WHO signals alarm over possible unreported Ebola cases in Tanzania

The World Health Organization issued an extraordinary statement Saturday raising concerns about possible unreported Ebola cases in Tanzania and urging the country to provide patient samples for testing at an outside laboratory.

The statement relates to a Tanzanian doctor who died Sept. 8 after returning to her country from Uganda; she reportedly had Ebola-like symptoms. Several contacts of the woman became sick, though Tanzanian authorities have insisted they tested negative for Ebola. 

But the country has not shared the tests so they can be validated at an outside laboratory, as suggested under the International Health Regulations, a treaty designed to protect the world from spread of infectious diseases.

It is highly unusual for the WHO, which normally operates through more diplomatic means, to publicly reveal that a member country is stymying an important disease investigation. 

“The presumption is that if all the tests really have been negative, then there is no reason for Tanzania not to submit those samples for secondary testing and verification,” Dr. Ashish Jha, director of the Harvard Global Health Institute, told STAT.

“It’s only upside for them to do that, to put any of these issues to rest. And the fact that they’re not doing that, I think both raises concern and … whatever they do next, people are going to have less confidence in it,” Jha said.

Further, Tanzanian authorities waited four days to respond to the WHO’s first urgent request for information — a wait that is well outside what is required of a country under these circumstances. Two days into the wait, the WHO alerted member countries of the alarming situation via a secure website it uses to communicate sensitive information.

The delay in the country’s initial response adds to the sense of unease about this case. “There’s really no reason to take four days to respond to an urgent request from the WHO,” Jha said.

The concern is heightened by the fact that all of east Africa is on alert for possible spread of Ebola from the protracted outbreak occurring in the eastern part of the Democratic Republic of the Congo. The outbreak, the second largest on record, is in its 14th month. As of Friday there have been 3,160 cases reported and 2,114 deaths.

The woman had been in Uganda studying. She reportedly returned to Tanzania on Aug. 22, and travelled to multiple parts of the country doing field work. She developed Ebola-like symptoms on Aug. 29, including fever and bloody diarrhea. She died in the Tanzanian capital, Dar es Salaam, and was buried immediately. Dar es Salaam has a population of 6 million people.

Two days later, the WHO received information through unofficial channels that a person suspected of having Ebola had died. The information indicating the woman had tested positive for Ebola, but the Tanzanian authorities have not been forthcoming about the cause of her death. Nor have they revealed what was ailing two of her contacts who later became sick, saying only that their tests were negative for Ebola.

On Thursday, the WHO received another informal tip that another contact was sick and had been hospitalized. When it asked Tanzania for information about this latest possible case, the country replied that it did not have “any EVD case” and did not have “any suspected case admitted anywhere.”

There currently is no information to suggest the dead woman had traveled to the DRC. But that doesn’t preclude the possibility that she might have been infected. She might have had contact with an unreported case in Uganda, or might have been infected in a new, as yet undetected emergence of Ebola. 

Tanzania has never had an Ebola outbreak. In cases where Ebola is suspected in a country with no history of dealing with the disease, the International Health Regulations recommend early testing efforts be validated by a laboratory with Ebola experience, a so-called reference lab. Tanzanian authorities told the WHO on Monday that they would not agree to outside testing of their samples.

The WHO statement goes step by step through the attempts it has made to try to get the country to be forthcoming with information about the case, including sending a mission to Tanzania to meet with authorities and offer help.

The situation has also been of concern to the United States. On Saturday, the CDC said it was aware of the situation and is working with the WHO to learn more.

On Tuesday, Health and Human Services Secretary Alex Azar, who was in East Africa to review the Ebola response in the DRC, urged Tanzania to be more forthcoming.

“We call upon the government of Tanzania to comply with its obligation under the International Health Regulations immediately with transparent disclosure of information and full cooperation with the international health community to allow for independent verification as to the circumstances of that individual’s death,” Azar told reporters during a briefing. 

He later asked Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, to travel to Tanzania. Redfield had been on the mission to East Africa with Azar.