Monday, July 28, 2014

Ebola can spread like 'forest fire,' US warns

Ebola can spread like 'forest fire,' US warns

Hindustan Times - ‎5 minutes ago‎
The deadly Ebola virus can spread like a forest fire, US health authorities said Monday, urging travelers to West Africa to take extra precautions amid the largest outbreak in history.
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2014 West Africa Ebola outbreak

2014 West Africa Ebola outbreak

From Wikipedia, the free encyclopedia
2014 West Africa Ebola outbreak
Guinea Sierra Leone Ebola Map April 14 2014 png.png
Situation map of the outbreak as of 20 July 2014
Date February 2014 – Ongoing
Location West Africa
(Guinea, Liberia, Sierra Leone)
Casualties
 Guinea: 427 cases, 319 deaths
 Liberia: 249 cases, 129 deaths
 Sierra Leone: 525 cases, 224 deaths
 Nigeria: 1 case (a Liberian visiting Lagos), 1 death[1]
Total mortality:
673 deaths / 1202+ cases (56.0%)
An ongoing epidemic of the Ebola virus disease has spread throughout Guinea and beyond the nation's borders in West Africa, particularly in Sierra Leone. The outbreak is the most severe in recorded history, both in the number of cases and fatalities.[2] A total of 1201 suspected cases with 672 deaths have been reported as of 23 July 2014.[3] Various organizations, including the Economic Community of West African States, U.S. Centers for Disease Control, and European Commission have donated funds and mobilized personnel to help counter the outbreak; charities including Médecins Sans Frontières and Samaritan's Purse are also working in the area.

Evolution of the outbreak

Initial outbreak in Guinea

In February 2014, the first Ebola virus outbreak registered in the region occurred in Guinea. By 23 April, the total number of suspected and confirmed cases in the Ebola haemorrhagic fever (EHF) outbreak had increased to 242, including 142 deaths at a fatality rate of 59%.[4] Originally, the suspected cases were reported in Conakry (four cases), Guéckédougou (four), Macenta (one) and Dabola (one) prefectures. On 25 March the Ministry of Health of Guinea reported that four southeastern districts—Guekedou, Macenta, Nzerekore, and Kissidougou—were affected with an outbreak of Ebola hemorrhagic fever.[5] The following day the Pasteur Institute in Lyon, France confirmed the Ebola strain as Zaire ebolavirus.[5] An initial report suggested that it was a new strain of ebolavirus,[6] but this was refuted by later studies which placed it within the lineage of the Zaire strain.[7] One suspected case was admitted to hospital on 28 March 2014.[8] On 31 March, the US Centers for Disease Control sent a five-person team "to assist Guinea Ministry of Health (MOH) and World Health Organization (WHO) lead an international response to the Ebola outbreak".[5]

Conakry, Guinea

Around 23 May, the outbreak spread to Guinea's capital Conakry,[5] a city of about two million inhabitants. According to Ibrahima Touré, Country Director of Plan Guinea, an NGO: "The poor living conditions and lack of water and sanitation in most districts of Conakry pose a serious risk that the epidemic escalates into a crisis. People do not think to wash their hands when they do not have enough water to drink."[9]

Subsequent spread

In Liberia, the disease was reported in Lofa and Nimba counties in late March,[10] and by mid-April, the Ministry of Health and Social Welfare (MOHSW) had recorded possible cases in Margibi and Montserrado County.[11]
Sierra Leone, Mali and Ghana identified suspected cases by mid-April, but all clinical samples of suspected cases tested negative for ebola virus.[12] The overall situation with the Ebola virus infection in Guinea improved in May. For several days no new alerts, cases or nosocomial transmission were reported from Liberia and from five out of the six affected prefectures in Guinea. Gueckedou was the only hotspot where community transmission and deaths were still being reported.
From 23 to 27 May 2014, three previously affected districts (Guéckédou, Macenta and Conakry), four new districts (Boffa, Télimélé, Boke and Dubréka) and one new country (Sierra Leone) reported several new EVH clinical cases.[13] In mid-June the first cases in Liberia's capital Monrovia were reported.[14]
Médecins Sans Frontières described the situation as being "totally out of control" in late June.[15] By early July, Liberia had reported 107 infections (52 laboratory-confirmed) and at least 65 deaths from Ebola,[16] and while only four deaths had been reported outside Lofa County by mid-April,[11] in mid-June, the MOHSW announced seven additional deaths in Montserrado County alone.[17]
The outbreak progressed rapidly in Sierra Leone. The first cases were reported on 25 May in the Kailahun District, near the border with Guéckédou in Guinea.[18] By 20 June, there were 158 suspected cases, mainly in Kailahun and the adjacent district of Kenema, but also in the Kambia, Port Loko and Western districts in the north west of the country.[19] By 17 July, the total number of suspected cases in the country stood at 442, and had overtaken those in Guinea and Liberia.[20] By 20 July, cases had additionally been reported in the Bo District;[21] the first case in Freetown, Sierra Leone's capital, was reported in late July.[22][23]
The first case in Nigeria was reported by WHO on 25 July 2014; a Liberian man arriving at the city of Lagos by air on 20 July was hospitalised and later died of the disease.[3][22] On 25 July 2014, WHO described the situation as "precarious," with a recent resurgence in new cases in Guinea, as well as the first case in Nigeria.[3]

Fatality rate

The infection and mortality data from Guinea, where new infections almost came to a standstill by 18 June, indicate a fatality rate of about 75%, which includes also cases of probable and suspected Ebola infections, as reported by the World Health Organisation.[24] Guinea and WHO disagree on patient data, including mortality data.[25]

Response

The national authorities of Guinea, Sierra Leone, and Liberia have activated their national emergency committees, prepared EHF response plans and carried out needs assessments.[8] The Economic Community of West African States (ECOWAS) issued a statement that called for the support of the international community in the fight against the epidemic: "The Board of Mediation and Security of ECOWAS appeals to the international community to provide support in the management of the Ebola epidemic in the region."[26] On 30 March 2014, during the 44th Summit of the heads of state and government of West Africa, ECOWAS disbursed USD $250,000 to deal with the outbreak.[27] Sierra Leone has instituted a temporary measure which includes reactivation of its "Active Surveillance Protocol" that will see all travellers into the country from either Guinea or Liberia subjected to strict screening to ascertain their state of health.[28]
Senegal's Ministry of Interior has ordered all movements of people through the southern border with Guinea to be suspended indefinitely to prevent the spread of the disease, according to a statement published on 29 March 2014 by state agency APS.[29] Since 26 March, Mauritania closed all crossings along the Senegal River, the natural border between Mauritania and Senegal, except for the Rosso and Diama points of entry. From 1 April, Saudi Arabia stopped issuing visas for the Muslim pilgrimage to Mecca to those from Guinea and Liberia. Moreover, Morocco reinforced medical surveillance at the Casablanca airport, a regional hub for flights from and to West Africa.[30][31][32] Conversely, the border between Guinea and Liberia remained open; Guinea's ambassador in Monrovia noted his government's belief that efforts to fight the disease directly would be more effective than closing the border.[33]
The European Commission (EC) gave €500,000 to help contain the spread of the virus in Guinea and its neighbouring countries. The EC has also sent a health expert to Guinea to help assess the situation and liaise with the local authorities. EU Commissioner for International Cooperation, Humanitarian Aid and Crisis Response Kristalina Georgieva said: "We are deeply concerned about the spread of this virulent disease and our support will help ensure immediate health assistance to those affected by it. It's vital that we act swiftly to prevent the outbreak from spreading, particularly to neighbouring countries."[34]
A mobile laboratory, capable of performing the molecular diagnosis of viral pathogens of risk groups 3 and 4, was deployed in Guinea by the European Mobile Laboratory consortium as part of the WHO/GOARN outbreak response. Prior samples were analyzed at the Jean Mérieux BSL-4 Laboratory in Lyon.[35]
The humanitarian aid organisation Médecins Sans Frontières (Doctors Without Borders) has a team of 300 staff working in Guinea, Sierra Leone and Liberia, has set up specialist centers to give medical care to affected people, and has sent over 40 tonnes of equipment and supplies.[36] Samaritan's Purse is also providing direct patient care in multiple locations in Liberia.[37]
In July, the WHO convened an emergency sub-regional meeting with health ministers from eleven countries in Accra, Ghana.[38] On 3 July 2014, the West African states announced collaboration on a new strategy, and the creation of a World Health Organization sub-regional centre in Guinea "to co-ordinate technical support";[39] the centre was inaugurated in Conakry on 24 July.[40] On or before 23 July, the Liberian health ministry began to implement a strategic plan in line with the Accra meeting's conclusions to improve the country's response to the outbreak.[41] Luis Sambo, WHO's Regional Director for Africa, visited the affected countries from 21 to 25 July, meeting with political leaders, ministers of health, NGOs and other agencies. He stressed the need to "promote behavioural change while respecting cultural practices."[3] On 24 July, WHO's Director General met with agencies and donors in Geneva to facilitate an increase in funding and manpower to respond to the outbreak.[3] On 26 July, after a case in the Nigerian capital Lagos which was imported from Liberia, the Nigerian government increased surveillance at all entry points to the country; health officials have been placed at entry points to conduct tests on people arriving the country.[42] Subsequently Arik Air, Nigeria's main airline, stopped flying to Liberia and Sierra Leone.[43] On 27 July, Ellen Johnson Sirleaf, the Liberian president, announced that Liberia would close its borders, with the exception of a few crossing points such as the country's principal airport, at which screening centres are being established; the worst-affected areas in the country are to be placed under quarantine.[43]

Media

A dance tune with a serious message became popular in Guinea and Liberia in the first quarter of 2014, warning people of the dangers and explaining how to react to the virus.[44]

Containment complications

Difficulties faced in attempting to contain the outbreak include the outbreak's multiple locations across country borders,[15] inadequate equipment given to medical personnel,[45] funeral practices,[46] and public reluctance to follow preventive practices,[47] including "freeing" suspected Ebola patients from isolation,[22][48] and suspicion that the disease is caused by witchcraft, or that doctors are killing patients.[49] In late July, the former Liberian health minister Peter Coleman stated that "people don't seem to believe anything the government now says."[43]
There has also been an attack on aid workers who were hurrying to retrieve "freed" patients and did not explain to villagers who they were,[50] and the Red Cross were forced to suspend operations in Guinea after staff were threatened by a group of men armed with knives.[51] Demonstrations outside the main hospital treating Ebola patients in Kenema, Sierra Leone, on 25 July were broken up by police.[52]
Infection of healthcare workers is another problem. Samuel Brisbane, a former advisor to the Liberian health ministry described by The Guardian as "one of Liberia's most high-profile doctors", is among the fatalities.[53] Two American aid workers at a treatment center in Monrovia run by Serving in Mission (SIM)/Samaritan's Purse have also been infected.[53][54]

Virology

Main article: Ebola virus § Virology
Researchers performed full-length genome sequencing and phylogenetic analysis of samples from 20 patients. Results suggest that the Zaire ebolavirus (EBOV) in Guinea is a different clade than the strains from outbreaks in the Democratic Republic of Congo and Gabon.[55]
However, this was contradicted by two subsequent reports.
A subsequent analysis reached the conclusion that the outbreak "is likely caused by a Zaire ebolavirus lineage that has spread from Central Africa into Guinea and West Africa in recent decades, and does not represent the emergence of a divergent and endemic virus".[56]
A further report published in June 2014 supported the latter view, determining that it was "extremely unlikely that this virus falls outside the genetic diversity of the Zaïre lineage" and that their analysis "unambiguously supports Guinea 2014 EBOV as a member of the Zaïre lineage".[57]

Economic effects

In addition to the loss of life, the outbreak is having an economic effect. Conakry's Palm Camayenne Hotel, which is popular among businessmen and politicians, has less than a third of occupancy rate.[58] On Brussels Airlines flights between Brussels and Conakry, there are reduced numbers of people arriving in Conakry but more people leaving Conakry.[58] Regional airline Gambia Bird delayed the start of a route to Conakry due to Senegal closing "its border with Guinea because of the outbreak".[58]
Non-essential employees of British firm London Mining in Sierra Leone were transported out of the country in June following an outbreak of the virus. At the time, at least 50 suspected cases of Ebola with five deaths had been reported.[59]
The ongoing outbreak in Sierra Leone caused the closure of schools, markets, Kailahun's lone bank and stores.[60]

Timeline of the outbreak

Timeline of the outbreak, using data reported by the Centers for Disease Control and Prevention [5] and the World Health Organisation.[24]

Temporal evolution of total cases and deaths

Temporal evolution of new cases and deaths per day
Date of report Total Guinea Liberia Sierra Leone
cases deaths cases deaths cases deaths cases deaths
23 Jul 2014 1201 672 427 319 249 129 525 224
20 Jul 2014 1093 660 415 314 224 127 454 219
18 Jul 2014 1048 632 410 310 196 116 442 206
15 Jul 2014 964 603 406 304 172 105 386 194
10 Jul 2014 888 539 409 309 142 88 337 142
8 Jul 2014 844 518 408 307 131 84 305 127
2 Jul 2014 759 467 413 303 107 65 239 99
24 Jun 2014 599 338 390 270 51 34 158 34
18 Jun 2014 528 337 398 264 33 24 97 49
10 Jun 2014 474 252 372 236 13 9 89 7
5 Jun 2014 438 231 344 215 13 9 81 7
2 Jun 2014 354 208 291 193 13 9 50 6
27 May 2014 309 200 281 186 12 9 16 5
23 May 2014 270 181 258 174 12 9

14 May 2014 245 164 233 157 12 9

5 May 2014 243 162 231 155 12 9

30 Apr 2014 233 153 221 146 12 9

23 Apr 2014 220 143 208 136 12 9

21 Apr 2014 215 136 203 129 12 9

17 Apr 2014 209 129 197 122 12 9

10 Apr 2014 169 108 157 101 12 9

7 Apr 2014 163 102 151 95 12 7

2 Apr 2014 135 88 127 83 8 5

1 Apr 2014 130 82 122 80 8 2

31 Mar 2014 114 70 112 70 2 0

27 Mar 2014 103 66 103 66



26 Mar 2014 86 60 86 60



25 Mar 2014 86 59 86 59



References

  1. "Sierra Leone hunts Ebola patient kidnapped in Freetown". British Broadcasting Corporation. 25 July 2014.
  2. "Chronology of Ebola Hemorrhagic Fever Outbreaks". Centers for Disease Control and Prevention. 24 June 2014. Retrieved 25 June 2014.
  3. "Ebola virus disease, West Africa – update 25 July 2014". WHO: Outbreak news. 25 July 2014. Retrieved 27 July 2014.
  4. "Ebola outbreak in Guinea 'unprecedented' – MSF". BBC News. 31 March 2014. Retrieved 31 March 2014.
  5. "Outbreak of Ebola in Guinea and Liberia". Centers for Disease Control and Prevention.
  6. "Emergence of Zaire Ebola Virus Disease in Guinea — Preliminary Report". New England Journal of Medicine. 16 April 2014. Retrieved 3 May 2014.
  7. "Guinea ebola outbreak sequences". Epidemic: Molecular Epidemiology and Evolution of Viral Pathogens. 17 April 2014. Retrieved 6 July 2014.
  8. "Ebola Haemorrhagic Fever, Guinea (Situation)". WHO. 30 March 2014. Retrieved 31 March 2014.
  9. Diallo, Boubacar (29 March 2014). "Ebora en Guinée : l’ONG Plan Guinée craint une aggravation de l’épidemie" [Ebola in Guinea: the NGO Plan Guinea fears a worsening of the epidemic] (in French). Africa guinée. Retrieved 31 March 2014.
  10. "2 of 5 Test Positive for Ebola in Liberia", Liberian Observer, 31 March 2014, retrieved 6 July 2014
  11. Ebola Virus Disease Epidemic in Liberia: Situation Report 11 (PDF), LR: Ministry of Health and Social Welfare, 13 April 2014, retrieved 6 July 2014
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  13. "Ebola Haemorrhagic Fever, West Africa (Situation)". WHO. 27 April 2014. Retrieved 27 April 2014.
  14. "Seven die in Monrovia Ebola outbreak". BBC News. 17 June 2014. Retrieved 28 July 2014.
  15. "Doctors Without Borders: West Africa's Ebola Outbreak is Totally Out of Control". CTVNews. 20 June 2014. Retrieved 21 June 2014.
  16. "Outbreak of Ebola in Guinea, Liberia, and Sierra Leone". Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Retrieved 3 July 2014.
  17. "Seven die in Monrovia Ebola outbreak". BBC News. 17 June 2014. Retrieved 18 June 2014.
  18. "Ebola virus disease, West Africa (Update of 26 May 2014)". WHO: Outbreak news. 26 May 2014. Retrieved 28 July 2014.
  19. "Ebola virus disease, West Africa – update 23 June 2014". WHO: Outbreak news. 23 June 2014. Retrieved 28 July 2014.
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  21. "Outbreak of Ebola in Guinea, Liberia, and Sierra Leone". CDC. Retrieved 27 July 2014.
  22. "Sierra Leone hunts Ebola patient kidnapped in Freetown". BBC News. 25 July 2014. Retrieved 27 July 2014.
  23. "Ebola outbreak: Sierra Leone escaped patient dies". BBC News. 27 July 2014. Retrieved 27 July 2014.
  24. "Disease Outbreak News". WHO. 18 July 2014.
  25. "H5N1: Guinea: Government disagrees with WHO on Ebola case numbers". Crofsblogs.typepad.com. 2014-06-08. Retrieved 2014-07-27.
  26. "The West Africa requires the support of the international community in the fight against Ebola". abidjan.net. 28 March 2014. Retrieved 31 March 2014.
  27. "La CEDEAO décaisse 250 000 dollars pour faire face à la fièvre Ebola" (in French). abidjan.net. 30 March 2014. Retrieved 31 March 2014.
  28. Cham, Kemo (1 April 2014). "Sierra Leone restricts movement across borders over Ebola fears". Africa Review. Retrieved 1 April 2014.
  29. "Ebola Death Toll in Guinea Rises to 70 as Senegal Closes Border". Bloomberg News. 29 March 2014. Retrieved 31 March 2014.
  30. "Fièvre Ebola : contrôle sanitaire renforcé au Maroc" [Ebola fever: sanitary control reinforced at Morocco] (in French). Nouvelobs. 1 April 2014. Retrieved 1 April 2014.
  31. "Visas refusés aux pèlerins de Guinée et du Libéria" (in French). 20min.ch. 1 April 2014. Retrieved 1 April 2014.
  32. Ndiaye Moctar, Pape (29 March 2014). "Le fleuve Sénégal infranchissable depuis mardi dernier" [The uncrossable river Senegal since last Tuesday] (in French). Sud Quotidien. Retrieved 31 March 2014.
  33. Kwanue, C.Y. "Guinean Gov’t Provides Ebola Updates", Liberian Observer, 7 April 2014. 7 April 2014.
  34. "Ebola in West Africa: European Union joins effort to stop spread of disease and releases €500,000 in immediate funding". EU: Europa. 19 November 2013. Retrieved 31 March 2014.
  35. "Inserm and the Institut Pasteur identify a new variant of Ebola virus in Guinea". INSERM.fr. 18 April 2014. Retrieved 24 Apr 2014.
  36. "Ebola in West Africa: "The epidemic is out of control"". msf.org.uk. 25 June 2014. Retrieved 2 July 2014.
  37. "Battling an Ebola Outbreak". SP.
  38. "WHO calls emergency sub-regional Ministerial meeting in Accra, Ghana to tackle the on-going Ebola virus in West Africa". 2 July 2014. Retrieved 2 July 2014.
  39. "Ebola outbreak: West African states agree strategy". BBC News. 3 July 2014. Retrieved 4 July 2014.
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  41. "Ebola virus disease, West Africa – update 23 July 2014". WHO: Outbreak news. 23 July 2014. Retrieved 27 July 2014.
  42. "Nigeria 'on red alert' over Ebola death in Lagos". BBC News. 26 July 2014. Retrieved 27 July 2014.
  43. "Ebola outbreak: Liberia shuts most border points". BBC News. 28 July 2014. Retrieved 28 July 2014.
  44. "Ebola virus causes outbreak of infectious dance tune". May 27, 2014.
  45. "Liberia: Unheralded Fear - Ebola Pose Risks for Liberia Health Workers". FrontPage Africa via AllAfrica.com. 19 June 2014. Retrieved 21 June 2014.
  46. "Growing Ebola Outbreak Threatens to Overwhelm Volunteers". Today Health. 8 June 2014. Retrieved 21 June 2014.
  47. "Ebola virus disease, West Africa – update 3 July 2014". World Health Organisation. 3 July 2014. Retrieved 4 July 2014.
  48. "8 ebola suspects freed by relatives in Sierra Leone". Global Post. 28 May 2014. Retrieved 21 June 2014.
  49. "Ebola, snakes and witchcraft: Stopping the deadly disease in its tracks in West Africa". International Federation of Red Cross and Red Crescent Societies. 24 June 2014. Retrieved 28 June 2014.
  50. "Villagers stone ebola trackers in Sierra Leone as cases rise". Chicago Tribune. 28 May 2014. Archived from the original on 2 July 2014. Retrieved 2 July 2014.[dead link]
  51. "Red Cross suspends Ebola operations in southeast Guinea after threats". Reuters. 2 July 2014. Retrieved 4 July 2014.
  52. "Ebola center in Sierra Leona under guard after protest march". Reuters news. 26 July 2014. Retrieved 27 July 2014.
  53. "Liberia: top doctor becomes latest Ebola victim". Guardian Online. 27 July 2014. Retrieved 28 July 2014.
  54. "Samaritan’s Purse Doctor Serving in Liberia Tests Positive for Ebola". Samaritan's Purse. 27 July 2014. Retrieved 28 July 2014.
  55. Baize, Sylvain; Pannetier, Delphine; Oestereich, Lisa; Rieger, Toni (16 Apr 2014). "Emergence of Zaire Ebola Virus Disease in Guinea — Preliminary Report". New England Journal of Medicine. doi:10.1056/NEJMoa1404505.
  56. "Phylogenetic Analysis of Guinea 2014 EBOV Ebolavirus Outbreak". PLOS Current Outbreaks. 2 May 2014.
  57. "Clock Rooting Further Demonstrates that Guinea 2014 EBOV is a Member of the Zaïre Lineage". PLOS Current Outbreaks. 16 June 2014.
  58. Adama Diarra and Misha Hussain (4 April 2014). "Mali suspects first Ebola cases as regional death toll tops 90". Reuters. Retrieved 4 April 2014.
  59. "UK employees leave Sierra Leone over Ebola threat". BBC News. 3 June 2014. Retrieved 4 June 2014.
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External links

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World

Ebola can spread like 'forest fire,' US warns
Kerry Sheridan, AFP
Washington, July 29, 2014
First Published: 09:34 IST(29/7/2014)
Last Updated: 09:36 IST(29/7/2014)
The deadly Ebola virus can spread like a forest fire, US health authorities said Monday, urging travelers to West Africa to take extra precautions amid the largest outbreak in history.

Since March, there have been 1,201 cases of Ebola and 672 deaths in Guinea, Liberia and Sierra Leone, the Centers for Disease Control and Prevention said.
Two Americans -- one doctor and one healthcare worker -- in Monrovia, Liberia have come down with the virus, characterized by fever, joint pain, diarrhea, vomiting and often fatal bleeding.
"The likelihood of this outbreak spreading beyond West Africa is very low," admittedd Stephan Monroe, deputy director of the CDC's National Center for Emerging and Zoonotic Infectious Diseases.
But, he added, it is a "rapidly changing situation" and the CDC must be "prepared for the very remote possibility" that a sick traveler could bring the disease into the United States.
The CDC issued a level two notice  -- one notch below a call to avoid nonessential travel to the region -- warning people to avoid contact with blood and bodily fluids of sick people in the affected countries.
The CDC also sent out a notice to health care professionals in the United States, reminding them to find out if patients have traveled to West Africa in the last two weeks, to familiarize themselves with the symptoms of Ebola and to isolate any suspected cases.
Most of the exposures to Ebola in health care settings have been through needle sticks and exposure while disposing of the diarrhea, vomit and blood of sick people, said Monroe.
   
Symptoms may be mistaken
People are not contagious unless they exhibit symptoms, but often these signs -- like fever and body aches -- can be mistaken for other diseases like malaria and Lassa fever, experts said.
Also, only about half of cases involve bleeding, despite the perception that Ebola is characterized by widespread hemorrhage.
The state department said the United States was providing "personal protective equipment and other essential supplies" to the affected areas.
"We're taking every precaution, of course, as would be expected," said spokeswoman Jen Psaki, adding that the situation was not expected to affect a planned summit of African leaders next week in Washington.
The CDC said the family members of the American doctor who has contracted Ebola, Kent Brantly, had been living with him in Liberia.
However, by the time he fell ill they had already returned to the United States. As a precaution, they are being monitored for signs of fever for the incubation period of 21 days.
An outbreak could not be declared over until two full incubation periods -- 42 days -- have passed without new cases, he added.
Like a forest fire
"The concern is that the outbreak can be reseeded, much like a forest fire with sparks from one tree," said Monroe.
"That is clearly what happened in Liberia," he said, noting that the country made it for more than 21 days without cases, but Ebola returned.
"They were reseeded by cases coming across the border, so until we can identify and interrupt every source of transmission, we won't be able to control the outbreak."
The fatality rate from Ebola can reach as high as 90 percent, though this time it has stayed around 60 percent, suggesting that protective measures are having an effect, the CDC said.
However, there is no end in sight to the outbreak, and cases are expected to mount in the coming months.
"The response to this outbreak will be more of a marathon than a sprint," said Monroe.
- See more at: http://www.hindustantimes.com/world-news/ebola-can-spread-like-forest-fire-us-warns/article1-1245785.aspx#sthash.UMcP5uDD.dpuf
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