a full health sector recovery agenda to restart and strengthen key public health programmes, especially maternal and child health, while continuing to maintain the capacity to detect, prevent and respond to any flare-up of Ebola.
(Continue . . .)