Budding Nightmare: Toddler who brought Ebola virus to Mali dies – 43 people in isolation who had close contact

October 2014 – BAMAKO, Mali — Many people in Mali are at high risk of catching Ebola because the toddler who brought the disease to the country was bleeding from her nose as she travelled on a bus from Guinea, the World Health Organization warned Friday. The U.N. agency is treating the situation as an emergency since many people may have had “high-risk exposures” to the 2-year-old girl during her journey through several towns in Mali, including two hours in the capital, Bamako. The girl was travelling with her grandmother. The toddler died in an isolation tent at a hospital in the western city of Kayes on Friday, according to a nurse at the facility, who spoke on condition of anonymity because he was not authorized to speak to the press. This is the first Ebola case in Mali and may expand to many more. The case highlights how quickly the virus can hop borders and even oceans, just as questions are being asked about what precautions health care workers who treat Ebola patients should take when they return home from the hot zone. Doctors Without Borders insisted Friday, after one of its doctors who worked in Guinea came down with Ebola in New York, that quarantines of returning health workers are not necessary when they do not show symptoms of the disease.

In the Mali case, however, the girl was visibly sick, WHO said, and an initial investigation has identified 43 people, including 10 health workers, she came into close contact with who are being monitored for symptoms and held in isolation. The child was confirmed to have Ebola on Thursday. “The child’s symptomatic state during the bus journey is especially concerning, as it presented multiple opportunities for exposures — including high-risk exposures — involving many people,” the agency said in a statement. The girl first went to a clinic in Mali on Monday and she was initially treated for typhoid, which she tested positive for. When she did not improve, she was tested for Ebola, and she is now being treated in isolation in the western city of Kayes. Mali has long been considered highly vulnerable to Ebola’s spread since it shares a border with the Ebola-hit countries of Guinea and Senegal, and staff from WHO and the U.S. Centers for Disease Control and Prevention were already there helping to prepare for a case. More WHO staff are being deployed. The Ebola outbreak began in Guinea and has since spread to five other West African countries. The virus has also been imported to Spain and the United States. On Thursday, Craig Spencer, who had been working with Doctors Without Borders in Guinea and returned home to the U.S. about a week before, reported a fever and is now being treated at a New York hospital.

Some countries have banned travelers from the three main Ebola countries — Guinea, Liberia and Sierra Leone — and the U.S. started health screening of travelers arriving from there. But Doctors Without Borders said having its staffers quarantine themselves after leaving a country with Ebola is going too far if no symptoms are evident. A person infected with Ebola is not contagious until he or she starts showing symptoms. “As long as a returned staff member does not experience any symptoms, normal life can proceed,” Doctors Without Borders said in a statement sent to The Associated Press on Friday. “Self-quarantine is neither warranted nor recommended when a person is not displaying Ebola-like symptoms. Extremely strict procedures are in place for staff dispatched to Ebola affected countries before, during, and after their assignments,” said Sophie Delaunay, the group’s executive director, said in a statement. “Despite the strict protocols, risk cannot be completely eliminated. However, close post-assignment monitoring allows for early detection of cases and for swift isolation and medical management.” The group is investigating how Spencer became infected, it said. –CTV News

Hundreds exposed? A two-year-old Mali girl, who became the first to die of Ebola in the country, could have exposed hundreds of people to the deadly disease. The tot, who has not been identified, had travelled hundreds of kilometers by bus with her grandmother to seek treatment. Health workers are now scrambling to trace hundreds of people she may have come into contact with. In a statement Mali’s government confirmed the death and said: “In this moment of sadness, the government would like to express its condolences to her family and reminds the population that maintain very strict hygiene rules remains the best way to contain this disease.” Ebola has killed 4,900 people mainly in nearby Liberia, Sierra Leone and Guinea. –ITV

Contagious when trip began: On Thursday, Health Minister Ousmane Kone told state television that she had traveled from neighboring Guinea, where more than 900 people have died in an outbreak that has killed nearly 4,900 and infected more than 9,900 others. The girl was admitted to a hospital on Wednesday night, where she tested positive for Ebola. Health officials told the World Health Organization (WHO), according to a report released Friday, that she was accompanied to Mali by her grandmother. The girl’s mother was reported to have died a few weeks earlier, but WHO could not yet confirm that the grandmother went to Kissidougou, in southern Guinea, for the funeral. The pair returned to Mali by public transportation and arrived in the capital, Bamako, where they stayed for two hours before moving on to Kayes. The girl had begun bleeding from the nose before she left Guinea, the report found, “meaning that the child was symptomatic during their travels through Mali” and that “multiple opportunities for exposure occurred when the child was visibly symptomatic.” –Time