Ebola virus disease in Mali

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In late October 2014, a two-year-old girl died from Ebola in the city of Kayes.[8] The child, later identified as Fanta Kone, was admitted to hospital on 21 October, where she tested positive for typhoid. Further tests confirmed Ebola.[9][10] The child, her grandmother, uncle, and five-year-old sister[11] arrived in Bamako after traveling roughly 1000 km (600 miles) from Guinea, where Kone's father had died.[8][10] They then traveled to Kayes by bus.[3][12]

Fanta Kone's father, a Red Cross worker, assisted at a private medical clinic in Beyla that was owned and run by his father, Fanta's paternal grandfather. It is suspected that he may have contracted Ebola from a farmer from another village, who sought treatment at the clinic and was accompanied by his two daughters. The farmer died on 12 September, and his daughters on 23 September. After falling ill in late September, Fanta's father traveled to his native village of Sokodougou, 70 kilometres away, where he died on 3 October. By 20 October, the paternal grandfather, his wife, and two sons had also died, with some deaths confirmed to have been from Ebola disease. Fanta's mother and 3-month-old sibling remain disease-free and are residing in Guinea during a 40-day mourning period before joining the rest of her family in Mali.[13]

The hospital pediatrician in Kayes said he was told that the child had been born and raised in Kayes, and that he was not informed of her journey from Guinea.[14] The child's samples were tested at Mali's Center for TB and AIDS Research.[15] Hemorrhagic fevers like Ebola, Marburg virus, and Lassa fever can have similar symptoms, and testing can help determine if a person has a case of one of these diseases.[16] There are about half a million cases of Lassa fever per year in West Africa, causing about 5,000 deaths.[17]

There was concern that Kone had exposed others to the virus during her journey because she had been bleeding from her nose.[18] Contact with blood or feces from someone ill with Ebola is a high risk factor for the disease.[19] By 25 October, it was estimated that the child had contact with as many as 300 people, 43 of whom were placed in isolation to prevent the disease from spreading.[20] Of the 43, 10 were health care workers.[21] By 27 October, 111 people had been identified as contacts, but the search was hampered by a lack of health care workers,[22] and 40 volunteers were trained to help with the contact tracing.[23] By 29 October it was thought she had contact with 141 people, however not all of them were found, including 6 of the 10 people on the bus ride with the child from the Guinea border to Bamako.[24]

By 5 November there were no known cases besides the child, although the risk of more cases was still considered to be high.[25] 108 people who had contact with the child were quarantined, although 40 contacts remained missing as of 9 November.[25] Those being watched have their temperature taken twice daily.[14] The Mali Ministry of Health hoped to release these 108 people from monitoring in mid-November, and all contacts successfully completed their 21-day waiting period on 15 November.[26]

Mali regions with Ebola cases (Kayes, Bamako)

On 12 November, Mali confirmed its second and third deaths from Ebola: an imam from Guinea, and a nurse who was treating him at a clinic in Mali's capital city Bamako. The cases are unrelated to the earlier case in Kayes.[27]

A nurse in Bamako who had treated the imam subsequently fell ill; on 11 November he tested positive for Ebola and died on the same day. A second case was confirmed in a doctor who also worked at the clinic and treated the imam. He developed symptoms on 5 November and died on 20 November.[27][28]

By 12 November, 90 contacts had been quarantined across the city of Bamako, including about 20 U.N. peacekeepers who were treated at the clinic for injuries sustained while on duty. The government placed both the clinic and the imam's mosque in full lock-down. Contact tracing has been hampered because the imam died two weeks prior to his diagnosis; he was not suspected of having Ebola until the nurse tested positive for the disease. He was buried with full traditional rites, including washing the body, and may have exposed many mourners to the virus.[29]

On 19 November, the WHO updated the status of cases in Mali. The imam was reclassified and not counted in Mali, but considered a Guinea case. The second case in Mali was that of the nurse who treated the imam, and the doctor who treated the imam was the third case. The next three cases were related to the imam as well: a man who had visited the imam while he was in hospital, his wife, and his son. Ebola infection was laboratory-confirmed in the wife and the son.[30] As of 15 November, a total of 407 possible contacts are being traced, according to an official health ministry report.[31] On 18 November, the number of contacts was raised to 600 people that were being monitored.

On Monday 24 November, a government statement raised the number of cases in Mali to eight and six deaths. All the new cases are linked back to the imam.[32] On 4 December, Mali received its first mobile lab, which can be sent to remote hotspots, if needed.[33][34] On 6 December, U.N. peacekeepers were released from quarantine at the Pasteur Clinic.[35] On December 12, the last case in treatment recovered and was discharged, "so there are no more people sick with Ebola in Mali,” according to a Ministry of Health source.[36] On December 16, Mali released the final 13 individuals that were being quarantined, therefore the country will be declared free of the virus on January 18, according to WHO. "There is no more contact-tracing ... and there is no suspected case of Ebola," a spokesperson for WHO indicated.[1][37]