Ebola Emergency Over: WHO

Despite recent flare-ups, the West African Ebola epidemic is no longer an international public health emergency, the World Health Organization (WHO) said.

All of the original chains of transmission in the epidemic have been ended, according to WHO Director-General Margaret Chan, MD.

And while occasional new cases can be expected, the three countries hardest hit by the outbreak -- Guinea, Liberia, and Sierra Leone -- now have the ability to cope with them, Chan told reporters after the ninth meeting of the agency's emergency committee on the outbreak.

Indeed, Guinea is now battling a cluster of five confirmed and three probable Ebola cases, all linked to the same sexual transmission from a survivor, the agency is reporting.

But the likelihood of international spread is now "low," Chan said.

The emergency committee recommended ending the so-called public health emergency of international concern (PHEIC) for three reasons, said committee vice-chair Robert Steffen, MD, of the University of Zurich:

• There is no longer any transmission linked directly to the original outbreak.
• New clusters, associated with sexual transmission from male survivors, are small and their numbers are expected to fall as survivors clear the virus from semen.
• And all three countries have shown they can mount a "strong and adequate reaction" to flare-ups.

But Steffen cautioned that "Complacency at this stage would be completely wrong."

He noted that Ebola crops up from time to time in sub-Saharan Africa and is likely to continue to do so in West Africa. "That will be normal life," he said.

The epidemic was the largest ever seen since the Ebola virus was first identified in 1976 -- some 28,639 cases and 11,316 deaths, most of them in West Africa -- and controlling it called for an extensive international response.

It is thought to have started in late 2013 in a remote forested region of Guinea, probably as a result of transmission from an infected animal, perhaps a bat. The outbreak was reported in March 2014, but the WHO came under fire for not declaring it an international emergency until August.

One of the unexpected outcomes of the epidemic is that among the large number of survivors are people who continue to have the virus in their systems despite clinical recovery. In men, the virus can persist for several months in semen and be transmitted sexually.

Indeed, about 90% of male survivors have evidence of Ebola RNA in their semen immediately after discharge, even though they have no clinical signs and no evidence of the virus in their blood, commented Bruce Aylward, MD, the agency's assistant director-general for outbreak and health emergencies.

That can persist for a year or more in a small proportion of cases, he said, although both the number of men with Ebola in the semen and the levels of virus in those men begin to drop rapidly, Aylward said.

There's no evidence of chronic excretion of Ebola in the semen, he added.

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Ebola Emergency Over: WHO