Ebola: Mali has local transmission

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Wednesday, 12 November, 2014

A nurse has died from Ebola at the Pasetur Clinic in Bamako, the capital of Mali. The case was reported today by BBC - http://www.bbc.com/news/world-africa-30015329. The nurse was infected while caring for a patient who arrived from Guinea. The body of the patient, a grand imam, was taken back into Guinea for burial. The nurse died on 12 November and a doctor from the clinic is also reported to be ill. See additional details at Reuters. Police are reported to be deployed around the clinic. Let's hope they are assisting with contact tracing and monitoring, not just standing around.

The cases are unrelated to the 2 year old girl who arrived in Mali from Guinea and died in October. Most of the identified contacts of this girl have just completed 21 days of quarantine. 21 days is the maximum incubation period for Ebola virus disease and if contacts develop no symptoms over this period, they are considered not to be infected with Ebola virus.

Only people that are symptomatic can transmite the Ebola virus.

There is a high probability that these two cases (patient and nurse) may be the start of a major Ebola epidemic. Mathematical modeling shows that the greater the number of cases in the initial cluster, the higher the probability of a major outbreak (Chowell et al. 2014). With initial clusters of 5 cases the probability of a major outbreak is 90%. Knowing how many additional cases are in this initial cluster will be informative.

Mali's Ebola classification now moves from a country with travel associated Ebola to one with localised transmission. The three countries with ongoing transmission are Guinea, Liberia, and Sierra Leone.

This event highlights the need for health professionals in non-Ebola countries to rapidly identify and isolate suspect Ebola cases and to care for them using protocols that protect themselves, the health care workers.

Update 13 November 2014: WHO has now officially reported on this case - see http://www.who.int/mediacentre/news/ebola/12-november-2014-mali/en/. There are now 4 deaths and 4 confirmed and probably cases in this outbreak. Since the index case was a Grand Imam and his funeral was attended by many people, there is a high liklihood of multiple secondary cases. The body was ritually washed in a mosque in Mali.

Bodies of people who have died from Ebola are highly infectious. The two most dangerous sources of transmission in EVD are in health care institutions and activities associated with funerals. Stopping transmission at these sites is absolutely essential in controlling Ebola outbreaks. It appears in this new outbreak that control has failed at both points.

Dteails of the original case in Guinea are also available at http://www.who.int/mediacentre/news/ebola/10-november-2014-mali/en/.

References

Chowell et al. Transmission dynamics and control of Ebola virus disease (EVD): A review. BMC Med 2014;12:196.

A police officer stands guard outside the quarantined Pasteur Clinic in Bamako November 12, 2014. From www.nst.com.my521

Posted by Rick Speare