DAKAR, Senegal — West Africa's first-ever Ebola outbreak in humans is now the most deadly and geographically widespread outbreak on record and is threatening to spread, health officials say.
According to the latest figures from the World Health Organization (WHO), there have been more than 635 cases of Ebola across three countries in the region since the outbreak was first declared in southeastern Guinea in March. It has since spread to Liberia and Sierra Leone. At least 399 people have died.
"It's very much a serious outbreak," said Daniel Epstein, spokesperson for the WHO. "I wouldn't say it's out of control, but the emergence of this outbreak definitely threatens regional public health security. We've ramped up our response, in so far as we can, but we have to continue to improve our work to contain this outbreak."
About 150 WHO experts are now on the ground, working alongside local health ministries and clinics as well as international partners to stop the transmission chain, prevent new cases and treat those currently affected.
WHO announced Friday that key players from 11 countries in the region will meet in Ghana starting Wednesday to discuss the outbreak, as well as how countries in the region can work together to step up response efforts.
Many challenges to fighting the virus have developed, stirring concern the outbreak could get worse because of ignorance, the free movement of people, local customs and suspicion of foreigner doctors.
"In some cases, we've had really bad experiences where we've sent teams of health communicators into villages: They've been run out of the town, stones have been thrown at them, they've been threatened with machetes and told to stay away," Epstein said.
That's because many people are suspicious of foreign doctors and nurses and often deny the existence of Ebola, he said.
Despite mass public health campaigns about the dangers of Ebola and the modes of transmission, many communities continue to practice traditional burial rituals, which can help spread the virus.
"People come to say goodbye, they touch the body, they kiss the body, they leave presents with the body," said Hilde De Clerck, a medical doctor with Doctors Without Borders who just returned from Guinea. "And since Ebola is spread through very close physical contact (via bodily fluids, such as sweat, saliva or blood), people who care for the sick or their bodies are particularly at risk."
Often, patients who are suspected of having Ebola will run away from treatment centers, fearing the stigma that may come along with the diagnosis, health officials say. Other times, family members who have been in contact with infected individuals will deny such contact when questioned by health workers, further complicating the process of cutting off the chain of contamination.
Cross-border transmission to neighboring countries also remains a concern, as people continue to travel freely from one country to another, even if sick.
"People have very big social networks in this region and they often move about, whether it's for work or to go to the market or to visit family," De Clerck said. "And since Ebola has an incubation time of up to three weeks, it means a person can be infected and move around and then fall sick elsewhere, sometimes quite far away."
Another challenge has been following up with those who have been potentially infected. For example, in Guinea's Guéckédou region, where the outbreak first began, health workers say they must take the vital signs of at least 500 people each day to make sure they have not become infected. Such efforts require extensive resources and manpower, which are now stretched thin.
While experts say these moves have been helping, they have not been enough to stop or contain the outbreak. Earlier this month, Ebola spread to Liberia's capital, Monrovia, for the first time and the death toll across all three countries, particularly in Sierra Leone, continues to rise.
The United Nations Children's Fund (UNICEF), which has been launching mass media campaigns and educating people door-to-door to spread information about the virus since the outbreak first began, says it's now time for all the countries in the region to work together.
"(This Ebola outbreak) has always been a critical emergency," said Dr. Maurice Hours, a health adviser for UNICEF in West and Central Africa. "But now there is a real danger that it could spread to neighboring countries, such as the Ivory Coast and Guinea Bissau. We are quite concerned."