The Telegraph
Monday , August 11 , 2014
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Virus onset traced to two-year-old boy

Aug. 10: Patient Zero in the Ebola outbreak, researchers suspect, was a two-year-old boy who died on December 6, just a few days after falling ill in a village in Guéckédou, in southeastern Guinea. Bordering Sierra Leone and Liberia, Guéckédou is at the intersection of three nations, where the disease found an easy entry point to the region.

A week later, it killed the boy’s mother, then his 3-year-old sister, then his grandmother. All had fever, vomiting and diarrhoea, but no one knew what had sickened them.

Two mourners at the grandmother’s funeral took the virus home to their village. A health worker carried it to still another, where he died, as did his doctor. By the time Ebola was recognised in March, dozens of people had died in eight Guinean communities.

In Guéckédou, where it all began, “the feeling was fright”, said Dr Kalissa N’fansoumane, the hospital director.

On March 31, Doctors Without Borders, which has intervened in many Ebola outbreaks, called this one “unprecedented”, and warned that the disease had erupted in so many locations that fighting it would be difficult.

Now, with 1,779 cases, including 961 deaths, the outbreak is out of control and still getting worse. Not only is it the largest ever, but it also seems likely to surpass all two dozen previous known Ebola outbreaks combined.

Some experts warn that the outbreak could destabilise governments in the region. On Saturday, Guinea announced that it had closed its borders with Sierra Leone and Liberia.

Past Ebola outbreaks have been snuffed out, often within a few months. How, then, did this one spin so far out of control? It is partly a consequence of modernisation in Africa, and perhaps a warning that future outbreaks will pose tougher challenges.

Unlike most previous outbreaks, which occurred in remote, localised spots, this one began in a border region where roads have been improved and people travel a lot. In this case, the disease was on the move before health officials even knew it had struck.

Also, this part of Africa had never seen Ebola before. Health workers did not recognise it and had neither the training nor the equipment to avoid infecting themselves or other patients.

Public health experts acknowledge that the initial response, both locally and internationally, was inadequate.

“That’s obviously the case,” said Dr Thomas R. Frieden, director of the Centres for Disease Control and Prevention. “Look at what’s happening now.”

The outbreak occurred in three waves: The first two were relatively small, and the third, starting about a month ago, was much larger, said Gregory Hartl, a spokesperson for the WHO. “That third wave was a clarion call,” he said.

As is often the case in Ebola outbreaks, no one knows how the first person got the disease or how the virus found its way to the region.

The disease does not spread through the air like the flu; contact with fluids is necessary.

A research team that studied the Guinea outbreak traced the disease back to the 2-year-old who died in Guéckédou. He and his relatives were never tested to confirm Ebola, but their symptoms matched it and they fit into a pattern of transmission that included other cases confirmed by blood tests.

But no one can explain how such a small child could have become the first person infected. Contaminated fruit is one possibility. An injection with a contaminated needle is another.