FREETOWN (Reuters) - A woman who died of Ebola this week in Sierra Leone potentially exposed at least 27 other people to the disease, according to an aid agency report on Friday, raising the risk of more cases just as the deadliest epidemic on record appeared to be ending.
Just a day earlier, the World Health Organization (WHO) had declared that "all known chains of transmission have been stopped in West Africa", meaning that the region was officially free of the disease after a two-year epidemic that killed more than 11,300 people.
It warned, however, of potential flare-ups, as survivors can carry the virus for months. The new case in Sierra Leone is especially disquieting because authorities failed to follow basic health protocols, according to the report seen by Reuters. It was compiled by a humanitarian agency that asked not to be named.
The victim, a 22-year-old female named Mariatu Jalloh, began showing symptoms at the beginning of the year, though the exact date is unknown, the report states.
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A student in Port Loko, the largest town in Sierra Leone's Northern Province, Jalloh traveled to Bamoi Luma near the border with Guinea in late December.
Sierra Leone's northern border area, a maze of waterways, was one of the country's last Ebola hot spots before it was declared Ebola-free on Nov. 7, and contact tracing was sometimes bedeviled by access problems.
By the time she traveled back to her parents' home in Tonkolili district, east of the capital Freetown, using three different taxis, Jalloh had diarrhea and was vomiting, the report said. She was nursed by members of a household of 22 people.
She sought treatment at a local hospital on Jan. 8 where a health worker, who did not wear protective clothing, took a blood sample. It was not immediately clear whether the sample was tested for Ebola.
She was treated as an outpatient and returned home, where she died on Jan. 12. Health workers took a swab test of Jalloh's body following her death, which tested positive for Ebola.
Asked about apparent errors in handling the case, Sierra Leone health ministry spokesman Sidi Yahya Tunis said that the patient had been tested for the virus and had received treatment in a government hospital. He did not give further details.
Information campaigns calling upon residents of Ebola-affected countries to respect government health directives have been largely credited with turning the tide of the epidemic. However, safety measures, particularly a ban on traditional burial ceremonies, have faced stiff resistance at times.
The report stated that five people who were not part of Jalloh's parents' household were involved in washing her corpse, a practice that is considered one of the chief modes of Ebola transmission.
Almost all the victims of the regional epidemic, which originated in the forests of Guinea in 2013, were in Sierra Leone, Guinea and Liberia. All three nations have been declared free of the virus at various times.
But both Sierra Leone and Liberia have seen the disease return despite passing a 42-day period with no new cases, after which countries are declared free of Ebola transmission.
"It is really important that people don't understand this 42-day announcement as the sign that we should all just pack up and go home," said WHO spokesman Tarik Jasarevic. "We should stay there and be ready to respond to these possible cases."
Ben Neuman, an Ebola expert and lecturer in virology at Britain's University of Reading, said: "My first thought is that a hospital in Sierra Leone completely misdiagnosing a case of Ebola, apparently without sending a sample to one of the many testing labs that are being kept open for just this reason is ridiculous -completely unacceptable."
He said Ebola was hard to distinguish from many other diseases that cause pain, fever, diarrhea and vomiting.
"The only way to know for sure is by testing whether pieces of the Ebola virus are present in the blood," Neuman added.
"People still make better doctors and nurses than computers, but people will always make mistakes. Unfortunately this mistake is a big one."
Ebola is passed on through blood and bodily fluids, and kills about 40 percent of those who contracted the virus.
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While the WHO has said that another major outbreak is unlikely, it stated that there was a risk of flare-ups throughout 2016 because of the way the virus can persist in those who survive it. Research on survivors has located it in semen, breast milk, vaginal secretions, spinal fluid and fluids around the eyes.
(Additional reporting by Tom Miles and Stephanie Nebehay in Geneva, Emma Farge in Dakar and Kate Kelland in London; Writing by Edward McAllister; Editing by Joe Bavier and Mark Trevelyan)