Cluster of Ebola Virus Disease Linked to a Single Funeral — Moyamba District, Sierra Leone, 2014 | MMWR

> http://www.cdc.gov/mmwr/volumes/65/wr/mm6508a2.htm?s_cid=mm6508a2_w#contribAff <http://www.cdc.gov/mmwr/volumes/65/wr/mm6508a2.htm?s_cid=mm6508a2_w#contribAff>
>
> Cluster of Ebola Virus Disease Linked to a Single Funeral — Moyamba District, Sierra Leone, 2014
>
> As of February 17, 2016, a total of 14,122 cases (62% confirmed) of Ebola Virus Disease (Ebola) and 3,955 Ebola-related deaths had been reported in Sierra Leone since the epidemic in West Africa began in 2014 (1). A key focus of the Ebola response in Sierra Leone was the promotion and implementation of safe, dignified burials to prevent Ebola transmission by limiting contact with potentially infectious corpses. Traditional funeral practices pose a substantial risk for Ebola transmission through contact with infected bodies, body fluids, contaminated clothing, and other personal items at a time when viral load is high; however, the role of funeral practices in the Sierra Leone epidemic and ongoing Ebola transmission has not been fully characterized (2). In September 2014, a sudden increase in the number of reported Ebola cases occurred in Moyamba, a rural and previously low-incidence district with a population of approximately 260,000 (3). The Sierra Leone Ministry of Health and Sanitation and CDC investigated and implemented public health interventions to control this cluster of Ebola cases, including community engagement, active surveillance, and close follow-up of contacts. A retrospective analysis of cases that occurred during July 11–October 31, 2014, revealed that 28 persons with confirmed Ebola had attended the funeral of a prominent pharmacist during September 5–7, 2014. Among the 28 attendees with Ebola, 21 (75%) reported touching the man’s corpse, and 16 (57%) reported having direct contact with the pharmacist before he died. 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; these measures remain important during the current response phase.
>
> The Sierra Leone Ministry of Health and Sanitation and CDC conducted a retrospective analysis of laboratory-confirmed Ebola cases in Moyamba during July 11–October 31, to investigate the increase in cases in September 2014, determine the source and risk factors, and recommend prevention and control measures. The Moyamba District Health Management Team (DHMT) received and responded to alerts from health workers, contact tracers, and community members regarding ill persons, possible Ebola cases, and unexplained deaths. Interviewers completed standardized case investigation forms with patients or proxies regarding demographics, symptoms, illness onset, and potential exposures during the month before illness onset, including contact with ill persons, persons with suspected Ebola, and corpses, plus funeral attendance, hospital or traditional healer visits, and travel history. Laboratory technicians collected whole blood from living patients with suspected Ebola and oral swab specimens from corpses and sent the samples to a centralized laboratory for testing.
>
> A suspected case was defined as 1) the occurrence of fever and at least three of 12 symptoms (i.e., vomiting, headache, nausea, diarrhea, difficulty breathing, fatigue, abdominal pain, loss of appetite, muscle or joint pain, unexplained bleeding, difficulty swallowing, and hiccups) in any person; or 2) any sudden, unexplained death. A confirmed case was defined as a suspected case with a positive laboratory test result by reverse transcription–polymerase chain reaction (RT-PCR) test specific for Ebola virus. If RT-PCR results from blood specimens collected <72 hours after symptom onset were negative or indeterminate, additional specimens were collected for repeat diagnostic testing. Paper case investigation forms and laboratory results were entered into the Sierra Leone Viral Hemorrhagic Fever database. Descriptive statistics were calculated using statistical software.
>
> Among 281 suspected Ebola cases in Moyamba District during July 11–October 31, a total of 109 (39%) were confirmed; among these patients, 40 died (case fatality rate = 37%). The median age of patients with suspected Ebola was 30 years (range = 11 months–84 years), and 59% were male. Incidence peaked during the week of September 13–19 at 32 confirmed cases ( <>Figure 1). Overall, during the month before becoming ill, 78 (72%) patients with confirmed Ebola reported having contact with a known or suspected Ebola patient (alive or dead) or ill person. Forty-two (39%) had attended a funeral, 36 (33%) had carried or touched a corpse at a funeral, 10 (9%) had traveled, and eight (7%) had visited a hospital or traditional healer. Among 78 patients with confirmed Ebola who reported contact, 23 (29%) had contact with a corpse, 26 (33%) had contact with a live patient, and 29 (37%) had contact with an Ebola patient both while the patient was alive and after the patient had died.