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Hygienic Funerals, Better Protection for Health Workers Offer Best Chance to Stop Ebola

African burial practices are “super-spreader events,” experts say

Hygienic funeral practices, case isolation, contact tracing with quarantines, and better protection for health care workers are the keys to stopping the Ebola epidemic that continues to expand in West Africa, researchers said in a report published October 30 in Science.

Continuing the status quo of intervention efforts that were in place as of September 19 would allow continued expansion of the epidemic by about 224 new cases daily in Liberia by December 1, and by 348 new cases daily by December 30, the scientists reported in their analysis.

However, they said broad implementation “with utmost urgency” of the more aggressive approaches that they recommend could lead to control of the disease in Liberia, the focal point of the epidemic, by mid-March.

Researchers at Yale University, Oregon State University, and the Ministry of Health and Social Welfare in Liberia concluded that funerals, as they have been customarily practiced in this region, were “super-spreader events” that have had a disproportionate effect on the early transmission of the virus.

Changes in those practices are the single most important, practical step that could help place the number of new Ebola infections on a downward path, the authors said. But a whole suite of actions are needed, and reducing transmission in hospitals and the community will not by itself bring the epidemic under control.

“The cultural body preparation and funeral practices that are common in West Africa have driven the initial spread of this disease,” said Dr. Jan Medlock of Oregon State University, an expert in mathematical epidemiology and in the evolution of infectious diseases.

“These funeral practices often include washing, touching, and kissing of bodies that were still capable of spreading the Ebola virus,” Medlock said. “It is imperative that funeral transmission be stopped, and also that we take other aggressive steps to isolate cases and better protect health care workers.”

Instead of traditional burial preparations, the researchers endorsed a hygienic approach that includes disinfecting the cadaver before placing it in a plastic body bag and doing further disinfecting. Human-to-human transmission of Ebola occurs mostly through direct or indirect contact with body fluids, the researchers noted in their report, and deceased victims still carry a high viral load in their blood and excretions.

Another significant concern, the researchers said, is under-reporting of cases, both in hospitals and in the general community. This could slow the stoppage of the epidemic and increase the level of intervention needed to halt it.

Other things could also change as the epidemic evolves. Funeral attendance and traditional burial practices may decline as awareness builds about the disease, but contacting people who may have been exposed could become even more difficult as people move from urban to rural areas.

The study’s findings were specific to Liberia but should have some relevance to other places with similar cultural practices or approaches to disease management, Medlock said. They are less relevant in situations where the disease has spread beyond Africa and into the U.S., Europe, and other parts of the developed world, he said, where aggressive isolation and containment of infected people or quarantine of those exposed is more practical.

Given the magnitude of the Ebola crisis, it is already apparent that the disease poses an international threat that requires an international response and aid, the scientists said in their conclusion.

“Ebola poses an urgent threat not only to West Africa but also to the international community,” they wrote. “The implementation of effective interventions needed to reverse the growth of the Ebola outbreak in impoverished West African countries will be logistically challenging even with substantial international aid, but impossible without it.”

Source: Oregon State University; October 30, 2014.

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