The World Health Organization have issued a new protocol for the "safe and dignified burial" of people who have died from suspected or confirmed Ebola virus disease.
The UN health agency says the new procedures emphasize the inclusion of family members of the deceased and encourage religious rites as an essential part of safe burials.
When a person dies infected with Ebola, their body contains high levels of the virus and is potentially still contagious for the disease.
Members of a deceased patient's family or community can become infected with Ebola when because of local customs or religious rites they touch or wash the body of the deceased. They can also become infected from handling personal property or sheets, clothing and bandages contaminated with virus-containing body fluids.
The World Health Organization (WHO) expert on Ebola, Dr. Pierre Formenty, says at least 20% of new infections occur during burials of people who died from Ebola virus disease, and:
"By building trust and respect between burial teams, bereaved families and religious groups, we are building trust and safety in the response itself. Introducing components such as inviting the family to be involved in digging the grave and offering options for dry ablution and shrouding will make a significant difference in curbing Ebola transmission."
The new WHO protocol is not just for medical staff but for anyone involved in the management of dead bodies and burial of patients suspected or confirmed as being infected with Ebola when they died.
It consists of 12 steps that burial teams should follow to ensure safe burials, beginning with the moment they arrive in the village or community of the deceased Ebola patient and finishing with their arrival back at the hospital or headquarters following burial and disinfection.
The new protocol was developed by an interdisciplinary team of experts from WHO, the International Federation of Red Cross and Red Crescent Societies and faith organizations including World Council of Churches, Islamic Relief, Caritas Internationalis and World Vision.
They consulted religious leaders in affected countries to help identify and define what is meant by a "dignified burial" in Muslim and Christian faiths.
Ebola burial protocol outlines dry ablutions and other safe and meaningful alternatives
Medical anthropologists who researched the cultural significance and values of burial practices in the affected countries also contributed. They developed meaningful and safe alternatives for touching and bathing the deceased.
The procedures describe step by step how to conduct safe and dignified burials - giving specific instructions for Muslim and Christian burials - and encourages the inclusion of family members and clergy in the planning and preparation of the burial as well as the burial itself.
Rehanah Sadiq, a Muslim chaplain with University Hospitals Birmingham NHS Foundation Trust in the UK was a consultant on the preparation of the new protocol. She says giving families safe alternatives to retain the practices they hold dear, "helps them be part of the decision-making process, which is critical particularly during a time when they may be feeling helpless."
"It is clear from Islamic juristic ruling that the necessity of religious washing of the body before burial of patients who die from Ebola is over-ruled," she notes, and adds, "However, it is vital to help bereaved families grieve and find closure by ensuring that sacred rites, such as performing a dry ablution, shrouding the body and praying over the deceased are represented in Muslim funerals."
Caritas Internationalis health expert Monsignor Robert J. Vitillo, who has been helping the local Church in Monrovia, Liberia, in its Ebola response, and is also Head of Delegation to the United Nations in Geneva, says:
"Giving the family an opportunity to view the body of the deceased, ensuring that the grave is appropriately labelled, and allowing religious leaders to offer prayers and family members the option to throw the first soil - these are important incentives for encouraging families to continue to find strength in their faith, and to keep other family members safe from becoming infected."
Protective equipment not necessary when meeting families of deceased Ebola patients
The protocol includes ways for Ebola burial teams to work safely while respecting the needs of families and communities. For example, it does not require them to wear the personal protective equipment (PPE) when they first meet with the family, and it suggests they ask the family if they have any specific requests about managing the burial and the deceased's personal effects.
WHO say they will seek and use feedback from religious and community leaders, as well as the burial teams themselves, to update and improve the protocol.
In their latest situation assessment, the UN health agency reports that up to 2 November 2014, there have been 13,042 confirmed, probable and suspected cases of Ebola virus disease and 4,818 reported deaths. Six countries - Guinea, Liberia, Mali, Sierra Leone, Spain and the US - are currently affected by the outbreak, and two - Nigeria and Senegal - are no longer affected.
In the three countries with widespread and intense transmission, incidence rates appear to be stable in Guinea, continuing to rise in Sierra Leone, and declining in Liberia.
Meanwhile, Medical News Today recently learned how an experimental inhalable anti-Ebola vaccine is showing promise following animal trials that compared it to injected forms.