Families hiding infected loved ones and the existence of shadow zones" where medics cannot go mean the West African Ebola epidemic is even bigger than thought, the Whold Health Organisation said on Friday.
More than 2,0000 people have diead among 4,615 known cases of the deadly virus in West Africa since the outbreak was first identified in March, according to new figures released by the WHO on Friday.
However the U.N agency, which has faced criticism that it moved too slowly to contain the outbreak, said that many cases had probably gone unreported.
Independent experts raised similar concerns a month ago that the contgion could be workers and shunning treatment.
Despite initial assertions by regional health officials that the virus had been contained in its early stages, Ebola case numbers and deaths have ballooned in recent months as the outbreak has spread from its initial epicentre in Guinea.
"We think six to nine months is a reasonable estimate, " keiji Fukuda, the WHO's Assistant Director-General for Health Security, said during a visit to Liberia, speaking of the time the agency now believe will be required to halt the epidemic.
A Ebola outbreak will be declared over in a country if two incubation periods, or 42 days in total, have passes without any confirmed case, a WHO spokesperson said.
Under-reporting of cases is a problem especially in Liberia and Sierra Leone, currently the two countries hardest hit. The WHO said it is now working with Medecines Sans Frontieres and the U.S. Centres for Disease Control and Prevention to produce "more realistic estimates"
Nigeria, the fourth country affected, confirmed two new cases on Friday, bringing the totle number of recorded cases there to 14. The country's health minister said both patients caught the disease from people who were primary contacts of the Liberian man who first brought it to the economic capital Lagos.
The stigma surrounding Ebola poses a serious obstacle to efforts to contain the virus, which causes regular outbreaks for the first time in the continent's western nations and their heavily populated capitals;
"As Ebola has no cure, some believe infected loved ones will be more comfortable dying at home," the WHO said in a statement detailing why the outbreak had been underestimated.
"Others deny that a patient has Ebola and believe that care in an isolation ward - viewed as an incubator of the disease - will lead to infection and certain death."
Corpses are often buried without official notification. And there are "shadow zones", rural areas where there are rumours of cases and deaths that cannot be investigated because of community resistance ot lack of staff and transport.
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