Is Ebola Here to Stay?

Kisses are at a premium in the capital of Liberia. Even a hug or a handshake between friends is often out of the question. That’s the new normal ever since Ebola began ravaging communities throughout Liberia, Sierra Leone and Guinea. For much of the past year, residents of these west African countries have wondered if daily life will ever be able to return to the way things once were. And at the heart of the matter is a scientific question: has Ebola now found a permanent foothold among humans? The answer, however, is not easy to suss out. In fact, it’s a guessing game. Even for top scientists.

In public health terminology the word used to describe this kind of health threat is “endemic.” The term describes any malady that routinely crops up without having to be reintroduced from an outside source—either imported from another country or another species. The flu, for example, is endemic in the U.S. because various strains reappear the following year without any trouble. Yet the many Ebola outbreaks of the past 40 years are not referred to as endemic because the original source of the infection in each case is widely believed to be an animal that somehow infected a human.

Changing the technical description of the current outbreak from epidemic to endemic is more than a matter of semantics. The difference between responding to an epidemic versus an endemic disease is as great as the difference between preparing for a sprint versus a marathon. A sprint requires a massive surge of effort after which the runner can recover. A marathon, like endemic Ebola, requires an entirely different mindset and extensive resources to go the distance. Failure to prepare for a marathon leaves a runner puffing shortly into the race. And failure to prepare for endemic Ebola results in a higher body count than might otherwise occur. But a premature shift to prepping for endemic Ebola could also result in a higher body count by crippling the short-term response; it would rob responders of the emergency beds and equipment needed to tamp down the massive viral surge still plaguing west Africa. Consequently, wary top health officials must draw up blueprints for the current crisis while eyeing the unpredictable road ahead.

When it comes to Ebola, “To say it is endemic is, in one sense, to admit failure,” says Christopher Dye, who serves as director of strategy in the office of the director general at the World Health Organization. “Our goal, and our expectation, is that we will eliminate infection from the human population,” he says. But there is no firm cutoff for a time period or series of symptoms that would demarcate the line between Ebola transmission as a perpetual threat or just a virus that is taking too long to extinguish.

From the time Ebola was first recognized in 1976 until this past year the virus never managed to gain much ground. All of the prior outbreaks were located in such remote areas that the combination of fast action and the relative isolation of the communities allowed the outbreaks to remain contained. But following that same strategy in the current case was impossible because the outbreak occurred in the more populous intersection of three countries and quickly escalated to dwarf every earlier Ebola outbreak. Left unchecked, Ebola would have been even more devastating for west Africa and beyond. But since Ebola still managed to ravage so many communities in west Africa its longevity raises questions about when or if Ebola will be considered endemic.

But where did Ebola come from in the first place? The virus did not appear out of thin air. Most virologists think the outbreaks are the result of a spillover from one or more animals that naturally carry the virus. One leading theory is that humans have contracted Ebola by consuming infected fruit bats. Multiple research groups have theorized bats are behind the disease, partly because a closely related malady, Marburg disease, has been linked to bats. Endemic Ebola, however, could cut out the need to encounter an infected animal altogether. Instead, Ebola would continue to readily spread between humans since there would always be low levels of the virus in the population.

Dye first sounded the alarm of a future with endemic Ebola in a New England Journal of Medicine article in September. For the first time, he wrote, scientists must “face the possibility that [Ebola Virus Disease] will become endemic among the human population of west Africa, a prospect that has never previously been contemplated.” In a recent interview with Scientific American he spelled out what he meant: “I think the reason we have used the word endemic in the first instance is to emphasize that the persistence of transmission has been a lot longer than anything we’ve seen before,” he says. But it could also be used to point to the need for an entirely different kind of response, one that would hinge on addressing the virus beyond an exponential growth phase, “where we get the virus to low levels in the population and there will be a different kind of response. Then we might use the word endemic there too,” he says.

Ebola expert Daniel Bausch, who has worked to quash Ebola during planning sessions in Geneva and on the ground in west Africa, unequivocally says that the epidemic that has led to more than 20,000 cases and 7,000 deaths is not at risk of becoming endemic in humans. Endemic Ebola, he says, would involve “long-standing perpetual transmission of Ebola virus in the area.” And although Ebola has ravaged west Africa since early 2014, the virus, he says, is on the correct path to be stamped out. An area would be considered Ebola-free after no new cases of Ebola appear for 42 days, twice the maximum incubation period for Ebola virus disease. Ebola may still crop up sporadically in the years to come, Bausch says, but “I think ultimately we will eventually get a handle on this, wait 42 days and call this outbreak over, so it is not fair to consider it endemic.”

Yet grappling with how to get answers to this endemic question through knowable, testable research is murky at best. As Bausch says, “What’s the difference between a big long outbreak that takes a long time to control and endemic disease?” The very characteristics of Ebola that make it so lethal also simultaneously block it from becoming a strong candidate to be endemic. Since Ebola kills pretty readily, for example, it doesn’t have the opportunity like HIV to pass itself on. And there’s no chronic carrier of this virus who appears to harbor the virus even after it has been eliminated from a community. Ebola can take months to be cleared from certain protected sites in the body like the gonads, but that’s not like HIV, which has true abilities to survive for years in the body and mount a resurgence if a patient stops taking medications to suppress the amount of virus circulating in the body.

Genetic sequencing can allow scientists to start answering questions about where the virus is coming from – say if Ebola was clearly just being passed from one person to the next or if the virus was being repeatedly introduced to communities from an outside source, likely an animal. One such study published in Science this summer concluded that so far Ebola circulating in Sierra Leone does not appear to haveoriginated from multiple reintroductions of the virus. Rather, by sequencing 99 Ebola virus genome sequences of the majority of Ebola patients in Sierra Leone this past spring the group found that all the cases were traceable to a “patient zero” of Ebola in the community. Yet if there was continuous reintroduction of the same strain of the virus from animals to humans there may not be significant enough mutations to detect what was happening and it could appear to be a continuous chain of transmission, cautions Gary Kobinger, head of the special pathogens program at the Public Health Agency of Canada. And if the virus, hypothetically, somehow adapted to the human population and became less aggressive over time then perhaps that would provide an early sign of endemicity, he says. But tracing that evolution would prove quite challenging. Still, top Ebola experts are not ready to start calling Ebola endemic, at least not yet.

One thing is certain: If Ebola is still persisting a year from now, “The whole response will need to be integrated back into the health system,” says Dye. Although changes to the Ebola response – like creating isolation units at hospitals in west Africa – are under active discussion, no plans are being made right now because the focus still needs to be on the emergency response, he says. Yet if Ebola does become truly endemic – perpetuating itself through the human population – that’s what would be needed. For starters, local health infrastructure would have to be significantly shored up to face such a harsh and long-standing threat. And health officials would need to be ready to immediately transport Ebola patients from one part of the country to isolation wards in another part of the country, says Dye.

The end result would need to look much more like the health care system in the U.S. or western Europe. In those locations dangerous infectious viruses appear relatively rarely and affected patients are placed in special isolation units at hospitals. That setup would be a significant financial and logistical undertaking for African nations, vastly different from the stand-alone specialized Ebola treatment units that currently accommodate hundreds of patients at a time. Gregory Taylor, the chief public health officer of Canada, states that the public health infrastructure build-up would also mean expanding west African lab capacities, something Canada has already been assisting with. And if low levels of Ebola manage to persist throughout 2015, Dye says, such infrastructure actions will need to be taken. After all, underestimating the power of Ebola to spread across west Africa is how the virus was able to flourish in the first place.

First Ebola boy likely infected by playing in bat tree

Bat being captured to be tested for EbolaOther researchers have been testing bats in West Africa for Ebola virus

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The Ebola victim who is believed to have triggered the current outbreak – a two-year-old boy called Emile Ouamouno from Guinea – may have been infected by playing in a hollow tree housing a colony of bats, say scientists.

They made the connection on an expedition to the boy’s village, Meliandou.

They took samples and chatted to locals to find out more about Ebola’s source.

The team’s findings are published in EMBO Molecular Medicine.

Ebola trail

MeliandouMeliandou is a small village surrounded by farmland and large trees

Meliandou is a small village of 31 houses.

It sits deep within the Guinean forest region, surrounded by towering reeds and oil palm cultivations – these are believed to have attracted the fruit bats carrying the virus passed on to Emile.

During their four-week field trip in April 2014, Dr Fabian Leendertz and colleagues found a large tree stump situated about 50m from Emile’s home.

Villagers reported that children used to play frequently in the hollow tree.

Emile – who died of Ebola in December 2013 – used to play there, according to his friends.

The villagers said that the tree burned on March 24, 2014 and that once the tree caught fire, there issued a “rain of bats”.

the treeChildren from the village used to play in and around the tree

A large number of these insectivorous free-tailed bats – Mops condylurus in Latin – were collected by the villagers for food, but disposed of the next day after a government-led ban on bushmeat consumption was announced.

While bushmeat is thought to be a possible source of Ebola, the scientists believe it didn’t trigger the outbreak.

Instead, it was Emile’s exposure to the bats and their droppings as he played with his friends in the hollowed tree.

Pest control

The scientists took and tested ash samples from the tree and found DNA traces that were a match for the animals.

While they were unable to test any of the bushmeat that the villagers had disposed of, they captured and tested any living bats they could find in and around Meliandou.

No Ebola could be detected in any of these hundred or so animals, however.

But previous tests show this species of bat can carry Ebola.

Dr Leendertz, from the Robert Koch Institute in Germany, and his colleagues say this must be a pretty rare occurrence though.

The expedition team

Dr Leendertz said: “That is also obvious when you think about how many tonnes of bat meat is consumed every year.

“If more bats carried the virus, we would see outbreaks all the time.”

He says it is vital to find out more about the bats.

“They have moved into human settlements. They do not just live in the trees but also under the roofs of houses in the villages.

“The Ebola virus must jump through colonies from bat to bat, so we need to know more.”

But culling the animals is not the answer.

“We need to find ways to live together with the wildlife. These bats catch insects and pests, such as mosquitoes. They can eat about a quarter of their body weight in insects a day.

“Killing them would not be a solution. You would have more malaria.”

WHO: True Ebola Toll Hidden

The toll in the West African Ebola epidemic is now more than 18,000 reported cases and 6,800 known deaths, the World Health Organization (WHO) said.

That’s nowhere near the worst-case scenario suggested in late September by a mathematical model — some 1.4 million cases by Jan. 20. But the reported cases could still be only what a local saying describes as the “ears of the hippo” — just the visible part of a huge hidden beast.

That’s because much of the region is rural, where communication is poor and the challenges of containing the epidemic remain great despite the international effort to halt the epidemic.

Online today in Morbidity and Mortality Weekly Report, the CDC is describing the limited progress in four rural counties in Liberia, while a recent WHO report shows how the virus can flourish out of sight.

The four counties (Grand Cape Mount, Grand Bassa, Rivercess, and Sinoe) were assessed in late August and early September, when they had just begun reporting cases — a total of 25 suspected, 16 probable, and 19 confirmed infections.

At the time, the CDC report stated, response teams in the four counties said they lacked adequate training in case investigation, contact tracing, infection control (including safe burial practices), and health education.

In three counties, people untrained in safe burial practices were transporting corpses and healthcare workers were not trained in how to transport a patient with possible Ebola. Two counties said they had no functioning ambulance and only one reported having an ambulance crew trained in transporting a suspected Ebola patient.

Only two counties said they had a lab tech — one each — trained to collect and handle possible Ebola specimens safely. In all four, healthcare workers had limited amounts of personal protective equipment but had not been trained to use it properly. And clinics were short of essential drugs, according to the CDC report.

Also, health officials reported communication difficulties, such as roads that were often impassable, telephone service that was spotty, and lab results that were often delayed for days.

As on Nov. 21, the Ebola toll in the four counties had grown to a cumulative total of 100 suspected, 114 probable, and 101 confirmed Ebola cases, but many of the challenges remained.

Despite additional training in case investigation, contact tracing, infection control, safe burials, and health education, the CDC said, the four counties still had a lack of trained personnel, not enough vehicles to transport patients or to carry out case finding and contact tracing, and continuing difficulties with telephone and Internet communication.

The danger of such situations was graphically spelled out by the WHO, reporting on the response to what it called an “ominous spike” in Ebola in the remote district of Kono in eastern Sierra Leone.

The region bordering Guinea is known for its rich diamond reserves. In early December, the WHO was concerned that the Ebola outbreak in the area was being under-reported, the agency said. Like the Liberian counties, Ebola resources were limited, communication was difficult, and training was minimal.

An epidemiologist sent in to investigate found a grim scene: dozens were dead, burial teams were exhausted and overworked, and hard-pressed doctors were piling patients in ambulances and sending them on a 4-hour trip over bad roads to a distant Ebola treatment center.

They were “all doing the best they could but they simply ran out of resources and were over-run with gravely ill people,” said Olu Olushayo, MD, the WHO’s national coordinator for the Ebola response, in a statement.

Because the district is so remote, a WHO spokesman said, people were simply not aware of the details of the epidemic; they didn’t know they should seek treatment quickly or that a fever might not be the usual malaria, but Ebola.

And because of the isolation, people were usually very ill by the time they sought care.

When a response team from the CDC, WHO, and the national health ministry arrived, they buried 87 bodies in 11 days, including a nurse, an ambulance driver, and a janitor who had been drafted into removing bodies as they piled up at the only area hospital.

In the 5 days before the team arrived, the WHO statement said, 25 people had died in a makeshift Ebola holding center cordoned off from the hospital.

The district had a total of 119 known cases by Dec. 9, the WHO said, but still more could remain unreported. The agency quoted Amara Jambai, MD, of the country’s health ministry, as saying “we are only seeing the ears of the hippo” thus far.

Ebola: Mapping the outbreak

The Ebola outbreak in West Africa was first reported in March 2014, and has rapidly become the deadliest occurrence of the disease since its discovery in 1976.

In fact, the current epidemic sweeping across the region has now killed more than all other known Ebola outbreaks combined.

Up to 15 December, 6,856 people had been reported as having died from the disease in six countries; Liberia, Guinea, Sierra Leone, Nigeria, the US and Mali.

The total number of reported cases is more than 18,000.

The World Health Organization (WHO) admits the figures are underestimates, given the difficulty collecting the data. WHO officials this week discovered scores of bodies in a remote diamond-mining area of Sierra Leone , raising fears that the scale of the Ebola outbreak may have been underreported.

Ebola deaths

Up to 13 December

6,856

Deaths – probable, confirmed and suspected

(Includes one in the US and six in Mali)

  • 3,290 Liberia
  • 2,033 Sierra Leone
  • 1,518 Guinea
  • 8 Nigeria

The WHO has declared the outbreaks in Nigeria and Senegal officially over, as there have been no new cases reported since 5 September.

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How the virus spread: Ebola death toll

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Researchers from the New England Journal of Medicine have traced the outbreak to a two-year-old toddler, who died in December 2013 in Meliandou, a small village in south-eastern Guinea.

In March, hospital staff alerted Guinea’s Ministry of Health and then MSF. They reported a mysterious disease in the south-eastern regions of Gueckedou, Macenta, Nzerekore, and Kissidougou.

It caused fever, diarrhoea and vomiting. It also had a high death rate. Of the first 86 cases, 59 people died.

The WHO later confirmed the disease as Ebola.

Disease spreadsThe Gueckedou prefecture in Guinea, where the outbreak started, is a major regional trading centre and, by the end of March, Ebola had crossed the border into Liberia. It was confirmed in Sierra Leone in May.

In June, MSF described the Ebola outbreak as out of control.

Nigeria had its first case of the disease in July and, in the same month, two leading doctors died from Ebola in Liberia and Sierra Leone.

In August, the United Nations health agency declared an “international public health emergency”, saying that a co-ordinated response was essential to halt the spread of the virus.

Senegal reported its first case of Ebola on 29 August. A young man from Guinea had travelled to Senegal despite having been infected with the virus, officials said.

By September, WHO director general Margaret Chan said the number of patients was “moving far faster than the capacity to manage them”.

Director of the Centers for Disease Control and Prevention (CDC) in the US, Thomas Frieden, said in October that the Ebola outbreak in West Africa was unlike anything since the emergence of HIV/Aids.

Authorities in Mali confirmed the death of the country’s first Ebola patient, a two-year-old girl, on 25 October. The girl had travelled hundreds of kilometres by bus from Guinea through Mali showing symptoms of the disease, the WHO said.

Mali is currently battling a second wave of the deadly virus.

An infected Islamic preacher from Guinea, who was initially diagnosed with a kidney problem, was treated at a clinic in Bamako. The preacher died a few days after entering the country.

Two health workers who cared for the preacher also died after contracting the virus. In total, Mali has recorded six deaths from Ebola.

Ebola outside West Africa

Ebola outside West Africa

*In all but three cases the patient was infected with Ebola while in West Africa. Infection outside Africa has been restricted to health workers in Madrid and in Dallas. DR Congo has also reported a separate outbreak of an unrelated strain of Ebola.

The first case of the deadly virus diagnosed on US soil was announced on 1 October. Thomas Eric Duncan, 42, who contracted the virus in Liberia before travelling to the US, died on 8 October.

He had not displayed symptoms of the disease until 24 September, five days after his arrival. Other people with whom he came into contact are being monitored for symptoms.

Two medical workers in Dallas, Texas, who treated Duncan tested positive for Ebola since his death but have both recovered.

Spanish nurse Teresa Romero was the first person to contract the virus outside West Africa. She was part of a team of about 30 staff at the Carlos II hospital in Madrid looking after two missionaries who returned from Liberia and Sierra Leone after becoming infected.

Germany, Norway, France, Italy, Switzerland and the UK have all treated patients who contracted the virus in West Africa.

Ebola weekly cases chart for Guinea, Liberia and Sierra Leone

Are cases levelling off?Efforts to tackle Ebola have been hindered by fierce resistance from local communities with a history of suspicion towards outside intervention.

This has enabled new chains of transmission to pop up.

Over the last few weeks, health officials admit that the disease is now entering a new phase, with a marked slowing down in the some of the affected areas in the three countries, especially Guinea and Liberia.

According to the WHO, transmission remains intense in Sierra Leone, especially in the country’s west and north

2014 outbreak in contextEbola was first identified in 1976 and occurs in regions of sub-Saharan Africa. There are normally fewer than 500 cases reported each year, and no cases were reported at all between 1979 and 1994.

In August 2014 the WHO confirmed a separate outbreak of Ebola in the Democratic Republic of Congo. By the beginning of October there had been 70 cases reported and 43 deaths.

However, the outbreak in DR Congo is a different strain of the virus and unrelated to the epidemic in West Africa, which now dwarfs all previous outbreaks.

Past epidemics

Ebola past outbreaks

More on This Story

Chinese Medics in Liberia to Beef up Ebola Fight

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A large team of Chinese health workers arrived in Liberia to boost the Ebola fight as a US-based doctor infected in Sierra Leone was described as being “extremely ill”.

The 160-strong Chinese deployment to the west African country worst hit by the virus came as the world’s most powerful economies vowed to “extinguish” the epidemic, which has claimed more than 5,100 lives.

The Chinese doctors, epidemiologists and nurses will staff a $41 million (33 million euro) Ebola treatment unit which will be up and running in 10 days, ambassador Zhang Yue said in a statement on Sunday.

The health workers have had previous experience in tackling the SARS (Severe Acute Respiratory Syndrome) in Asia, Zhang said, adding that its total aid to Liberia would be $46 million.

At least 2,812 people have so far died of Ebola in Liberia.

So far Beijing has promised Ebola-hit countries the equivalent of $122 million to help fight the epidemic.

Since the beginning of the year, China has given west African countries a total of 234 million yuan ($38.2 million) in emergency assistance, including disease prevention and control materials, grain and cash, according to the Chinese foreign ministry.

China is Africa’s largest trading partner, and its diplomatic footprint across the continent has expanded hugely in recent years as it seeks resources to power its economy.

Still it is a long way behind the European Union, whose leaders have boosted their Ebola aid to one billion euros ($1.26 billion).

On Sunday, a Dutch aid ship, the “Karel Doorman”, docked at Dakar on its way to Freetown, Conakry and Monrovia. On board were vehicles and emergency equipment from nine European countries, the Netherlands’ embassy in Senegal said.

– ‘Hour by hour situation’ –

Meanwhile a doctor said to be “extremely ill” after being infected with Ebola in Sierra Leone was being treated in the United States.

Martin Salia, a US resident who was infected with the deadly haemorrhagic fever while treating patients in his home country, was flown to Nebraska for treatment.

“This is an hour-by-hour situation,” said Phil Smith, medical director of the biocontainment unit at the Nebraska hospital, one of a handful of medical facilities in the United States specially designated to treat Ebola patients.

“He is extremely ill,” Smith said. “We will do everything humanly possible to help him fight this disease.”

World leaders meeting at the Group of 20 summit in the Australian city of Brisbane said they were prepared “to do what is necessary to ensure the international effort can extinguish the outbreak”.

The Ebola outbreak which began earlier this year has been centred around Guinea, Liberia and Sierra Leone.

– Charity single –

In London, musicians including boy band One Direction and Led Zeppelin’s Robert Plant recorded a new “Band Aid” single to help raise funds combat the virus.

Other performers ranging from U2 frontman Bono, Coldplay’s Chris Martin and Sinead O’Connor recorded late into the night for a 30th anniversary version of the charity single “Do They Know It’s Christmas?”

“It’s not just about what’s happening in west Africa, it could happen here tomorrow,” said rocker-turned-activist Bob Geldof, one of the forces behind the original Band Aid.

Set to be officially released Monday, the single will be the fourth incarnation of the song, which became one of the biggest-selling singles ever after its release in 1984 to raise funds for Ethiopian famine relief.

In Brisbane, G20 members welcomed an International Monetary Fund initiative to release $300 million to combat Ebola and promised to share best practices on protecting health workers on the front line.

The G20 pledge came as Togo, whose president is coordinating the west African fight, warned that the world “cannot relax efforts” despite some encouraging signals.

There is no known cure for Ebola, one of the deadliest known pathogens, but trials for several possible treatments were announced last week in west Africa and Canada. The disease spreads through contact with bodily fluids.

The World Health Organization said Friday that 5,177 people are known to have died of Ebola across eight countries, out of a total 14,413 cases of infection since December 2013.

UN chief Ban Ki-moon urged “G20 countries to step up”, warning that Ebola’s disruptive effect on farming could potentially spark a food crisis for a million people.

“Transmission continues to outpace the response from the international community,” Ban told reporters.

Thai health officials monitor thousands arriving from Africa to prevent Ebola outbreak

Updated Sun at 11:28pmSun 9 Nov 2014, 11:28pm

Thai health officials are closely monitoring thousands of people who have arrived from Africa in an effort to prevent an Ebola outbreak.

Since June 8, health officials have kept track of almost 2,800 passengers who have arrived in Thailand from Africa.

Only three, including one Australian, have shown symptoms of Ebola and all have been cleared.

Dr Vichan Pawan, the man in charge of health control at Bangkok’s busy international airport, said he was leaving nothing to chance.

“I think the risk of getting Ebola is minimal,” Dr Pawan said.

Despite this, as passengers stream off flights arrival from Africa twice a day, thermal imaging machines measure the body temperature of each person.

A reading of 37 degrees Celsius or over is a fail and a further medical examination follows.

Other passengers have to proceed to a second counter to explain where they have come from and where they are going.

“We cannot guarantee that this is 100 per cent effective,” Dr Pawan said.

“If the passenger can feel their fever, they don’t tell the health control staff so we may miss them.”

However, most passengers said they did not mind the inconvenience.

“I think it’s good, what they’re doing, to make sure people are safe when they come into the country,” one traveller said.

Another said the checks were no problem: “You know it’s not only here. In Mali [which is] my country, they are checking the same [way].”

While Thai health experts said the risk of an airline passenger slipping through their screening procedures and infecting others was low, they admitted there was a much greater risk of the disease travelling to Thailand via land corridors.

With 5,000 kilometres of land borders to patrol, it is impossible for Thailand to monitor all those who enter the country from neighbouring countries.

“We’ve had some cases in Cambodia. It’s maybe the threat for Thailand,” said deputy director-general of Thailand’s department of disease control, Dr Opart Karnkawingpong.

“I think we can control people from the airport because we have immigration processes but [at] the border, there are so many people.”

South East Asian health ministers will meet in Bangkok next month to develop a more coordinated response to Ebola prevention.

‘Ebola spread risk too serious’: Morocco refuses to host Africa football cup

Published time: November 08, 2014 23:55

A fan of Ivory coast holds a sign with a message against Ebola during the 2015 African Nations Cup qualifying soccer match between Ivory Coast and Sierra Leone at the Felix Houphouet Boigny stadium in Abidjan September 6, 2014.  (Reuters/Luc Gnago)

A fan of Ivory coast holds a sign with a message against Ebola during the 2015 African Nations Cup qualifying soccer match between Ivory Coast and Sierra Leone at the Felix Houphouet Boigny stadium in Abidjan September 6, 2014. (Reuters/Luc Gnago)

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Morocco has rejected an ultimatum and refused to host the 2015 Africa Cup of Nations in January over the fear that Ebola virus may find its way into the country with the crowds of football fans and easily spread among them during the mass sporting event.

“The decision is dictated by health reasons because of the serious threat of Ebola and the risk of its spreading,” said a statement from Morocco’s sports ministry on Saturday, the last day when the country was supposed to confirm the hosting of the championship.

The Moroccan government is concerned that a flow of football fans from West Africa could bring the disease to the Ebola-free country and has been asking the confederation to postpone the event until June – and if the virus continues to spread, to January 2016.

U.S. soldiers train foreign and local health workers in the management of Ebola at a treatment unit at Liberia's police academy in the capital Monrovia, November 7, 2014. (Reuters/James Giahyue)

U.S. soldiers train foreign and local health workers in the management of Ebola at a treatment unit at Liberia’s police academy in the capital Monrovia, November 7, 2014. (Reuters/James Giahyue)

The fate of the 16-team tournament, scheduled on January 17-February 8, 2015, will be decided next week when Confederation of African Football (CAF) executives meet in Cairo on Tuesday. CAF could either move the event to another country or cancel it, as so far no country has volunteered as an emergency host.

The Confederation accused Morocco of alarmism and exaggerating the Ebola threat, among other arguments, claiming that “there is unlikely to be a team from the worst affected area in the finals,” according to Reuters.

But besides the medical risks, the decision was also motivated “by humanitarian reasons” since it is the host’s responsibility “to welcome all our guests and supporters in the best conditions,” the Moroccan government statement added.

Meanwhile, African Union officials and business leaders met in the Ethiopian capital to launch the emergency response fund. So far it has managed to raise $28.5 million to fight Ebola.

According to the latest official UN figures, the Ebola outbreak in West Africa has killed 4,950 people out of the 13,241 infected, mostly in Sierra Leone, Liberia and Guinea.