A failure to send a suspected Ebola patient directly to a specialist treatment unit in a fresh outbreak of the virus in Liberia may reflect fatigue and complacency among health workers, a health expert said on Tuesday.
Ebola flare-up stokes fears over health workers' vigilance
"There were no cases for a while and Liberia was nearing the end of a 90-day period of heightened surveillance... it is quite possible that people were tired and got complacent," Guild said.
Liberia has placed 153 people under surveillance after three Ebola cases emerged on Friday, more than two months after the West African country was declared free of the virus.
The first of the new patients was 15-year-old Nathan Gbotoe from Paynesville, a suburb east of the capital Monrovia, and his father and brother have since been confirmed as positive.
The teenager went to several health centres before being referred to an Ebola treatment unit and several health workers who cared for him may have not worn protective equipment, said Medecins Sans Frontieres (MSF) representative Carissa Guild.
"Normally with a surveillance system, if someone has signs and symptoms (of Ebola) they would not be hospitalised but immediately sent to an Ebola treatment centre to be tested."
Ebola symptoms can be similar to other diseases, especially in the early stages of infection, making it crucial to identify and contain any flare-ups rapidly, said Adam Kucharski, a lecturer at the London School of Hygiene and Tropical Medicine.
It is not known how Gbotoe, who died of Ebola late on Monday and is the first such fatality for months in Liberia, was infected but investigations are under way.
Cross-border transmission appears unlikely as Guinea has no cases and Sierra Leone was declared Ebola-free on Nov. 7 after 42 days without a case.
Liberia has twice been declared Ebola-free, in May and September, only for new cases to emerge, and the latest flare-up should be a warning to Guinea and Sierra Leone to remain vigilant, the United Nations children's agency UNICEF said.
"Everyone celebrates when the last case is treated but we can't let our guard down. There will be other fires, we need to be ready for them too," said UNICEF representative Sheldon Yett.
Liberia has suffered the highest death toll in the worst known Ebola outbreak in history, losing more than 4,800 people in an epidemic which has killed 11,300 in Guinea, Liberia and Sierra Leone since it began in December 2013.
The World Health Organization's failure to sound the alarm until months into the outbreak was an "egregious failure" which added to the enormous suffering and death toll, a panel of global health experts said on Monday.
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