It looks like it's a bit too early to celebrate the end of the largest Ebola outbreak in history. Just hours after the World Health Organization (WHO) declared the spread of Ebola over in West Africa, Sierra Leone's Ministry of Health has confirmed a new case in the country's northern province.
The body of 22-year-old Mariatu Jalloh tested positive for the virus early Friday morning. It is Sierra Leone's first case in nearly four months. According to reports, the woman had been in Guinea recently and fell ill earlier this month. Upon returning to Sierra Leone she was already experiencing key symptoms of the hemorrhagic fever, which include vomiting and diarrhea. For the remaining duration of her illness she stayed in her family home in the capital city of Freetown where nearly two-dozen people reside. They risk having contracted the virus.
Ebola has killed more than 11,000 people across the region over the last two years, but on Thursday WHO declared an end to Ebola transmission in West Africa after Liberia announced that it had gone 42 consecutive days without a confirmed case — the period of time required by WHO in order for an outbreak to be officially over. Sierra Leone and Guinea had both recently passed that benchmark.
WHO has maintained that flare-ups are possible even with all known chains of transmission contained, which is likely a result of the fact that the virus is believed to stay in the system of survivors for up to nine months — a sharp increase over previous estimates of 90 days. The virus has reemerged twice in Liberia since the country was first declared Ebola-free in May 2015, and the UN health agency believes transmission through survivors has sparked 10 new chains of minor Ebola outbreaks to date.
"It's terrible news, but we knew it was possible because of Liberia," said Fatima Musa, who sells pastries in east Freetown. "We have to be more careful."
Although the news is disheartening, Freetown residents are cautiously optimistic. Some see it as a reminder to be diligent, but others think the country has come far enough to know how to handle sporadic cases like this.
"I'm not worried at all," said Sylvester Hughes, a volunteer at Freetown's YMCA. "We know what to do now when these things happen. We have contract tracers that I'm confident can contain it."
Ebola killed 3,589 Sierra Leoneans in 18 months, including 221 nurses and 11 doctors. The first cases were reported in the country's far east in May 2014, after an infected child crossed over the border from Guinea, which is where the virus first appeared six months earlier.
A weak initial response from both the government and the international community was blamed for allowing the virus to spread rapidly, reaching Freetown less than two months after the country began recording cases.
The crisis threw Sierra Leone into the global spotlight after a surge of cases in August 2014. The virus was eventually reined in by the country's National Ebola Response Center (NERC) and support from WHO, the international medical charity Doctors Without Borders, and many other international organizations. NERC ceased operations on December 31; containment responsibility now falls with the Ministry of Health and the Office of National Security (ONS).
"With the Ministry now leading the response, we'll hopefully see the same vigor we saw from the NERC," said Ministry of Health spokesperson Yaya Tunis. "We will handle the medical and technical sides while ONS will provide a coordinating role."
Both agencies are currently engaged in emergency discussions with WHO and other development partners to determine the best course of action going forward, Tunis added. An initial investigation is now underway and a larger response is set to deploy Friday afternoon.
"The Sierra Leone government acted rapidly to respond to this new case," WHO said in a statement on Friday. "Through the country's new emergency operations center, a joint team of local authorities, WHO, and partners are investigating the origin of the case, identifying contacts and initiating control measures to prevent further transmission."
The 27 individuals suspected of having come into contact with the infected woman are being contained at their homes, and there are currently no plans for a community-wide quarantine.
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Sierra Leone remains under a national state of emergency, though many of its restrictions — including curfews and a ban on public gatherings — were lifted in August 2015. But while the new case is indeed a setback, Tunis sees little possibility that the state of emergency's harsher guidelines will make acomeback.
"We don't see this resulting in a larger outbreak," he said. "We now have the capacity and technical support to manage the incident and keep it contained before it can grow into something more serious."
Sierra Leone will restart its 42-day countdown, and Ebola transmission will once again be declared over if no new Ebola cases are discovered among contacts of the deceased. Liberia now joins Guinea in a 90-day period of heightened surveillance.
Follow Cooper Inveen on Twitter: @cinveen