On 2017 Jan 31, Robert Garry commented:

It is critical that the scientific literature provides an accurate account of the beginnings of the historic 2013–2016 epidemic of Ebola virus disease in West Africa. Wauquier and coauthors report incorrect information regarding the earliest known cases of Ebola in Sierra Leone. The timeline of the transmission chain that initiated the outbreak in Sierra Leone began earlier than described and the individual who performed the initial Ebola diagnosis in a Sierra Leonean is not properly acknowledged.

The date of death of a traditional healer from the village of Kpondu, Kailahun District in Sierra Leone differs from a timeline established by two independent highly credible investigations. Other publications that referred to the healer did not provide a date of her death, indicating that it occurred at an uncertain date before mid-May 2014 (1). Wauquier et al. state that, “On April 28, the healer became extremely ill and died two days later.” Investigations by the Awareness Times of Sierra Leone under the direction of Dr. Sylvia O. Blyden, who is currently Sierra Leone’s Honorable Minister of Social Welfare, Gender and Children Affairs, and separately by Dr. Sheri Fink and colleagues of the New York Times placed the date of death of the healer at or around April 8, 2014, three weeks earlier than April 30, 2014 (2, 3).

Wauquier and coauthors state that, “Ultimately, most of those who attended her [the healer’s] funeral ceremony became sick, each infected with the yet-to-be-identified Ebola virus.” This account is challenged by video taken at the funeral of the healer clearly documenting that hundreds of individuals were present (4). Only 14 confirmed Ebola cases are known to have attended the healer’s funeral. The scientific literature should reflect the fact that it is highly unlikely most individuals who attended the funeral of the healer become infected with Ebola virus.

While the first 14 cases of Ebola diagnosed in Sierra Leone are likely to have attended the healer’s funeral these individuals, all females, were diagnosed between May 25 and 31, 2014 (5). The latency period of Ebola from time of infection to symptoms is generally considered to be 2-21 days. The approximately 50 day delay to diagnosis from the actual date of the funeral circa April 8, 2014 indicates that these 14 individuals were unlikely to have been infected by contact with the healer’s corpse. Furthermore, Gire et al. (5) demonstrated that these 14 individuals were infected by Ebola virus of two genetically distinct lineages (Clade 1 and 2). This represents further strong evidence against direct infection of these individuals by pre- or post-mortem contact with the healer.

Conspicuously absent from Wauquier et al. are details of the early transmission in Sierra Leone documented in a March 19 memorandum from the World Health Organization [WHO], and emailed to a Tulane University co-author of Wacquier et al. on April 1, 2014 by a representative of Médecins Sans Frontières [MSF] (2, 3). The WHO memorandum described a probable case of Ebola who lived in or near the healer’s village. This probable early Sierra Leone Ebola case died approximately March 3, 2014. She is plausibly linked to the healer through a relative who was a close friend or assistant of the healer. Details of the March 3, 2014 death of a Sierra Leonean likely from Ebola were reported to have also been discussed in the field with the Wauquier et al. co-author by a MSF field operative.

Wauquier and coauthors state that, “On the afternoon of May 25th, the laboratory received the first blood sample from Koindu. Using reagents provided by the US Critical Reagents Program (CRP) in coordination with the US Army Medical Research Institute of Infectious Diseases (USAMRIID), the sample was analyzed by real-time reverse transcription polymerase chain reaction (RT-PCR), along with a batch of other routine samples received that same day.” The blood sample was received by Mr. Augustine Goba, Director of the Kenema Government Hospital [KGH] laboratory. Mr. Goba performed RT-PCR with detection by agarose gel electrophoresis showing that the sample sent from the Public Health Unit at Koindu was positive for Ebola virus (3). This sample was from a person living in the village of Sokoma, who attended the healer’s funeral. Confirmatory results using the USAMRIID RT-PCR were obtained only after Mr. Goba’s results had been obtained. Mr. Goba was awarded a Presidential Citation from His Excellency Ernest Bai Koroma for diagnosing this first case of Ebola in Sierra Leone.

Several co-authors of Wauquier et al. have been supported by grants and contracts on which I am the Principal Investigator. These grants and contracts contributed to the early epidemiological investigations of the Ebola outbreak in Sierra Leone. I was not informed about the submission of Wauquier et al. I also state that did not become aware of the March 19 WHO Memorandum until almost one year after April 1, 2014.

1. J. S. Schieffelin et al. (2014). Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone. N Engl J Med 371: 2092.
2. K. Sack, S. Fink, P. Belluck, A. Nossiter, “How Ebola roared back,” New York Times, December 29, 2014.
3. A. Goba et al. (2016). An Outbreak of Ebola Virus Disease in the Lassa Fever Zone. J Infect Dis 214 (supplement 3):S110.
4. D. Edge, S. Achilli. (2015). Outbreak, PBS.
5. S. K. Gire et al. (2014). Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak. Science 345:1369.

On 2017 Jan 31, Robert Garry commented:

It is critical that the scientific literature provides an accurate account of the beginnings of the historic 2013–2016 epidemic of Ebola virus disease in West Africa. Wauquier and coauthors report incorrect information regarding the earliest known cases of Ebola in Sierra Leone. The timeline of the transmission chain that initiated the outbreak in Sierra Leone began earlier than described and the individual who performed the initial Ebola diagnosis in a Sierra Leonean is not properly acknowledged.

The date of death of a traditional healer from the village of Kpondu, Kailahun District in Sierra Leone differs from a timeline established by two independent highly credible investigations. Other publications that referred to the healer did not provide a date of her death, indicating that it occurred at an uncertain date before mid-May 2014 (1). Wauquier et al. state that, “On April 28, the healer became extremely ill and died two days later.” Investigations by the Awareness Times of Sierra Leone under the direction of Dr. Sylvia O. Blyden, who is currently Sierra Leone’s Honorable Minister of Social Welfare, Gender and Children Affairs, and separately by Dr. Sheri Fink and colleagues of the New York Times placed the date of death of the healer at or around April 8, 2014, three weeks earlier than April 30, 2014 (2, 3).

Wauquier and coauthors state that, “Ultimately, most of those who attended her [the healer’s] funeral ceremony became sick, each infected with the yet-to-be-identified Ebola virus.” This account is challenged by video taken at the funeral of the healer clearly documenting that hundreds of individuals were present (4). Only 14 confirmed Ebola cases are known to have attended the healer’s funeral. The scientific literature should reflect the fact that it is highly unlikely most individuals who attended the funeral of the healer become infected with Ebola virus.

While the first 14 cases of Ebola diagnosed in Sierra Leone are likely to have attended the healer’s funeral these individuals, all females, were diagnosed between May 25 and 31, 2014 (5). The latency period of Ebola from time of infection to symptoms is generally considered to be 2-21 days. The approximately 50 day delay to diagnosis from the actual date of the funeral circa April 8, 2014 indicates that these 14 individuals were unlikely to have been infected by contact with the healer’s corpse. Furthermore, Gire et al. (5) demonstrated that these 14 individuals were infected by Ebola virus of two genetically distinct lineages (Clade 1 and 2). This represents further strong evidence against direct infection of these individuals by pre- or post-mortem contact with the healer.

Conspicuously absent from Wauquier et al. are details of the early transmission in Sierra Leone documented in a March 19 memorandum from the World Health Organization [WHO], and emailed to a Tulane University co-author of Wacquier et al. on April 1, 2014 by a representative of Médecins Sans Frontières [MSF] (2, 3). The WHO memorandum described a probable case of Ebola who lived in or near the healer’s village. This probable early Sierra Leone Ebola case died approximately March 3, 2014. She is plausibly linked to the healer through a relative who was a close friend or assistant of the healer. Details of the March 3, 2014 death of a Sierra Leonean likely from Ebola were reported to have also been discussed in the field with the Wauquier et al. co-author by a MSF field operative.

Wauquier and coauthors state that, “On the afternoon of May 25th, the laboratory received the first blood sample from Koindu. Using reagents provided by the US Critical Reagents Program (CRP) in coordination with the US Army Medical Research Institute of Infectious Diseases (USAMRIID), the sample was analyzed by real-time reverse transcription polymerase chain reaction (RT-PCR), along with a batch of other routine samples received that same day.” The blood sample was received by Mr. Augustine Goba, Director of the Kenema Government Hospital [KGH] laboratory. Mr. Goba performed RT-PCR with detection by agarose gel electrophoresis showing that the sample sent from the Public Health Unit at Koindu was positive for Ebola virus (3). This sample was from a person living in the village of Sokoma, who attended the healer’s funeral. Confirmatory results using the USAMRIID RT-PCR were obtained only after Mr. Goba’s results had been obtained. Mr. Goba was awarded a Presidential Citation from His Excellency Ernest Bai Koroma for diagnosing this first case of Ebola in Sierra Leone.

Several co-authors of Wauquier et al. have been supported by grants and contracts on which I am the Principal Investigator. These grants and contracts contributed to the early epidemiological investigations of the Ebola outbreak in Sierra Leone. I was not informed about the submission of Wauquier et al. I also state that did not become aware of the March 19 WHO Memorandum until almost one year after April 1, 2014.

1. J. S. Schieffelin et al. (2014). Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone. N Engl J Med 371: 2092.
2. K. Sack, S. Fink, P. Belluck, A. Nossiter, “How Ebola roared back,” New York Times, December 29, 2014.
3. A. Goba et al. (2016). An Outbreak of Ebola Virus Disease in the Lassa Fever Zone. J Infect Dis 214 (supplement 3):S110.
4. D. Edge, S. Achilli. (2015). Outbreak, PBS.
5. S. K. Gire et al. (2014). Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak. Science 345:1369.