Two days after expressing guarded confidence that Mali's first Ebola case had not triggered any more infections, the World Health Organization (WHO) today reported an unrelated fatal Ebola infection in a Malian nurse who worked at a clinic in the nation's capital where a 70-year-old man from neighboring Guinea had died of probable Ebola but was not tested.
The Guinean man was visited in the clinic in Bamako, Mali, by a friend who subsequently died of an unknown illness, and the friend's illness was probably Ebola as well, the WHO said. The three new fatal cases (one confirmed, two probable) raised Mali's total to four.
The three new cases are unrelated to the first one, the WHO said. Mali's first case involved a 2-year-old girl from Guinea who died Oct 24 in Kayes, Mali, after being brought there by a relative. Her case and the nurse's stemmed from independent chains of transmission involving different villages and families in Guinea, the agency said.
The WHO also said that the body of the 70-year-old Guinean, a grand imam, was not handled safely, raising the possibility that others were exposed to the virus during funeral rituals.
In addition, the WHO said today that its overall Ebola case count in West Africa has exceeded 14,000, while the death toll has topped 5,100.
Timeline of cases
The nurse, who worked at the Pasteur Clinic in Bamako, was isolated on the evening of Nov 10 after an alert from authorities in Guinea raised suspicion of Ebola, the WHO reported. A biosafety level 3 lab in Bamako confirmed the case yesterday, and the nurse died yesterday evening, the agency said.
The WHO did not list the nurse's sex or age, but a Reuter's report today, which also did not specify the gender, said the nurse was 25.
Explaining the background of the nurse's case, the WHO said the 70-year-old imam from Guinea, who lived in Koruemale village in Signuiri prefecture, fell ill on Oct 17 and was admitted to a local clinic in Guinea the next day. The area had intense Ebola transmission from early July to mid-August.
When the man didn't improve, he was transferred to another clinic across the border in Mali, and on Oct 25 he and four family members traveled by car to Bamako to seek treatment at the Pasteur Clinic, the WHO said. He was suffering from acute kidney failure—often seen in late stages of Ebola virus disease—and was tested for multiple pathogens but not for Ebola.
The man was treated at the Pasteur Clinic from Oct 25 to 27, when he died of kidney failure. "In addition, a friend who visited him at the clinic also died abruptly from an undiagnosed disease," the WHO said. Both men probably had Ebola, but no samples are available, the agency said. The statement gave no other details about the friend.
Because the 70-year-old was a grand imam, his body was taken to a Bamako mosque for a washing ceremony and was then returned to his home village in Guinea for funeral and burial rites. "Although these events are still under investigation, WHO staff assume that many mourners attended the ceremonies," the WHO said.
Concern about response
The WHO said 28 healthcare workers who had contact with the deceased man at the Pasteur Clinic are under observation, and investigators are tracing contacts in the community, including at the Bamako mosque.
The Reuters report said more than 90 people in Bamako were quarantined today in connection with the new cases. Among them are about 20 United Nations peacekeepers who were being treated at the Pasteur Clinic for injuries they suffered while serving in northern Mali, according to the report.
The story also said there is growing concern about how long it took for authorities to implement Ebola control measures after the imam's death. One aid worker who asked to remain anonymous told Reuters, "This case shows the lack of training of doctors in Bamako. This training should have been done six months ago."
In other findings, the WHO update said five of the imam's family members also fell ill with probable or confirmed Ebola cases in recent days, and two of them died. They included all four relatives who accompanied him on the car trip to Bamako. The man's son tested positive yesterday, and confirmation of his case increased the probability that the other illnesses were caused by Ebola.
Case count, death toll climb
In a separate situation report today, the WHO said the total case count in West Africa's epidemic through Nov 9 has reached 14,098, with a death toll of 5,160. Those numbers mark increases of 830 cases and 200 deaths since the previous update on Nov 7, which covered reports through Nov 4.
The latest figures indicate 118 more cases and 88 deaths in Guinea since the last report, 203 new cases and 70 deaths in Liberia, and 506 new cases with 39 deaths in Sierra Leone.
"There is some evidence that case incidence is no longer increasing nationally in Guinea and Liberia, but steep increases persist in Sierra Leone," the report says. "A mixed picture emerges at the district level. Transmission is consistently high in Conakry and Macenta in Guinea; Montserrado in Liberia; and in the western and northern areas of Sierra Leone."
Declines in incidence are continuing in Lofa in Liberia and in Kenema and Kailahun in Sierra Leone, the WHO said, adding that cases and deaths continue to be under-reported.
As for interventions, the WHO said 19 of 53 planned Ebola treatment centers are now open. "A total of 140 trained burial teams are on the ground, and more than 4400 burials have reportedly been conducted in a safe and dignified manner since the outbreak began. Samples from all 53 Ebola-affected districts can be sent to a laboratory within 24 hours by road," the report said.
Among observations on individual countries, the WHO said weekly case numbers in Liberia fell from mid-September to the end of October, but the decline has since stabilized, and a reversal of the trend is possible. Liberia reported 97 confirmed and probable cases in the week that ended Nov 8.
"EVD transmission remains high in Sierra Leone, with 421 new confirmed cases reported in the week to 9 November," the report states. "Much of this was driven by intense transmission in the country's west and north. Transmission remains intense in the capital Freetown, which reported 77 new confirmed cases in the past week."
Intense transmission also continues in Guinea, despite a stabilizing trend in some districts, the WHO reported. It said 145 cases were newly confirmed in the week that ended Nov 9.
Senegal vows to reopen Guinea border
In other news, Senegal has decided to reopen its border with Guinea and resume flights to Liberia and Sierra Leone, according to yesterday's situation report from the United Nations Mission for Ebola Emergency Response (UNMEER).
In announcing the move, President Macky Sall said the step is in line with recommendations from the Economic Community of West African States. But he did not give a date for reopening the border and restoring air service, UNMEER reported.
Nov 12 WHO report on new cases in Mali
Nov 12 Reuters story on Mali cases
Nov 12 WHO Ebola response situation report
Nov 11 UNMEER report
Nov 7 WHO Ebola response situation report