Ebola: Why safe burial protocols matter in containing virus

Strict burial protocols, including discouraging body viewing and preventing direct contact with the deceased, are critical in containing the spread of Ebola, protecting grieving families, communities and the wider population.

Paul Olale, Public Health in Emergencies Technical Lead at the Kenya Red Cross Society, said the fight to contain the virus does not end when a patient dies, as the handling and burial of the body can determine whether the disease spreads or is contained.

“We are cognisant of customs and burial rites, but for safety, we do not allow them to override safety protocols. Handling the body of a person who died from Ebola virus disease is one of the highest-risk ways the disease is transmitted,” Dr Olale said.

Kenya reported its first fatal case of the Ebola Bundibugyo virus disease last week, prompting heightened attention to infection prevention measures.

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The Kenya Red Cross Society is designated by the Ministry of Health to conduct safe and dignified burials during public health emergencies.

In an interview with *The Standard*, Dr Olale said burial teams must handle bodies under strict infection prevention and control measures while respecting the dignity of the deceased and the grief of their families.

A standard burial team comprises at least seven members, each assigned a specific role to ensure safety and maintain communication with the family and community.

Four members are assigned to handle the body, while another oversees infection prevention and control. A sixth member is responsible for community engagement and psychosocial support, while the seventh handles security and scene safety.

“The issue around mental health and psychosocial support is taken care of,” Dr Olale said.

He said the teams also help manage anxiety among relatives and community members, explaining the safety measures while allowing families to observe burial rites that can be accommodated without compromising infection control.

Other precautions include ensuring equipment is handled correctly and contaminated materials are safely disposed of. Reusable equipment must be decontaminated appropriately to prevent exposure to the virus.

Following an Ebola-related death, the body is disinfected and subjected to strict precautions before, during and after handling.

For Kenya's imported case, the burial team was expanded to nine members. One member provided overall coordination and guidance without approaching the body or interfering with those handling it. Another focused on community engagement, while two additional members managed scene safety and ensured the body was transported safely from the hospital to Lang'ata Cemetery for burial.

The additional personnel helped ensure that infection prevention measures were observed throughout the process, from the hospital to the burial site.

“All individuals who handled the body from death to the burial place were properly trained. The body was disinfected and placed in a burial bag, and the bag was further disinfected,” Dr Olale said.

“Single-use equipment, including personal protective equipment (PPE), was burnt, and everything was disinfected as per protocols to avert any chances of contamination that could spread the virus,” he added.

Dr Olale said Kenya had invested in training teams to respond to Ebola outbreaks, drawing on lessons from previous emergencies, including the 2014–2016 outbreak in West Africa.

At least 170 Kenyan health workers, including clinical officers, doctors, nurses and public health officers, participated in the African Union Support to Ebola Outbreak in West Africa (ASEOWA) mission in Liberia and Sierra Leone.

The teams undergo periodic refresher training to maintain their skills and readiness. Dr Olale said a refresher exercise had been conducted shortly before the latest case was reported, reinforcing the country's preparedness.

With Ebola cases reported in the Democratic Republic of Congo (DRC), he said Kenya must remain vigilant and ensure that communities take the threat seriously.

He warned that the Bundibugyo strain has no approved vaccine, making early detection, prompt medical attention and strict infection prevention measures particularly important.

“As a community, as a country, and residents of this country, we really need to take this seriously,” he said.

Dr Olale said the outcome of Ebola infection depended partly on how quickly a patient sought medical care.

“This is a disease that does not have any treatment as of now. Its management is based on how early you can seek care,” he said.

Some early Ebola symptoms can resemble those of malaria and other common illnesses, making it important for patients to disclose their travel history and possible exposure when seeking treatment.

Anyone who develops a high fever, sore throat or abdominal pain after travelling to an outbreak-affected area, or following possible contact with an exposed person, should seek medical attention immediately and inform health workers about the potential exposure.

“If you know you travelled to a country with an outbreak, or had contact with someone who travelled out of DRC, and you are exhibiting high fever, sore throat or abdominal pain, you just need to get to the nearest hospital,” Dr Olale advised.

He urged people not to delay reporting symptoms, saying early reporting and prompt medical assessment would help health workers take the necessary precautions, improve the chances of survival and prevent further transmission.