Ebola remains an international health emergency, WHO warns

BMJ 2015; 350 doi: (Published 14 April 2015) Cite this as: BMJ 2015;350:h1997
  1. Anne Gulland
  1. 1London

Despite a significant fall in cases of Ebola virus disease in west Africa the outbreak remains a public health emergency of international concern, the World Health Organization has said.

The emergency committee convened by WHO under the International Health Regulations met on 9 April and agreed that, while the risk of international spread of the disease seems to have reduced, the outbreak still poses a threat and that Sierra Leone, Guinea, and Liberia must continue to screen travellers as they leave. Countries that border the three worst affected countries must also continue active surveillance for the disease, it added, particularly in the border areas.

The emergency committee also highlighted inappropriate health measures introduced by some countries that go beyond WHO’s temporary recommendations. These included the quarantine of returning travellers, refusal of entry, cancellation of flights, and border closures, which “negatively impact both the response and recovery efforts.” About 40 countries have implemented additional measures, and some airlines are still refusing to fly to west Africa.

The latest data, published on 10 April, showed a total of 25 556 cases in the three worst affected countries, including 10 587 deaths. However, in the seven days to 5 April just 30 new cases of the disease were reported, compared with 82 confirmed cases the previous week and 79 the week before that. The data also showed that Guinea reported 21 of these cases, Sierra Leone reported nine, and Liberia reported none.

Bruce Aylward, WHO assistant director general for emergencies, told a press briefing that the fall in cases was an “extremely important development.” Sierra Leone has seen a drop in the number of cases for the fifth week in a row, and Liberia has reported no new cases for the second week in a row.

Aylward said that this decrease was genuine despite a similar drop at the beginning of the year that was followed by a small rise in February and March. “Everyone who follows Ebola is aware of the bumpy road we keep talking about—is this just a pothole in the road or is this a real decline? This reflects real progress,” he said.

He added that all aspects of the control programme, in terms of contact tracing, case finding, and community awareness, were getting tighter. The three day lockdown in Sierra Leone from 27 to 29 March had shown this, he said. “What [Sierra Leone] saw was almost a doubling of the number of alerts and suspected cases. Despite all that additional sensitivity in the surveillance system they saw the number of cases drop from around 21 to nine cases,” said Aylward.

However, he said that public health officials were still concerned that people were dying from Ebola in the community rather than in treatment centres, thus exposing their relatives to the disease. Three such deaths occurred in Sierra Leone and seven in Guinea at the beginning of this month. Aylward said concerns remained that 50% of new cases were among people unknown to authorities rather than among those whose names were on contact lists.

“Ebola is very much a local disease and a disease of individuals, and it’s only when you get down to the level of the individual that you really are on track to getting this thing stopped,” he said.


Cite this as: BMJ 2015;350:h1997

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