The three West African nations ravaged by Ebola could struggle to prevent another major outbreak as vigilance fades among health workers and the public, a health expert said on Monday.
Ebola victims in recent flare-ups in Liberia and Sierra Leone were inspected by health workers who were not wearing protective clothing, while the corpse of one woman victim was washed by several people, contrary to best practice.
Health facilities must reinforce infection prevention and control measures or risk widening the spread of new Ebola outbreaks, according to Armand Sprecher, public health specialist at medical charity Medecins Sans Frontieres (MSF).
Communities must also help to keep Ebola at bay by avoiding old habits that can transmit the disease, such as eating bushmeat, caring for the ill and touching the dead, he said.
"It wasn't so long ago that Ebola was a real and present danger, yet many people have reverted to traditional practices," Sprecher told the Thomson Reuters Foundation, two years after the world's worst Ebola outbreak was first declared in Guinea.
"It is surprising that the ordeal they went through has not been enough to maintain a change in behaviour in the long term."
More than 28,600 people have been infected and 11,300 have died - mostly in Guinea, Liberia and Sierra Leone - since the epidemic began in December 2013.
While the epidemic is now under control, all three countries have suffered flare-ups recently. Experts have warned that Ebola could resurface at any time, as it can linger in the eyes, nervous system and bodily fluids of survivors.
Four people have died of Ebola in Guinea since a flare-up was announced on Thursday, just hours after the World Health Organization (WHO) declared Sierra Leone's latest outbreak over.
Sierra Leone was in a 90-day period of heightened surveillance but Mariatu Jalloh, a 22-year-old student who died from Ebola on Jan. 12, was examined by an official without protective equipment.
Jalloh had lived in a house with 22 people while she was unwell, and five people were involved in washing her corpse.
In a flare-up in Liberia in November, suspected Ebola patient Nathan Gbotoe was sent to several health centres, instead of being referred to an Ebola treatment unit at once. He later died from the virus.
Citing these examples and prior responses to Lassa fever, a deadly disease similar to Ebola, Sprecher said health workers in West Africa had quickly forgotten new measures and protocols.
"Having to deal with Lassa, and watch their colleagues die from it, health workers followed infection control measures - scared, upset and determined to avoid more deaths," he said.
"A couple of years later, and the health response had reverted back to the baseline. Are health workers now prepared to handle another major Ebola outbreak? It could go either way."
While some $6 billion has been pledged for Ebola recovery in the three countries, Sprecher said it was too early to expect significant changes to health systems - partly due to the "grey area" between emergency funding and long-term development aid.
Oxfam said in January that donors were failing West Africa, as $1.9 billion in recovery funds had not been delivered, and few details were available about the remaining $3.9 billion.
While the Ebola-hit nations stepped up surveillance in the wake of the epidemic, other African states where the virus is endemic, including Gabon, South Sudan and Uganda, are unlikely to follow suit, Sprecher said.
"Uganda does a good job of managing smaller outbreaks, and countries like the Democratic Republic of Congo don't have the road infrastructure and easy travel that exists in West Africa."
"Ebola can spread quickly in West Africa as people can travel within countries easily... but people in rural DRC can't just hop on a minibus to Kinshasa on a whim," Sprecher added.
While Guinea, Liberia and Sierra Leone still respond to Ebola flare-ups, the region is now tackling Africa's first case of neurological disorder microcephaly, thought to be linked to the Zika virus.
The WHO has sent a team to investigate the case in Cape Verde, the Atlantic Ocean nation west of Senegal with historical ties to Brazil, where a Zika outbreak is suspected of causing a spike in birth defects including babies born with small heads.
Several health experts have drawn parallels between Ebola and Zika, and some have called for testing for Zika in West Africa due to their similar symptoms and concerns that a patient presenting with Zika could raise false alarms of Ebola.
Sprecher said there was little in common between Ebola and Zika and the health responses to the two diseases.
"Zika is just one of a host of diseases that have similar early symptoms to Ebola, but it doesn't make most people sick."
"With Ebola, people die quickly and dramatically - and that is what sets alarm bells ringing," Sprecher said.