In a follow-up on the cluster of undiagnosed illness and deaths in Southern Liberia, the World Health Organization (WHO) offered up more details in an outbreak bulletin today.

Liberia map/CIA
Liberia map/CIA

The event of unknown etiology, which affected 20 patients resulting in 11 deaths (CFR 55 percent), has been linked to a funeral function, which started on 23 April 2017 when the index case, an 11 year old girl from Teah town, Greenville district developed an acute onset illness.

She presented to FJ Grante hospital with diarrhea, vomiting and mental confusion; and died within one hour of admission.

The following day (24 April 2017), the second case-patient, a 51 year old woman from Teah town, Greenville developed sudden onset of vomiting, abdominal pain and confusion. She was admitted to FJ Grante hospital on 25 April 2017 and died the same day.

On 25 April 2017 (the third day), a cluster of 13 case-patients from 5 communities in Greenville [Teah town – 6 cases, Congo town – 3 cases, Red hill – 2, Down town – 1, and Johnstone street – 1] developed similar acute onset illness. Seven out of the 13 case-patients died the same day on 25 April 2017.

Forty-two percent of the cases manifested with headache, 37% had vomiting, 27% had confusion, and 26% had abdominal pain and body weakness. Ninety five percent (19/20) of the cases came from Sinoe county.

Over 95% of the line-listed cases participated in at least one aspect of the funeral rites of the religious leader who reportedly died of a known cause. The aspects of the funeral activities include burial, “repass” and “wake keeping”.

Medical Books at Outbreak News Today

A total of 20 biological specimens were collected: 7 oral swabs, 7 whole blood, 3 urine, 2 cardiac fluid, and 1 rectal swab. Of these, the 7 oral swabs, 6 whole blood and 2 cardiac fluid tested negative for Ebola virus. One whole blood sample is still being tested for Ebola virus. Chemistry analysis on 3 urine specimens has not yielded any significant results. Further laboratory investigations for the pathogens including toxicological testing are ongoing. The first set of 11 samples have been shipped to Atlanta, United States. Another set of samples is being shipped to the WHO Reference Laboratory in South Africa.

The dramatic evolution of the event with very short course of illness and sudden death, and the clustering of the cases is indicative of a common source exposure to the pathogenic agent. All indications are pointing at the funeral functions of the religious leader. The likelihood of foods, drinks or water poisoning is high and the ongoing toxicology testing will be very critical to provide some answers.

The overall risk of spread of the event is lowering with the sharp decline in the number of cases and deaths reported. No new cases and/or death have been reported since 28 April 2017.