WHO announces Ebola milestone as Guinea outbreak ends (Update)

December 29, 2015

The Ebola virus, isolated in November 2014 from patient blood samples obtained in Mali. The virus was isolated on Vero cells in a BSL-4 suite at Rocky Mountain Laboratories. Credit: NIAID
The UN's health agency on Tuesday declared Guinea's Ebola outbreak over two years after it emerged, spreading death across west Africa and pushing the region's worst-hit communities to the brink of collapse.

One of the poorest nations in the world, the former French colony was the host for "patient zero"—an infant who became the first victim—and health authorities went on to record some 2,500 deaths.

"Today the World Health Organization (WHO) declares the end of Ebola virus transmission in the Republic of Guinea," the UN agency said in a statement in Geneva.

The fever spread stealthily and terrifyingly from December 2013, striking two neighbouring countries, Sierra Leone and Liberia, with sporadic cases also in Mali, Nigeria and Senegal.

As world health watchdogs struggled to respond, the death toll mounted at a dizzying rate, igniting fears in Europe and elsewhere of a virus that transgressed borders and national controls.

Around 11,300 people died out of almost 29,000 recorded cases, according to a WHO tally that many experts believe greatly understates the real impact of the outbreak.

It was the deadliest epidemic of Ebola since the disease was first identified in 1976.

The last known case in Guinea was a three-month-old named Nubia, who was born with the disease but whose recovery was confirmed on November 16.

That triggered the countdown to the announcement, as a period of 42 days—twice the virus's maximum incubation period—is required to declare a country free of transmission.

'Au revoir, Ebola'

"It's the best year-end present that God could give to Guinea, and the best news that Guineans could hope for," said Alama Kambou Dore, an Ebola survivor.

"From 2013 to 2015, Guineans suffered, they lived and survived, they endured, they were stigmatised, rejected, even humiliated because of this disease, which leapt out of nowhere."

The WHO declared Sierra Leone' epidemic over on November 7, triggering wild celebrations in the capital Freetown. On December 3, Liberia released its last two known Ebola cases from hospital, starting the six-week countdown.

President Alpha Conde is expected at an official celebration in Conakry on Wednesday, flanked by representatives from donor countries and dozens of organisations, from Doctors without Borders to the Red Cross, that were frontline responders in the crisis.

Guests will pay tribute to the 115 health workers who died fighting Ebola and eight members of an Ebola awareness team killed by hostile locals in Guinea's forested southeast.

A range of top African musicians, including Youssou N'Dour and Mory Kante, will take to the stage for a "memorial" concert—entitled "Bye-bye, au revoir Ebola" in the francophone country.

Amid the jubilation and hope for a return to normality, experts have sounded a note of caution, as the virus has been shown to persist in the sperm and other body fluids of survivors significantly longer than previously thought.

Shattered economies

Liberia was declared free of human-to-human transmission in May and again in September, but both times the fever resurfaced in small clusters.

"We have to be very careful because, even if open transmission has been stopped, the disease has not been totally defeated," said Alpha Seny Souhmah, a Guinean health technician and Ebola survivor.

Guineans battling Ebola have been faced with huge obstacles, not least the country's grinding poverty and a crumbling medical infrastructure.

Frontline workers have also had to combat the rumour mill, entrenched denial, fear of Ebola stigma and resistance to confinement measures deemed authoritarian or unreasonable.

They also had to persuade people to abandon funeral traditions whereby mourners touch the body of their loved one—a potent pathway to infection.

The epidemic devastated the economies of the worst-hit countries, as crops rotted in the fields, mines were abandoned and goods could not get to market.

Strong recent growth has been curtailed in Guinea and while Liberia has resumed growth, Sierra Leone is facing a severe recession, according to the World Bank, which has mobilised $1.62 billion for Ebola response and recovery efforts.

The bank's group president Jim Yong Kim called for continued support for Guinea and its neighbours, vowing to "do everything we can to help these countries and the world prevent another deadly pandemic".

Ebola: profile of a prolific killer

A factfile on Ebola ahead of Guinea's expected announcement on Tuesday that it is now officially Ebola-free:

Toll

The worst outbreak of Ebola started in December 2013 in southern Guinea before spreading to two neighbouring west African countries.

It has killed more than 11,300 people, out of 29,000 registered cases, according to World Health Organization (WHO) estimates. The real figure may be higher.

More than 99 percent of the victims were based in three neighbouring West African countries—Guinea (more than 2,500 dead), Sierra Leone (more than 3,900) and Liberia (more than 4,800).

Where does it come from ?

Ebola was first identified in central Africa.

The tropical virus was named after a river in the Democratic Republic of Congo—then known as Zaire—where it came to light in 1976.

Five species have been identified to date (Zaire, Sudan, Bundibugyo, Reston and Tai Forest), the first being the most virulent with death rates that have reached 90 percent among humans.

How is it transmitted ?

The virus' natural reservoir animal is probably the bat, which does not contract the disease itself. Chimpanzees, gorillas, monkeys, forest antelope and porcupines are also suspected of having transmitted Ebola to humans.

Only one certified contact with an animal has been recorded in the current outbreak. It has since been passed among humans.

Ebola is transmitted by contact with the blood, body fluids, secretions or organs of an infected or recently deceased person, but not by air.

Those infected do not become contagious until the symptoms appear. They then become more and more contagious until just after their death, which poses great risks during funerals.

What are the symptoms?

Following an incubation period of between two and 21 days, Ebola develops into a high fever, weakness, intense muscle and joint pain, headaches and sore throats. That is often followed by vomiting and diarrhoea, skin eruptions, kidney and liver failure, and internal and external bleeding.

How to avoid infection

In the absence of a confirmed vaccine or cure, it is recommended that preventive measures be taken to stop the spread of Ebola—notably through hand-washing and using gel or alcohol-based disinfectants.

A distance of several metres (yards) should also be kept from infected people or bodies, and healthcare providers must wear disposable protective clothing that includes masks and gloves.

Possible treatments

Several tests have been carried out with experimental drugs and vaccines during the epidemic in west Africa.

Among these are Avigan (favipiravir) an antiviral treatment being developed by the Japanese company Toyama Chemical.

The best known is ZMapp, a cocktail of three monoclonal (single cell) antibiotics developed through a Canadian/US partnership.

The WHO said in July that the world "is on the verge of an effective Ebola vaccine" after Canadian drug VSV-EZEBOV was found in clinical trials in Guinea to provide 100-percent protection from the disease.

The drug may therefore become the first licensed vaccine against the disease.

Ebola: Timeline of an epidemic

Key dates in the latest Ebola epidemic, the worst ever outbreak of the haemorrhagic fever which first surfaced in 1976 in what is now the Democratic Republic of Congo.

According to the latest toll given by the World Health Organization (WHO), the epidemic has left 11,300 dead, mainly in the west African states of Guinea, Liberia and Sierra Leone, out of almost 29,000 cases.

Epidemic starts in Guinea

- December 6, 2013: A two-year-old child dies in southern Guinea and is later identified as "patient zero". The virus remains localised until February 2014, when a careworker in a neighbouring province dies.

Ebola begins to spread

- On March 31, 2014 two cases are confirmed by the WHO in Liberia, while on May 26 Sierra Leone confirms its first case, to be followed in late July by Nigeria, in August by Senegal and in October by Mali. Senegal and Nigeria are declared free of Ebola in October 2014 while Mali is declared Ebola-free in January 2015.

- May 30, 2014: Ebola is "out of control", according to the aid group Doctors Without Borders (MSF). The three worst-hit countries, Guinea, Sierra Leone and Liberia, declare measures including states of emergency and quarantines. Many neighbouring nations close their borders with the affected countries.

A 'public health emergency'

- August 8, 2014: The WHO declares Ebola a "public health emergency of international concern". Four days later it authorises the use of experimental drugs to fight Ebola after an ethical debate. That day, a Spanish missionary infected in Liberia dies in Madrid, the first European fatality.

Death in the US

- September 30, 2014: A Liberian man is hospitalised in the US state of Texas, the first Ebola infection diagnosed outside Africa. He dies on October 8.

October 6, 2014: A Spanish nurse in a Madrid hospital becomes the first person to be infected outside Africa. She is treated and given the all-clear on October 19.

Ebola begins a halting retreat

- February 22, 2015: Liberia says it is lifting nationwide curfews and re-opening borders, as the epidemic begins to retreat.

- February 26, 2015: The US ends its military mission in west Africa where it had deployed 2,800 soldiers to help in the fight against Ebola, mainly in Liberia.

- May 9, 2015: Liberia is declared Ebola-free by the WHO after no new cases were recorded for 42 days.

Surge in Guinea and Sierra Leone

- May 20, 2015: The WHO reports a spike in new cases in Guinea and in Sierra Leone. Guinea extends its health emergency on June 6.

- June 12, 2015: Sierra Leone reimposes a three-week curfew. The capital Freetown suffers a fresh outbreak in mid-June.

- June 30, 2015: Liberia says Ebola has returned there too.

Closing in on a vaccine

- July 10, 2015: International donors pledge $3.4 billion to help stamp out Ebola.

- July 31, 2015: The WHO says that an Ebola vaccine provided 100-percent protection in a field trial in Guinea, suggesting the world is "on the verge of an effective Ebola vaccine".

Hardest-hit countries emerge from the epidemic

- November 7, 2015: Sierra Leone is declared free of the outbreak by the WHO.

- November 17, 2015: The last known Ebola case in Guinea, a three-week-old girl, is declared recovered from the virus.

- December 4, 2015: Liberia releases from hospital its last two known Ebola cases.

Explore further: Liberia records first Ebola death since July

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