Local health officials and researchers with the CDC identified 28 confirmed cases of Ebola linked to a single funeral in rural Sierra Leone.
Of the patients who were infected during the 3-day funeral of a prominent pharmacist in September 2014, 75% reported touching the deceased man’s body, according to findings published in MMWR that underscore the potential complications of burying Ebola victims.
As opposed to an Ebola burial team, relatives of the pharmacist buried him, Kathryn G. Curran, PhD, of the CDC’s Epidemic Intelligence Service, and colleagues reported. Eight of the 28 Ebola patients linked to the funeral later died — all of them males who had touched the corpse.
“Immediate, safe, dignified burials by trained teams with appropriate protective equipment are critical to interrupt transmission and control Ebola during times of active community transmission,” the investigators wrote.
Investigation shows spike in cases
By the end of February, there were more than 14,100 reported cases of Ebola in Sierra Leone since the West Africa outbreak began in 2014, with nearly 4,000 associated deaths, according to WHO statistics. The pharmacist’s funeral was held during the same month as a sudden increase in reported cases of Ebola in Moyamba, a rural district in Sierra Leone that had not previously experienced widespread infection, according to Curran and colleagues.
To investigate the spike in cases, the Sierra Leone Ministry of Health and Sanitation along with the CDC conducted a retrospective analysis of laboratory-confirmed cases of Ebola in Moyamba from July 11, 2014, to Oct. 31, 2014. Of the 281 suspected cases during that span, 39% were confirmed, and 37% of those patients died. A spike in Ebola incidence was observed during the week of Sept. 13-19, with 32 confirmed cases.
Seventy-two percent of patients with laboratory-confirmed Ebola reported having contact with a known or suspected Ebola patient — alive or dead — or an ill person in the month before becoming sick, Curran and colleagues wrote. Among them, 29% had contact with a corpse, and 37% had contact with an Ebola patient before and after the patient’s death, according to the researchers.
Rate of transmission via funeral was ‘substantially higher’
The 28 patients who attended the pharmacist’s funeral from Sept. 5-7 and later were diagnosed with Ebola developed symptoms a median of 9 days after the funeral. Along with the patients who reported carrying or touching the pharmacist’s corpse, 57% reported having direct contact with him for days before he died.
The rate of secondary transmission related to the man’s funeral was “substantially higher” than that of the basic Ebola virus in Sierra Leone, according to Curran and colleagues.
“A high number of secondary cases might be explained by a high viral load in the primary patient, the type of contact, timing of contact (eg, while a patient was alive or dead), the number of persons exposed, or a combination of these factors,” they wrote.
Because authorities did not investigate the man’s death, no epidemiologic records exist of his exposures and illness, Curran and colleagues wrote. However, anecdotal reports suggested he treated an Ebola patient from a neighboring village.
While relatives buried the pharmacist, the district Ebola team buried the eight men, including five nephews, who touched his corpse and later died from Ebola. Their deaths may have resulted from traditional funeral practices in Sierra Leone that call for family and friends of the same sex to prepare, wash and clothe the corpse, Curran and colleagues wrote.
Rapid response helped limit further spread
A rapid response by the Moyamba District Health Management Team (MDHMT) — including a quarantine — limited further spread of Ebola to just eight cases beyond the 28 initially infected via the man’s funeral, according to Curran and colleagues.
“Early identification of Ebola cases along with prompt isolation, testing, and care of patients can limit transmission, improve likelihood of survival, and ensure safe burials of persons who die, ultimately preventing deaths from occurring at home and unsafe burials in the community,” they wrote. “Ebola response teams can strengthen community Ebola surveillance.” – by Gerard Gallagher
WHO. Ebola situation report – 2 March 2016: http://apps.who.int/ebola/current-situation/ebola-situation-report-2-march-2016. Accessed March 3, 2016.
Disclosure: The researchers report no relevant financial disclosures.