Liberia set to be declared Ebola-free

http://www.theguardian.com/world/2015/may/08/liberia-set-to-be-declared-ebola-free

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Liberia is a day away from being declared Ebola-free but the country remains on high alert, with neighbouring Sierra Leone and Guinea still reporting cases of the infectious disease.

If there are no new infections, the World Health Organisation (WHO) will declare Liberia Ebola-free on Saturday, 42 days – or twice the incubation period of the virus – after the last case was reported on 27 March.

But as Liberia emerges from the worst outbreak in history, the WHO said “heightened vigilance” was being maintained and warnings against complacency were being broadcast repeatedly.

Anyone with Ebola-like symptoms, which are similar to those for other killer diseases including malaria, is still being tested for the virus. It has killed 11,005 people and infected more than 25,000 in the three west African countries.

In the week to 3 May, 319 new laboratory samples were tested for Ebola, with no confirmed cases, the WHO said in its latest situation report.

There have been nine cases in Sierra Leone in the last week; in the two districts of Western Area Urban, which includes the capital of Freetown, and Kambia, which borders the Guinean district of Forecariah, where there were also nine new cases.

However the WHO said this was the lowest incidence of the disease in the year.

“It’s been 14 months of a national nightmare, at times, especially last August, when the country felt like it was teetering on the brink and panic was rising; anger was rising. And no one had seen an epidemic like this before. It was very hard to know what to do,” said Karin Landgren, the head of the United Nations mission in Liberia.

At the height of the crisis in September, Liberia was dealing with more than 400 new cases a week, forcing the country into a state of emergency.

“There are risks that it can come back. So we await Sierra Leone’s and Guinea’s conquering of Ebola as well,” Landgren said.

She told the UN security council this week that now was the time to address the factors that contributed to Ebola’s spread, including the weak economy and health infrastructure, lack of accountability and overly centralised government.

The British charity Street Child said that while the Ebola-free status was welcome, it did not change anything for those orphaned by the virus. Officially, 7,500 children have lost parents to Ebola, a figure Street Child believes is an underestimate.

“The schools have reopened, but the classrooms are not full,” said the programme director Chloe Brett, referring to the need for many children to work now that they were heading their household.

“We predict a surge in the number of street children. The work is only beginning,” she said.

In the coming months and years there will be a reckoning over the international response to the biggest ever Ebola outbreak, including the lessons for aid organisations. The UK and US, in particular, were accused of initially ignoring the crisis and focusing on domestic panic; blocking flights and quarantining returning health workers.

There has also been concern about a lack of published research into the virus to help future prevention.

Last month the WHO urged Ebola survivors to abstain from having sex or to use condoms “until further notice” after a sample of a Liberian man’s semen tested positive six months after he was considered free of the virus. Previous advice to survivors was to abstain from sex for three months.

There have been reports that the virus remains in ocular (eye) fluid as well as semen, paving the way for another transmission path in the infection chain. There are also reports that it survives in spinal fluid, which would pose a health risk to doctors conducting lumbar punctures.