Why Is Liberia on Taiwan’s Orange Alert? Resurrection of Ebola Stigma Fears


Monrovia – Months after being declared free of the deadly Ebola virus outbreak, Liberia, one of the West African nations hit hard by the deadly Ebola virus outbreak continues to suffer stigma.

Travel Warning Declaration Triggers Resurrection Of Ebola Stigma Fears

Citing possibilities that the virus could resurface in Liberia, Taiwan’s Ministry of Foreign Affairs (MoFA) last Friday issued a yellow travel alert for Ghana, which it says is a possible target for terrorist attacks, while issuing an orange travel alert for Liberia and Sierra Leone amid signs of Ebola cases reemerging there.

Under the MOFA’s four-color travel advisory system, the lowest warning level is gray, followed by yellow, then orange and finally red. A red alert is the highest warning level and advises people to refrain from traveling to the region in question.

The ministry said Ghana has been listed as one of the targets for the next terrorist attack, according to Mali terrorists caught by Ivory Coast authorities.

As for Liberia and Sierra Leone, the ministry said the Ebola outbreak, which had been under control until March, showed signs of resurging.

The travel advisory comes just days after a report by an international team of scientists in the journal Science Advances documented that declining genetic divergence in the flare-up strains, were perhaps due to diminished evolutionary rates in individuals with persistent infection.

According to the scientists, the sequence data supported the notion that the flare-ups involved strains related to those in the main outbreak, ruling out re-introduction from a reservoir animal or transmission of distinct strains from active infections elsewhere.

According to the report, researchers from the US Centers for Disease Control and Protection, the US Army Medical Research Institute of Infectious Diseases, Liberia’s Ministry of Health, and elsewhere analyzed genomic and epidemiologic data from seven individuals with confirmed Ebola infections to investigate an Ebola virus flare up in Liberia in June 2015 — the second re-emergence of the virus after the broader Ebola outbreak ended in that country.

The findings highlight the potential risk of re-introduction due to Ebola virus persistence in some individuals who survived the disease, highlighting the importance of enhanced surveillance, survivor services, and access to resources for responding to flare-ups, Christie, Ebola response lead for CDC in Liberia, told GenomeWeb in an e-mail.

“[T]his second flare-up, like the first, originated from a persistently infected source within Liberia,” co-senior authors USAMRIID’s Gustavo Palacios, the CDC Athalia Christie, and Ministry of Health researcher Tolbert Nyenswah, and their colleagues wrote.

They also noted that the new Ebola genomes “were characterized by significantly low levels of genetic divergence compared to other viral genomes sequenced from samples collected from infected persons in Liberia during the epidemic.”

It is highly likely that Taiwan based its travel advisory warning on Liberia and Sierra Leone due to the recent warnings which suggest that the two countries at the center of the outbreak should maintain high levels of vigilance for longer than thought to contain any future flare-ups of the deadly haemorrhagic fever.

World Health Organization data show West Africa’s Ebola epidemic killed more than 11,300 people and infected some 28,600 as it swept through Guinea, Sierra Leone and Liberia from 2013 in the world’s worst outbreak of the disease.

Each of the three countries has experienced brief flare-ups since being declared Ebola free, including three isolated clusters of Ebola cases in Liberia.

The second flare-up, which included seven confirmed cases, centered on a village in Margibi County, a rural area near the capital Monrovia. To find out more about what triggered it, researchers led by David Blackley of the U.S. Centres for Diseases Prevention and Control isolated and sequenced viral genomes from infected patients.

The scientists found a striking amount of genetic similarity with other Ebola sequences from West Africa, indicating the flare-up “was a continuation of the outbreak that began in 2013, and was not caused by an additional spillover event from an unknown, non-human reservoir”.

Further analysis, according to the report, suggested this cluster was sparked by “a persistent, sub-clinical infection” in a woman who had previously had Ebola infection with clear symptoms, but and appeared to recover.

It remains unclear how Ebola virus is able to lay dormant in an infected host, but the scientists noted that the virus may replicate more slowly and persist in immune-privileged sites, such as the eye and testes, long after the acute, symptomatic phase of disease has occurred.

It is also unclear whether other countries could follow suit and begin stigmatizing travelers from Liberia over fears of Ebola

At the height of the epidemic, several airlines abruptly cut of service to Liberia, Sierra Leone and Guinea and most countries stop granting visas to Liberians.