Death toll from Ebola in W. Africa hits 887: WHO

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ABUJA, Nigeria (AP) -- The doctor who treated a man who flew to Nigeria and died of Ebola now has contracted the disease, authorities said Monday, presenting a dire challenge to Africa's most populous nation as the regional toll for the outbreak grew to 887 dead.

As Nigerian health authorities rushed to quarantine others who had been exposed, a special plane left Liberia to evacuate the second American missionary who fell ill with Ebola. Nancy Writebol, 59, is expected to arrive in Atlanta on Tuesday, where she will be treated at a special isolation ward.

The second confirmed case in Nigeria is a doctor who treated Patrick Sawyer, the Liberian-American man who died July 25 days after arriving in Nigeria from Liberia, said Nigerian Health Minister Onyebuchi Chukwu.

Three others who also treated Sawyer now show symptoms of Ebola and their test results are pending, he said. Authorities are trying to trace and quarantine others in Lagos, sub-Saharan Africa's largest city of 21 million people.

"This cluster of cases in Lagos, Nigeria is very concerning," said Dr. Tom Frieden, director of the U.S. Centers for Disease Controls and Prevention, which is dispatching 50 experienced disease control specialists to West Africa.

"It shows what happens if meticulous infection control, contact tracing, and proper isolation of patients with suspected Ebola is not done. Stopping the spread in Lagos will be difficult but it can be done," he said.

The World Health Organization announced Monday that the death toll has increased from 729 to 887 deaths in Guinea, Sierra Leone, Liberia and Nigeria.

Cases in Liberia jumped from 156 to 255, WHO said, as the government ordered that all Ebola victims must now be cremated because of rising opposition to burials in neighborhoods around the capital. Over the weekend, police were called in amid a standoff over whether health authorities could bury nearly two dozen victims in a neighborhood on the outskirts of the capital, Monrovia.

Sierra Leone marked a national stay-at-home day Monday in an effort to halt the disease's spread. A documentary film of the first outbreak of the Ebola disease in Congo was being shown intermittently throughout the day by the national broadcaster.

The emergence of a second case in Nigeria raises serious concerns about the infection control practices there, and also raises the specter that more cases could emerge. It can take up to 21 days after exposure to the virus for symptoms to appear. They include fever, sore throat, muscle pains and headaches. Often nausea, vomiting and diarrhea follow, along with severe internal and external bleeding in advanced stages of the disease.

"This fits exactly with the pattern that we've seen in the past. Either someone gets sick and infects their relatives, or goes to a hospital and health workers get sick," said Gregory Hartl, World Health Organization spokesman in Geneva. "It's extremely unfortunate but it's not unexpected. This was a sick man getting off a plane and unfortunately no one knew he had Ebola."

Doctors and other health workers on the front lines of the Ebola crisis have been among the most vulnerable to infection as they are in direct physical contact with patients. The disease is not airborne, and only transmitted through contact with bodily fluids such as saliva, blood, vomit, sweat or feces.

Sawyer, who was traveling to Nigeria on business, became ill while aboard a flight and Nigerian authorities immediately took him into isolation upon arrival in Lagos. They did not quarantine his fellow passengers, and have insisted that the risk of additional cases was minimal.

Nigerian authorities said a total of 70 people are under surveillance and that they hoped to have eight people in quarantine by the end of Monday in an isolation ward in Lagos.

Tracking down all the people who came into contact with Sawyer and his caregivers could prove difficult at this late stage, said Ben Neuman, a virologist and Ebola expert at Britain's University of Reading.

"Contact tracing is essential but it's very hard to get enough people to do that," he said. "For the average case, you want to look back and catch the 20 to 30 people they had closest contact with and that takes a lot of effort and legwork ... The most important thing now is to do the contact tracing and quarantine any contacts who may be symptomatic."

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How Ebola Could Spread Beyond Africa

Death toll from Ebola in W. Africa hits 887: WHO
Dr. Jay Varkey, an infectious disease specialist at Emory Healthcare, speaks with reporters, Saturday, Aug. 2, 2014 in Atlanta. Varkey is part of a team of doctors who will treat the two American aid workers infected with the Ebola virus. The workers will be treated at Emory University Hospital in Atlanta. (AP Photo/Alex Sanz)
A Nigerian health official wearing a protective suit waits to screen passengers at the arrivals hall of Murtala Muhammed International Airport in Lagos, Nigeria, Monday, Aug. 4, 2014. Nigerian authorities on Monday confirmed a second case of Ebola in Africa's most populous country, an alarming setback as officials across the region battle to stop the spread of a disease that has killed more than 700 people. (AP Photo/Sunday Alamba)
A Nigerian health official wearing a protective mask waits to screen passengers at the arrivals hall of Murtala Muhammed International Airport in Lagos, Nigeria, Monday, Aug. 4, 2014. Nigerian authorities on Monday confirmed a second case of Ebola in Africa's most populous country, an alarming setback as officials across the region battle to stop the spread of a disease that has killed more than 700 people. (AP Photo/Sunday Alamba)
A woman prays with others from different religious groups against the spread of the Ebola virus, in Monrovia, Liberia, Saturday Aug. 2, 2014. An Ebola outbreak that has killed more than 700 people in West Africa is moving faster than efforts to control the disease, the head of the World Health Organization warned, as presidents from the affected countries met Friday in Guinea's capital. (AP Photo/Abbas Dulleh)
Women from different religious groups pray against the spread of the Ebola virus, in Monrovia, Liberia, Saturday Aug. 2, 2014. An Ebola outbreak that has killed more than 700 people in West Africa is moving faster than efforts to control the disease, the head of the World Health Organization warned as presidents from the affected countries met Friday in Guinea's capital. (AP Photo/Abbas Dulleh)
A man holds a newspaper featuring a front page story on the death of Liberian diplomat Patrick Sawyer (pictured with his wife Decontee) who died of the Ebloa virus in Lagos on July 30, 2014. Nigeria is on alert against the possible spread of Ebola after the first confirmed death from the virus in Lagos, Africa's biggest city and the country's financial capital. The victim, who worked for the Liberian government, collapsed at Lagos international airport after arriving on a flight from Monrovia via the Togolese capital Lome, according to the Nigerian government. Doctors Without Borders (MSF) warned that the crisis gripping Guinea, Liberia and Sierra Leone would only get worse and could not rule out it spreading to other countries. AFP PHOTO/PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images)
A man reads a newspaper with a headline announcing government efforts to screen for Ebola at a newsstand in Lagos on July 27, 2014. Nigeria was on alert against the possible spread of Ebola on July 27, a day after the first confirmed death from the virus in Lagos, Africa's biggest city and the country's financial capital. The health ministry said on July 25 that a 40-year-old Liberian man died at a private hospital in Lagos from the disease, which has now killed more than 650 people in four west African countries since January. AFP PHOTO/PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images)
Director of the Nigerian Centre for Disease Control, Professor Abdulsalam Nasidi, speaks during a briefing about Ebola outbreak in Lagos on July 28, 2014. Nigeria was on alert against the possible spread of Ebola on Saturday, a day after the first confirmed death from the virus in Lagos, Africa's biggest city and the country's financial capital. The health ministry said Friday that a 40-year-old Liberian man died at a private hospital in Lagos from the disease, which has now killed more than 650 people in four west African countries since January -- the deadliest outbreak in history. AFP PHOTO/PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images)
A picture taken on July 24, 2014 shows staff of the Christian charity Samaritan's Purse putting on protective gear in the ELWA hospital in the Liberian capital Monrovia. An American doctor battling West Africa's Ebola epidemic has himself fallen sick with the disease in Liberia, Samaritan's Purse said on July 27. AFP PHOTO / ZOOM DOSSO (Photo credit should read ZOOM DOSSO/AFP/Getty Images)
A 10-year-old boy receives treatment after being taken out of quarantine following his mother's death caused by the ebola virus, in the Christian charity Samaritan's Purse Ebola treatment center, at the ELWA hospital in the Liberian capital Monrovia, on July 24, 2014. A US doctor battling West Africa's Ebola epidemic has himself fallen sick with the disease in Liberia, Samaritan's Purse said on July 27. AFP PHOTO / ZOOM DOSSO (Photo credit should read ZOOM DOSSO/AFP/Getty Images)
A close up of newspaper front pages focusing on the Ebola outbreak, including a newspaper, left, reading 'Burn all bodies' in the city of Monrovia, Liberia, Thursday, July 31, 2014. The worst recorded Ebola outbreak in history surpassed 700 deaths in West Africa as the World Health Organization on Thursday announced dozens of new fatalities. (AP Photo/Jonathan Paye-Layleh)
Graphic provides an update on the Ebola outbreak in West Africa; 3c x 4 inches; 146 mm x 101 mm;
People working for a petroleum company take part in an Ebola awareness campaign to try and prevent the deadly Ebola virus spreading in the city of Monrovia, Liberia, Monday, Aug. 4, 2014. Health authorities in Liberia ordered that all those who die from Ebola be cremated after communities opposed having the bodies buried nearby. Over the weekend, health authorities in the West African country encountered resistance while trying to bury 22 bodies in Johnsonville, outside the capital Monrovia. (AP Photo/Abbas Dulleh)
An ambulance arrives with Ebola victim Dr. Kent Brantly, right, to Emory University Hospital, Saturday, Aug. 2, 2014, in Atlanta. Brantly, infected with the Ebola virus in Africa arrived in Atlanta for treatment Saturday, landing in a specially equipped plane at a military base, then being whisked away to one of the most sophisticated hospital isolation units in the country, officials say. (AP Photo/WSB-TV Atlanta) METRO ATLANTA TV OUT
In this 2014 photo provided by the Samaritan's Purse aid organization, Dr. Kent Brantly, left, treats an Ebola patient at the Samaritan's Purse Ebola Case Management Center in Monrovia, Liberia. On Saturday, July 26, 2014, the North Carolina-based aid organization said Brantly tested positive for the disease and was being treated at a hospital in Monrovia. (AP Photo/Samaritan's Purse)
Television news crews record a press conference at Emory University Hospital regarding the proposed treatment of two American aid workers who contracted Ebola in Africa at an isolated unit at the hospital to treat patients exposed to certain infectious diseases, Friday, Aug. 1, 2014, in Atlanta. Dr. Bruce Ribner said Friday he had no personal safety concerns over treating the patients of the dangerous disease. Hospital officials did not identify the patients, citing confidentiality rules. They were previously identified as Dr. Kent Brantly and Nancy Writebol. Ribner said one of the patients was expected to arrive Monday, while a second was expected several days later. (AP Photo/David Goldman)
Dr. David Mcray, left, listens to a question during a news conference with Dr. Jason Brewington, center, and Dr. Darrin D'Agostino about fellow doctor Kent Brantly Monday, July 28, 2014, in Fort Worth, Texas. Brantly is one of two American aid workers that have tested positive for the Ebola virus while working to combat an outbreak of the deadly disease at a hospital in Liberia. (AP Photo/LM Otero)
Dr. David Mcray speaks about his friend and colleague Dr. Kent Brantly during a news conference Monday, July 28, 2014, in Fort Worth, Texas. Brantly is one of two American aid workers that have tested positive for the Ebola virus while working to combat an outbreak of the deadly disease at a hospital in Liberia. (AP Photo/LM Otero)
Dr. David Mcray reads a recent message sent to him by his friend and colleague Dr. Kent Brantly during a news conference Monday, July 28, 2014, in Fort Worth, Texas. Brantly is one of two American aid workers that have tested positive for the Ebola virus while working to combat an outbreak of the deadly disease at a hospital in Liberia. (AP Photo/LM Otero)
In this undated photo released by the Center for Disease Control, a Aeromedical Biological Containment System which looks like a sealed isolation tent for Ebola air transportation is shown. On Thursday afternoon July 31, 2014, officials at Atlanta's Emory University Hospital said they expected one of the Americans to be transferred there "within the next several days." The hospital declined to identify which aid worker, citing privacy laws. (AP Photo/Center for Disease Control)
A private plane arrives at Dobbins Air Reserve Base in Marietta., Ga., Saturday, Aug. 2, 2014. Officials at Emory University Hospital in Atlanta expect an American who is infected with the Ebola virus to be transported for treatment today. (AP Photo/John Bazemore)
An ambulance is shown en route to Emory University Hospital after departing from Dobbins Air Reserve Base in Marietta., Ga., Saturday, Aug. 2, 2014. Officials at Emory in Atlanta expect an American who is infected with the Ebola virus to be transported for treatment today. (AP Photo/John Bazemore)
An ambulance arrives at Emory University Hospital transporting an American that was infected with the Ebola virus, Saturday, Aug. 2, 2014, in Atlanta. A specially outfitted plane carrying Dr. Kent Brantly from West Africa arrived at a military base in Georgia. Brantly was taken to the Atlanta hospital. Another American with Ebola is expected to join him at the hospital in a few days. (AP Photo/David Goldman)
Hospital workers pass police officers guarding an entrance to Emory University Hospital after an ambulance arrived transporting an American that was infected with the Ebola virus, Saturday, Aug. 2, 2014, in Atlanta. A specially outfitted plane carrying Dr. Kent Brantly from West Africa arrived at a military base in Georgia. Brantly was taken to the Atlanta hospital. Another American with Ebola is expected to join him at the hospital in a few days. (AP Photo/David Goldman)
A police officer clears an entrance to Emory University Hospital after ambulance arrived transporting an American that was infected with the Ebola virus, Saturday, Aug. 2, 2014, in Atlanta. A specially outfitted plane carrying Dr. Kent Brantly from West Africa arrived at a military base in Georgia. Brantly was taken to the Atlanta hospital. Another American with Ebola is expected to join him at the hospital in a few days. (AP Photo/David Goldman)
This photo provided by Jeremy Writebol show his parents, David and Nancy Writebol, who are Christian missionaries in Liberia. Nancy Writebol is one of two Americans working for a missionary group in Liberia that have been diagnosed with Ebola. Plans are underway to bring back the two Americans from Africa for treatment. (AP Photo/Courtesy Jeremy Writebol)
This Oct. 7, 2013 photo provided by Jeremy Writebol show his mother, Nancy Writebol, with children in Liberia. Writebol is one of two Americans working for a missionary group in Liberia that have been diagnosed with Ebola. Plans are underway to bring back the two Americans from Africa for treatment. (AP Photo/Courtesy Jeremy Writebol)
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