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Liberia declared Ebola-free, signals end to West African epidemic

Liberia was declared free of the Ebola virus by global health experts on Thursday, a milestone that signalled an end to an epidemic in West Africa that has killed more than 11,300 people.

First time 3 hardest hit countries get the all clear in outbreak

Cassius Kollie (right), receives a certificate for being cured of Ebola in Paynesville, Liberia, in July. (James Giahyue/Reuters)
Liberia was declared free ofthe Ebola virus by global health experts on Thursday, a milestone that signalled an end to an epidemic in West Africa that has killed more than 11,300 people.

But the World Health Organisation (WHO) warned there could still be flare-ups of the disease in the region, which hassuffered the world's deadliest outbreak over the past two years,as survivors can carry the virus for many months and could passit on.

Health specialists cautioned against complacency, saying theworld was still underprepared for any future outbreaks of thedisease.

Liberia was the last affected country to get the all-clear,with no cases of Ebola for 42 days, twice the length of thevirus's "incubation period" the time elapsed betweentransmission of the disease and the appearance of symptoms.

"All known chains of transmission have been stopped in WestAfrica," the WHO, a U.N. agency, said on Thursday.

The other affected countries, Guinea and Sierra Leone, weredeclared Ebola-free late last year. There were cases in sevenother countries including Nigeria, the United States and Spain,but almost all the deaths were in the West African nations.

"It is the first time since the start of the epidemic inWest Africa two years ago that the three hardest-hit countries
had zero cases for at least 42 days," said WHO's Liberiarepresentative Alex Gasasira.

The WHO announcement on Thursday is a major step in thefight against a disease that began in the forests of easternGuinea in December 2013 before spreading to Liberia and SierraLeone. It overwhelmed medical infrastructure in the region whichwas ill-equipped to deal with the outbreak, and at its height inlate 2014 sparked global fears among the general public.

However the agency urged caution Liberia had previouslytwice been declared virus-free, in May and September of 2015,but each time a fresh cluster of cases unexpectedly emerged.Its capital Monrovia was badly hit during the worst of theepidemic. Inadequate care meant patients lay strewn on thestreets or pavements waiting hours for tests and treatment;medical holding pens became growth centres for the disease.

With those memories still fresh, and society and the economystill reeling from the outbreak, the reaction to Thursday'sannouncement was muted. There was no signs of celebration suchas the "Ebola free" T-shirts that people wore after previous WHOannouncements.

"After the first declaration, people were dancing in thestreet," said Vivian Lymas Tegli, child protection officer forUNICEF in Monrovia. "But I don't think there will be anycelebrations today. People are tired of Ebola. They feel it is
here to stay."

'World unprepared'

Experts said progress had been made in the region's responseto Ebola, with new cases having dwindled due to public healthcampaigns, efforts to trace and isolate potential sufferers andthe safe treatment and burial of patients and victims.

But it said the countries would still struggle to deal withany future large outbreak of Ebola, which is passed on through
blood and bodily fluids and killed around 40 percent of thosewho contracted the virus.

Hundreds of healthcare workers in both urban and ruralcommunities were among those killed by the disease, a major blowto medical systems in countries which already had among thelowest numbers of doctors per head of population in the world.

"Today's WHO announcement is welcome news but we must learnfrom Ebola's devastating impact and ensure we are betterprepared for infectious disease outbreaks," said Dr. SethBerkley, head of Gavi, the Vaccine Alliance, an organizationthat aims to increase access to vaccines in poor countries.

"The world is still worryingly underprepared for potentialfuture health threats and a change of mind-set is required toensure we invest in research and development today to protectourselves in years to come."

Experts also warned other tropical diseases posed futurethreats, including the previously little known mosquito-borne
Zika virus, which has been linked to head-related birth defectsand is spreading in South America.

Hilde de Clerck, a doctor with Doctors Without Borderswhohas assisted with five Ebola outbreaks including in Congo,Uganda and the latest epidemic in West Africa, said vigilancewas crucial to prevent the re-emergence of the disease, forwhich there is no proven drug treatment, although researchershave developed a vaccine.

"I think we should not forget about the risk of otheroutbreaks," she said. "I am most concerned about some of the
basics: hygiene, equipment and training."

While WHO and other health specialists say another outbreakof this magnitude is unlikely, and much has been learned interms of monitoring patients and responding to outbreaks,problems remain, including with simple hygiene, such as notwashing hands.

"I do really believe that there is a much betterunderstanding, an acceptance that this is a real disease, andwhat the cause is of this disease, and that is much moreembedded in society than before," said Peter Graaff, head ofEbola operations at the WHO's headquarters in Geneva.

Mohammed Kamara, who lives in Monrovia, lost two relativesand a friend to Ebola in 2014. "I know exactly what it means tohave the disease in the country," he said.

"We must be grateful to God and then to the government andits partners for the country to be declared free of Ebola. I
only hope that it is the last time that we experience Ebola."