W

est Africa’s Ebola outbreak is not fully over, but the situation no longer constitutes an international health emergency, the World Health Organization said Tuesday.

The agency’s director general, Dr. Margaret Chan, said the panel of outside experts that advises her on Ebola — the so-called Emergency Committee — has recommended that the outbreak no longer constitute a public health emergency of international concern.

Chan said she accepted the advice, a decision that attempts to draw a line under the worst Ebola outbreak the world has ever seen. More than 28,639 people — a previously unthinkable number — were infected and more than 11,316 of them died.

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Despite the decision, one of the three countries at the heart of the outbreak, Guinea, is still in a state of high alert because of a recent cluster of five confirmed cases and three probable cases.

Dr. Bruce Aylward, the WHO’s special representative for the Ebola response, said the cluster is believed to have been ignited through sexual transmission involving an Ebola survivor. Aylward said the case appears to trace back to someone who survived Ebola 15 months ago and suggests the virus can be emitted in semen for longer than had been known. Previously the longest a survivor had been seen to be emitting virus in semen was nine months.

While the WHO expects to see more small clusters of Ebola cases, the sense is that the health departments in the three West African countries at the heart of the protracted outbreak are capable of responding. Aylward said the WHO has not sent outside help for the past two flare-ups; it was not needed.

The WHO has on several occasions declared transmission of the Ebola virus has stopped in individual countries. But lifting the public health emergency signals to the world that the WHO believes the outbreak no longer poses a risk to other countries or requires coordinated international action.

The global health agency said the lifting of the public health emergency should inspire all countries that still restrict travel from Guinea, Sierra Leone, and Liberia to repeal those bans.

The outbreak is believed to have begun in Guinea in December 2013. It was only declared a public health emergency of international concern by the WHO in August 2014 — a delay that earned the WHO considerable criticism.

Among those who died in the outbreak were hundreds of health-care workers, from West Africa and beyond, who risked their lives working in conditions that were bleak and often hellish, especially at the peak of the outbreak in the late summer and early fall of 2014.
At least 881 health-care workers were infected during the outbreak, and 513 died.

The Ebola virus only has 7 genes and is smaller than a blood cell, but during an infection the deadly disease it can shut down multiple organs. Here's how it works. Hyacinth Empinado/STAT

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