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Mali Reports a Second, Larger Ebola Outbreak First Outbreak Quashed, Ebola Reappears in Mali
(about 9 hours later)
Mali, an African country that just beat its first Ebola outbreak, has confirmed a second one that is larger and more threatening than the first, global health authorities said Wednesday. The West African nation of Mali, which just beat its first outbreak of Ebola, has confirmed a second one that is larger and more threatening, global health authorities said on Wednesday.
The first case in the new outbreak was a 70-year-old religious figure, a grand imam, who fell ill in Guinea and traveled to Mali for better treatment at a major private clinic in Bamako, Mali’s capital. The victim who apparently began the new outbreak was an imam who fell ill in Guinea and traveled to Mali for better treatment at a major private clinic in Bamako, the capital.
He died there on Oct. 27, and because of his importance, his body was washed at a large Bamako mosque before being returned to Guinea for burial. The new cases will add to the mounting total of Ebola victims. In its last update on Nov. 5, the World Health Organization said there had been more than 13,000 confirmed or suspected cases in West Africa since the epidemic began. Some 5,000 people have died.
But the Pasteur Clinic, where he was treated, failed to diagnose Ebola as the underlying cause of the kidney failure it was treating him for. According to a World Health Organization description of the case, numerous tests were performed, but not one for Ebola. The imam died at the Pasteur Clinic in Bamako on Oct. 27. Because of his status, his body was washed at a large mosque and then returned to Guinea for burial after a funeral at another mosque.
It was only realized how infectious he was after a nurse at the clinic fell ill and died, and when the chief W.H.O. representative in Mali heard from his counterparts in Guinea that the imam’s family members were dying. The Pasteur Clinic failed to diagnose Ebola as the underlying cause of the kidney failure for which it was treating the imam. Kidney failure is a possible complication of late-stage Ebola.
“It was a real failure by the clinic,” said Dr. Ibrahima Soce Fall, the W.H.O. Mali team leader, in a telephone interview. The outbreak was only detected after a nurse at the clinic fell ill and died, and the chief W.H.O. representative in Mali heard from his counterparts in Guinea that members of the imam’s family were dying.
Now the clinic is closed and under quarantine — as is the mosque, another small Malian clinic where the imam was treated, and the large family compound where the nurse lived. Health experts are trying to trace everyone the imam and the nurse were in contact with. “It was a real failure by the clinic,” the W.H.O. representative, Dr. Ibrahima Soce Fall, said in a telephone interview.
The task will be complex, since the imam fell ill nearly a month ago on Oct. 17 in Kourémalé, a town in Guinea near the border. The consequences for Mali were not recognized until Nov. 10, when doctors ordered an Ebola test on the dying Bamako nurse. Now, the clinic is closed and under quarantine — as are the mosque in Bamako, one or two other Malian clinics where the imam was treated, and the large family compound where the nurse lived.
So far, 28 staff members at the Pasteur Clinic — which is not related to the Pasteur Institute in France or any of its African offshoots — have been quarantined, as have 50 people who had contact with the nurse. Among the patients quarantined at the clinic are 10 United Nations peacekeepers stationed in Mali who were wounded in fighting in the north.
A friend who visited the imam at the clinic has also died of unknown causes and is considered a suspect case, although no blood samples are available to test, the W.H.O. said. On Wednesday evening, the Malian health authorities confirmed that one of the clinic’s doctors also had Ebola.
“We’re still working on the contact tracing,” Dr. Fall said. The mosque is worrisome, he said, because it is unclear who may have come into contact with the body there. No one has fallen ill there so far. The imam traveled in a private car, not on public transportation, and three members of his family who were in the car are now ill or dead in Guinea. The clinic is now surrounded by police officers. Armored vehicles from the United Nations peacekeeping mission are parked nearby.
Teams with advisers from the W.H.O. and other health agencies are working at the clinic, the mosque, and the border. “Most nurses and doctors had gone home when the clinic was quarantined, and I fear the patients will be left without proper care,” said Dramane Maiga, the clinic’s director.
Malian authorities have not closed the border. Closing it is considered impractical — it is 500 miles long with many gravel roads crossing it. Also, it is a hangover from the divisions of French colonialism and separates many extended families that are used to traveling back and forth. Health experts are trying to trace everyone with whom the imam, the nurse and others with suspected cases of Ebola came into contact.
In addition, Mali has a longstanding tradition of welcoming both strangers and those with clan connections — a principle known as diatiguiya (pronounced JAH-tih-GEE) — and closing the border was unthinkable, many Malians said. The task will be complex, because the imam fell ill nearly a month ago, on Oct. 17, in Kourémalé, a town that straddles the Guinea-Mali border. The consequences for Mali were not recognized until Nov. 10, when doctors ordered an Ebola test on the dying Bamako nurse.
The new outbreak is frustrating for health authorities because they were feeling triumphant about their success in containing the country’s first case: a 2-year-old Guinean girl, Fanta Condé, who died in the town of Kayes in northwest Mali on Oct. 24. The authorities had quarantined 108 people who were briefly in contact with Fanta on buses from Guinea, at a family compound in Bamako and at the hospital in Kayes where she died. So far, 28 staff members at the Pasteur Clinic, which is not related to the Pasteur Institute in France or any of its African offshoots, have been quarantined, as have 50 people who had contact with the nurse.
None had fallen ill — not even the three family members who brought her from Guinea on Oct. 19 — and all 108 were due to be released from quarantine by Friday. A friend who visited the imam at the clinic has died of unknown causes and is considered a suspected case, although no blood samples are available to test, the W.H.O. said.
When the new, unrelated cluster was first suspected on Monday, Dr. Rana Hajjeh, who directed the Centers for Disease Control and Prevention team in Mali that worked on the Fanta Condé case, mentioned it in an email and described it as “Murphy’s Law” — that is, the principle that anything that can go wrong will go wrong, and at the worst possible time. “We’re still working on the contact tracing,” Dr. Fall said. It is not yet clear how many people may have been exposed to the virus.
In Guinea, the imam’s first wife has died, as has his daughter. In the daughter’s case, the death took place Monday and Ebola was suspected, but the family declined offers of a safe burial. The imam’s brother, second wife and son are ill and in Ebola treatment centers. The mosque connection is worrisome, Dr. Fall added, because it is unclear how many people touched the imam’s body. No one has fallen ill there so far.
The imam traveled in a private car, not on public transportation, and at least four members of his family who were in the car are now ill or dead in Guinea.
His first wife has died, as has his daughter. The daughter died on Monday, and Ebola was suspected, but the family declined offers of a safe burial. The imam’s brother, second wife and son are ill and in Ebola treatment centers.
Teams including advisers from the W.H.O. and other health agencies are working at the clinic, the mosque and the border.
The Malian authorities have not closed the border, which is considered impractical. It is 500 miles long and crossed by many gravel roads. Also, in a holdover from the divisions of French colonialism, it separates many extended families who are used to traveling back and forth.
In addition, Mali has a longstanding tradition of welcoming both strangers and those with clan connections — a principle known as diatiguiya (pronounced JAH-tih-GEE).
The new outbreak is frustrating for the health authorities because they were feeling triumphant about their containment of the country’s first case: a 2-year-old Guinean girl, Fanta Condé, who died in the town of Kayes in northwestern Mali on Oct. 24.
The authorities had quarantined 108 people who were briefly in contact with Fanta on buses from Guinea, at a family compound in Bamako and at the hospital in Kayes where she died. None had fallen ill, not even the three relatives who took her to Mali from Guinea on Oct. 19, and all 108 were to be released from quarantine by Friday.
When the new, unrelated cluster was first suspected on Monday, Dr. Rana Hajjeh, who directed the Centers for Disease Control and Prevention team in Mali that worked on the Fanta Condé case, mentioned it in an email and described it as “Murphy’s Law” — the tongue-in-cheek principle that anything that can go wrong will go wrong, and at the worst possible time.