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Ebola re-appears just as outbreak is declared over

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More than 100 people in Sierra Leone have been placed into quarantine following confirmation of the death of a woman from Ebola.

Just hours after the World Health Organisation declared “all known chains of transmission [of Ebola] have been stopped in West Africa”, laboratory tests confirmed that a 22-year-old woman who died near the Sierra Leone capital Freetown on 12 January had contracted the deadly disease.

The discovery is a blow to hopes that the world’s deadliest outbreak of the disease, in which more than 11,300 people died, was finally over.

Sierra Leone health authorities are still trying to identify the source of the transmission, though the news agency Reuters reported that late last month she had travelled to an area near the border with Guinea which had been one of the last remaining hot spots in the country before it was declared Ebola-free on 7 November.

Reuters reported a joint statement of the Sierra Leone Ministry of Health and the Office of National Security said in which they announced 109 people had been quarantined, including 28 considered to be at high risk.

Authorities are considered that relatives of the dead women washed her body before burial, a cultural practice that had been blamed for helping the rapid transmission of the deadly disease during the outbreak.

In its announcement just before the latest case was confirmed, the WHO had declared an end to the outbreak in Liberia, but warned that the battle to eradicate the disease was not yet complete.

“The job is not over. More flare ups and expected and…strong surveillance and response systems will be critical in the months to come,” the Organisation said.

Liberia was first declared free of Ebola transmission in May last year, but there have been two flare-ups since – the most recent in November.

The WHO made its declaration on 14 January, 42 days after the last Liberian patient confirmed to have Ebola twice tested negative for the disease. The period allowed for two incubation cycles of the virus.

It said the date marked the first time since the epidemic began two years ago that all three of the hardest-hit countries – Guinea, Liberia and Sierra Leone – had not had a single case in 42 days.

But the WHO urged the need for continued vigilance and swift action when cases were identified.

It said the three West African countries remained at “high risk” of small outbreaks, most likely caused by the virus persisting in survivors even after recovery.

“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,” the WHO’s Special Representative for the Ebola Response, Dr Bruce Aylward, said.

Dr Aylward said the risk was diminishing as the virus gradually disappeared from the population of survivors, “but we still anticipate more flare-ups, and must be prepared for them”.

Health authorities are concerned that the latest case in Sierra Leone did not present as a typical Ebola infection, causing delays in its diagnosis, and that there may have involved a breakdown in procedures around the safe handling of a patient infected with the disease.

Adrian Rollins