Health authorities struggling to control the worst outbreak of Ebola on record said drastic action is needed to prevent more deaths.
More than 390 people have died in the outbreak in Guinea, Sierra Leone and Liberia, the World Health Organization said in a statement today. That toll is greater than the 280 people killed in 1976, when the virus was first identified near the Ebola River in what is now the Democratic Republic of Congo.
The WHO plans to meet with health ministers from 11 countries July 2-3 in Accra, Ghana, to agree on a plan to bring the outbreak under control. Health workers will have to tackle resistance from local people who are hiding infected family members, destroying medicines intended to help and adhering to rituals that fuel the spread of the virus.
“This is no longer a country-specific outbreak but a sub-regional crisis that requires firm action by governments and partners,” said Luis Sambo, the WHO’s regional director for Africa. “WHO is gravely concerned of the ongoing cross-border transmission into neighboring countries as well as the potential for further international spread.”
The outbreak is expected to last another three to four months, focused around the “hot spot” in the rural border areas where the three countries meet, said Francis Kasolo, the WHO’s director of disease prevention and control for Africa.
“What we are seeing is a lot of cross-border movement,” Kasolo said in a telephone interview. “When somebody comes in contact with a sick person in Guinea and crosses into Sierra Leone, as long as they don’t report having come into contact with an Ebola patient, there is a grave possibility that that person will transmit the disease.”
At next week’s meeting, the WHO will discuss forming a multi-country team that will share information daily on Ebola cases and people who have come into contact with those infected, Kasolo said. The Geneva-based organization has deployed more than 150 people to fight the epidemic, with tasks including surveillance, communication, infection control, logistics and data management.
The virus is also spreading because some hospitals are allowing infected patients to leave. Unsafe burial practices are also contributing.
Effective communication of safe measures to local communities is a major challenge that will be discussed in Accra, said WHO spokesman Daniel Epstein.
“If there isn’t a strong public-health information and education component to the control activities, then people don’t understand and end up infecting themselves and doing things they shouldn’t be doing,” said David Heymann, a professor at the London School of Hygiene and Tropical Medicine who has studied Ebola since the first outbreak in 1976.
Guinea has pockets of resistance, mainly in the town of Gueckedou, the epicenter of the disease, said Remy Lamah, the country’s health minister.
“There are always citizens who remain attached to their rites, their traditions and others do not even believe that Ebola exists,” he said by phone today from Conakry, Guinea’s capital. “We want to use teachers and students during the holidays for awareness caravans in their communities.”
The WHO is also recruiting Ebola survivors to speak at next week’s meeting and share their experience with their own communities to try to end resistance to control efforts.
“That’s one of the ways of trying to break the denial barrier of saying Ebola is just another disease,” Kasolo said. “We want them to be advocates within the communities where they come from on this particular disease.”
Suspicion of health workers’ motives has thwarted initiatives in some places. In Sierra Leone, youths in Kailahun burned drugs and other supplies, claiming the medicines were meant to kill Ebola patients, the country’s ministry of health and sanitation said this week.
Some households in Sierra Leone’s Kenema district are also hiding infected family members until they become very ill, health minister Miatta Kargbo said in an interview. Bogus vaccination programs are also causing undue confusion.
“The ministry wishes the general public to know that there is no vaccine for Ebola and it has not instituted any Ebola vaccine immunization in schools,” the ministry said in a statement. “The act of spreading this misleading and scaring information is a criminal offense and people involved in this act are warned to desist forthwith.”
In Liberia, traditions of waiting to bury bodies for months and touching the dead have made controlling the spread harder, Tolbert Nyesuah, assistant minister for health said. Denial that that disease exists has also complicated containment, he said.
There is low risk at present that the outbreak will spread to other nations, Kasolo said. Still, officials from neighboring countries such as Mali, Guinea-Bissau, Senegal, Ghana, Ivory Coast and Gambia have been invited to attend the Accra meeting in case the disease spreads, he said. The Democratic Republic of Congo and Uganda will share their experiences dealing with past outbreaks.
“We still think we have another three to four months to go with the epidemic, but the duration will be influenced by how national governments and affected communities respond,” Kasolo said.