Just hours after the World Health Organization (WHO) declared the end of Ebola virus transmission in the outbreak region, the agency reported a new case in Sierra Leone involving a 22-year-old woman whose illness was detected after she died.
Her case is worrying, because many people may have been exposed to the virus while she traveled and sought medical care, plus local authorities buried her without safety protocols in place.
Yesterday the WHO warned that flare-ups of the disease were likely, given lingering virus in some survivors.
On Nov 7 the WHO had announced that Ebola transmission had stopped in Sierra Leone, which began a 90-day enhanced surveillance period.
"We are now at a critical period in the Ebola epidemic as we move from managing cases and patients to managing the residual risk of new infections," said Bruce Aylward, MD, MPH, the WHO's special representative for the Ebola response, in a statement. "We still anticipate more flare-ups and must be prepared for them."
Travel and burial risk factors
A government spokesman said on a radio broadcast that the woman who died was from Kambia district in the north and had traveled to Tonkolili district for medical care, the Associated Press (AP) reported today.
Sierra Leone activated its new emergency operations center, and a joint investigation is under way involving country officials, the WHO, and other partners. Goals are to assess how the Sierra Leone woman contracted her infection and to trace her contacts.
Aylward told the AP that the woman wasn't buried safely, because local health workers didn't suspect that she was sick with Ebola. Unsafe burials have played a major role in spread of the Ebola virus.
Besides safe burials, another key response step in the outbreak region has been to test for Ebola in all people who die as a means of identifying any unknown cases or transmission chains.
Case marks 11th flare-up
Yesterday the WHO noted that there had been 10 flare-ups outside of the original outbreak, so Sierra Leone's new case moves that total to 11. Sexual transmission has been strongly suspected in many of the recurrence incidents. Immune-protected areas of the body such as the testes and the eyes can harbor the virus, perhaps for as long as 1 year.
However, health officials expect that threat to diminish as virus levels ebb in the survivor population.
Jan 15 WHO statement
Jan 14 WHO statement
Jan15 AP story