[stem-ebola] PRO/EAFR> Ebola virus disease - West Africa (38): WHO updat

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EBOLA VIRUS DISEASE - WEST AFRICA (38): WHO UPDATE
**************************************************
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International Society for Infectious Diseases
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Date: Wed 8 Oct 2014
Source: WHO Global Alert and Response (GAR), Pandemic and Epidemic
Diseases, Ebola virus disease situation reports: Ebola response roadmap
[edited]
<http://apps.who.int/iris/bitstream/10665/136020/1/roadmapsitrep_8Oct2014_eng.pdf>



Ebola response roadmap situation report -- 8 Oct 2014
-----------------------------------------------------
Overview
--------
The total number of confirmed, probable, and suspected cases in the West
African epidemic of Ebola virus disease (EVD) reported up to the end of
5 Oct 2014 (epidemiological week 40) is 8033 with 3865 deaths. Countries
affected are Guinea, Liberia, Nigeria, Senegal, Sierra Leone, and the
United States of America. A confirmed case of EVD has been reported in
Spain, but because the case was confirmed during the week ending 12 Oct
2014 (epidemiological week 41), information on this case will be
included in the next Ebola Response Roadmap update.

The past week has seen a continuation of recent trends: the situation in
Guinea, Liberia, and Sierra Leone continues to deteriorate, with
widespread and persistent transmission of EVD. Problems with data
gathering in Liberia continue. It should be emphasized that the reported
fall in the number of new cases in Liberia over the past 3 weeks is
unlikely to be genuine. Rather, it reflects a deterioration in the
ability of overwhelmed responders to record accurate epidemiological
data. It is clear from field reports and 1st responders that EVD cases
are being under-reported from several key locations, and laboratory data
that have not yet been integrated into official estimates indicate an
increase in the number of new cases in Liberia. There is no evidence
that the EVD epidemic in West Africa is being brought under control,
though there is evidence of a decline in incidence in the districts of
Lofa in Liberia, and Kailahun and Kenema in Sierra Leone.

Outline
-------
This is the 7th in a series of regular situation reports on the Ebola
Response Roadmap. The report contains a review of the epidemiological
situation based on official information reported by ministries of
health, and an assessment of the response measured against the core
Roadmap indicators where available. The data contained in this report
are the best available. Substantial efforts are ongoing to improve the
availability and accuracy of information about both the epidemiological
situation and the implementation of response measures.

Following the roadmap structure, country reports fall into 3 categories:
(1) those with widespread and intense transmission (Guinea, Liberia, and
Sierra Leone); (2) those with an initial case or cases, or with
localized transmission (Nigeria, Senegal, and the USA); and (3), those
countries that neighbour areas of active transmission (Benin, Burkina
Faso, Cote d'Ivoire, Guinea-Bissau, Mali, Senegal).

Countries with widespread and intense transmission
--------------------------------------------------
The upward epidemic trend continues in Guinea, Liberia, and Sierra Leone

Probable, confirmed, and suspected cases in Guinea, Liberia, and Sierra
Leone

Country / case definition / total cases / cases in last 21 days /
percent cases in last 21 days / deaths
Guinea
Confirmed / 1044 / 253 / 24 percent / 587
Probable / 180 / 13 / 7 percent / 179
Suspected / 74 / 65 / 88 percent / 2
All / 1298 / 331 / 26 percent / 768

Liberia
Confirmed / 941 / 136 / 14 percent / 1018
Probable / 1795 / 567 / 32 percent / 701
Suspected / 1188 / 651 / 55 percent / 491
All / 3924 / 1354 / 34 percent / 2210

Sierra Leone
Confirmed / 2455 / 924 / 38 percent / 725
Probable / 37 / 0 / 0 percent / 123
Suspected / 297 / 190 / 64 percent / 31
All / 2789 / 1114 / 40 percent / 879

Total / / 8011 / 2799 / 35 percent / 3857

Guinea
------
Transmission in Guinea is persistent, with approximately 100 new
confirmed cases of EVD reported in the past week. For many weeks the
outbreak in Guinea has been driven by transmission in 3 areas: the
capital Conakry, Macenta, and Gueckedou, the region in which the
outbreak originated. Although the number of reported new confirmed and
probable cases in Gueckedou has been stable and low over the past 4
weeks, with between 4 and 6 cases reported each week, the number of new
cases reported from Macenta varied between 15 and 71 cases reported each
week over the same period. Transmission remains high in Conakry, with 15
new confirmed and probable cases reported in epidemiological week 40
[end of 5 Oct 2014]. The district of N'Zerekore has also reported a
marked increase in the number of new cases reported, with 20 reported in
epidemiological week 40. In the east of country, on the border with Cote
d'Ivoire, the district of Lola has now reported cases of EVD for the 1st
time (3 confirmed cases). The neighboring district of Beyla reported its
1st confirmed cases the previous week.

Liberia
-------
There continue to be profound problems affecting data acquisition in
Liberia. Evidence obtained from responders and laboratory staff in the
country indicates beyond doubt that there is widespread under-reporting
of new cases, and that the situation in Liberia, and in Monrovia in
particular, continues to deteriorate from week to week. Approximately
200 new probable and suspected cases, but very few confirmed cases, have
been reported in the capital Monrovia in each of the past 3 weeks. A
substantial proportion of these suspected cases are most probably
genuine cases of EVD, and the reported fall in confirmed cases over the
past 3 weeks reflects delays in matching laboratory results with
clinical surveillance data. Efforts continue to urgently address
problems with data acquisition in what is an extremely challenging
environment, and it is likely that the figures will be revised upwards
in due course. The district of Margibi continues to report high numbers
of new confirmed and probable cases (31 in the past week), while the
district of Grand Cape Mount has reported new cases for the 1st time in
3 weeks. There continues to be a fall in the number of new cases
reported in Lofa, which borders Gueckedou in Guinea, with 12 confirmed
and probable cases reported this week compared with 39 the previous
week. This appears to be a genuine reduction.

Sierra Leone
------------
Nationally, the situation in Sierra Leone continues to deteriorate, with
an increase in the number of new confirmed cases reported over each of
the past 7 weeks. The capital, Freetown, and the neighbouring districts
of Bombali, Port Loko, and Moyamba, have all reported a surge in cases
over the past 7 to 8 weeks. The districts of Bo and Tonkolili have also
reported an increase in the number of new confirmed and probable cases
over the same period. By contrast, a low number of new cases have been
reported from Kailahun (3 cases in epidemiological week 40 [end of 5 Oct
2014]) and Kenema (5 cases in epidemiological week 40) for the past 4
weeks. These areas had previously reported high levels of transmission.
Reports from responders suggest this fall is a genuine decline in
incidence, although further investigation will be required before this
can be confirmed.

Health-care workers
-------------------
The high number of EVD infections in health-care workers (HCWs)
continues to be a cause of great concern. 401 HCWs are known to have
been infected with EVD up to the end of 5 Oct [2014]. 232 HCWs have 
died.

Ebola infections in healthcare workers as of the end of 28 Sep 2014:

Country / case definition / total cases / deaths
Guinea
Confirmed / 65 / 30
Probable / 8 / 8
Suspected / 0 / 0
All / 73 / 38

Liberia
Confirmed / 75 / 63
Probable / 89 / 27
Suspected / 24 / 4
All / 188 / 94

Nigeria
Confirmed / 11 / 5
Probable / 0 / 0
Suspected / 0 / 0
All / 11 / 5

Sierra Leone
Confirmed / 125 / 91
Probable / 2 / 2
Suspected / 2 / 2
All / 129 / 95

Total / / 401 / 232

Geographical distribution and newly affected districts
------------------------------------------------------
To the end of 5 Oct [2014], 8 districts in which previous cases were
confirmed have reported no cases during the 21 days prior (7 districts
in Guinea, one in Sierra Leone). In Guinea, the district of Lola has now
reported cases of EVD for the 1st time (3 confirmed cases).

Response in countries with widespread and intense transmission
--------------------------------------------------------------
In accordance with the aim of achieving full geographic coverage with
complementary Ebola response activities in countries with widespread and
intense transmission, WHO is monitoring response efforts in 5 specific
domains. The most recent developments in each domain are detailed below.

Case management: Ebola treatment centres, referral, and infection
prevention and control
----------------------------------------------------------------------
In Liberia, a new EVD isolation centre was established in Maryland
district. However, the number of beds currently available in Liberia and
Sierra Leone still falls well short of the capacity required (table 3
--[available at the source URL above]).

A multidisciplinary team of 165 Cuban HCWs has now arrived in Sierra
Leone. WHO is providing logistical support and training to the team to
ensure they are deployed to areas that have been hardest hit by the
outbreak.

Bed capacity and bed requirements for patients with Ebola virus disease
Country / Current no. of beds / Est. no. beds required / (Current
capacity / est. demand (percentage)
Guinea / 160 / 210 / 76
Liberia / 620 / 2930 / 21
Sierra Leone / 304 / 1148 / 26

Case confirmation
-----------------
A total of 11 laboratories (2 in Guinea, 5 in Liberia, and 4 in Sierra
Leone) are now operating at full capacity. However, laboratory data are
yet to be fully integrated with clinical surveillance systems.

Surveillance
------------
In Guinea, all districts apart from Dalaba and Lola report that more
than 90 percent of registered contacts were seen each day during
epidemiological week 40 [end of 5 Oct 2014]. In Liberia, only
Montserrado district, which includes the capital Monrovia, has reported
that 90 percent of registered contacts were seen on a daily basis. In
Sierra Leone, 7 of 14 districts reported that 90 percent of registered
contacts were seen on a daily basis. However, many contacts in many
areas are not registered with or known to the relevant authorities.

Safe and dignified burials
--------------------------
In Liberia, a newly established Ebola Task Force is now able to dispatch
trained dead-body-management teams to ETCs [Ebola treatment centres] and
into communities to conduct safe burials. The Liberian Red Cross has
trained additional dead-body-management teams in Montserrado district,
which includes the capital Monrovia. The non-governmental organization
Global Communities will fund the teams. In Sierra Leone, mechanisms for
safe burial are now in place in all 14 districts.

Social mobilization
-------------------
In Guinea, as part of the Tabaski Festival [Eid al-Adha, also called the
Feast of the Sacrifice], religious leaders were mobilized to deliver
Ebola-prevention messages in 7000 sermons across the country. This
effort was supplemented by an SMS-based campaign on hygiene practices.
UNICEF is supporting a new national organization for survivors of EVD to
facilitate their social reintegration, and help reduce the stigma
associated with EVD.

In Liberia, community engagement and empowerment of civil society
continues. However, denial of the existence of EVD remains a challenge.

In Sierra Leone, a National Communication Strategy on Ebola was
presented to the Ministry of Health for approval. If approved, social
mobilization activities linked to the strategy will be monitored in all
districts.

Countries with an initial case or cases, or with localized transmission
----------------------------------------------------------------------
Three countries, Nigeria, Senegal, and the USA have now reported a case
or cases imported from a country with widespread and intense 
transmission.

In Nigeria, there have been 20 cases and 8 deaths. In Senegal, there has
been one case, but as yet there have been no deaths or further suspected
cases attributable to Ebola. On 30 Sep 2014, the Pan American Health
Organization/World Health Organization (PAHO/WHO) was informed of the
1st confirmed imported case of EVD in the United States of America. The
patient is an adult with recent travel history to West Africa who
developed symptoms compatible with EVD on 24 Sep 2014, approximately 4
days after arriving in the USA. The patient sought medical care on 26
Sep 2014, and was admitted into isolation on 28 Sep 2014 at Texas Health
Presbyterian Hospital in Dallas. Samples were sent for testing to the US
Centers for Disease Control and Prevention in Atlanta, Georgia, and to
the Texas state laboratory. Results were positive for Ebola virus. [The
patient died on 8 Oct 2014.]

In Nigeria, all 891 contacts have now completed 21-day follow-up (362
contacts in Lagos, 529 contacts in Port Harcourt). A 2nd EVD-negative
sample was obtained from the last confirmed case on 8 Sep 2014 (27 days
ago). In Senegal, all contacts have now completed 21-day follow-up, with
no further cases of EVD reported. A 2nd EVD-negative sample was obtained
from the single confirmed case in Senegal on 5 Sep 2014 (30 days ago).
In the USA, 48 contacts are being followed up.

Ebola virus disease cases and deaths in Nigeria and Senegal as of the
end of [5 Oct 2014]:

Countries / cases / deaths
Nigeria
Confirmed / 19 / 7
Probable / 1 / 1
Suspected / 0 / 0
All / 20 / 8

Senegal
Confirmed / 1 / 0
Probable / 0 / 0
Suspected / 0 / 0
All / 1 / 0

USA
Confirmed / 1 / 0
Probable / 0 / 0
Suspected / 0 / 0
All / 1 / 0

Total / / 22 / 8

Preparedness of countries to rapidly detect and respond to an Ebola
exposure
----------------------------------------------------------------------
The 2nd meeting of the Emergency Committee convened by the WHO
Director-General under the IHR 2005 regarding the 2014 EVD outbreak in
West Africa was conducted with members and advisors of the Emergency
Committee through electronic correspondence from 16 through 21 Sep 2014.
The Committee emphasized that all unaffected States with land borders
adjoining States with EVD transmission should urgently establish
surveillance for clusters of unexplained fever or deaths due to febrile
illness; establish access to a qualified diagnostic laboratory for EVD;
ensure that health workers are aware of and trained in appropriate IPC
[infection prevention and control] procedures; and establish rapid
response teams with the capacity to investigate and manage EVD cases and
their contacts. Assessment of preparedness in States neighboring States
with EVD transmission is ongoing.

The Committee also recommends that all States should be prepared to
detect, investigate, and manage Ebola cases; this should include assured
access to a qualified diagnostic laboratory for EVD and, where
appropriate, the capacity to manage travelers originating from known
Ebola-infected areas who arrive at international airports or major land
crossing points with unexplained febrile illness.

--
Communicated by:
ProMED-EAFR
<promed-eafr@xxxxxxxxxxxxxx>

[The full document available at the source URL above includes additional
details, tables, graphs, and maps.

The inability to isolate most of the suspect EVD cases in each of the 3
countries with intense transmission (Guinea, Liberia, Sierra Leone) is a
huge setback for containment efforts towards interrupting community
transmission. Other interventions including active case finding, contact
listing and follow-up, and laboratory testing are also reported to be
operating at sub-optimal levels. It is no wonder outbreak trends in the
3 countries with intense transmission are reported to be either
sustained or on the increase and will definitely continue to worsen in
the coming weeks due to accumulation of transmission chains. Unless the
current response gaps are addressed urgently, the outbreaks are bound to
span out of control.

A HealthMap showing the areas with Ebola virus disease cases and deaths
can be seen at <http://healthmap.org/ebola/>. - Mod.JFW]

[see also:
Ebola virus disease - West Africa (37): WHO update 20141002.439638
Ebola virus disease - West Africa (36): WHO update 20140926.438253
Ebola virus disease - West Africa (35): WHO update 20140920.437039
Ebola virus disease - West Africa (34): WHO update 20140919.436733
Ebola virus disease - West Africa (33): WHO update 20140912.435158
Ebola virus disease - West Africa (32): WHO update 20140905.433868
Ebola virus disease - West Africa (31): Nigeria, WHO update 
20140904.433642
Ebola virus disease - West Africa (30): Senegal ex Guinea, WHO update
20140901.432880
Ebola virus disease - West Africa (29): Senegal ex Guinea, 1st case
20140831.432649
Ebola virus disease - West Africa (28): WHO update 20140830.432573
Ebola virus disease - West Africa (27): WHO update 20140827.431852
Ebola virus disease - West Africa (26): media reports, WHO 
20140819.430404
Ebola virus disease - West Africa (25): media reports, WHO 
20140814.429204
Ebola virus disease - West Africa (24): Morocco ex Liberia 
20140806.427347
Ebola virus disease - West Africa (23): WHO update 20140805.427197
Ebola virus disease - West Africa (22): WHO update 20140804.426964
Ebola virus disease - West Africa (21): WHO update 20140801.426444
Ebola virus disease - West Africa (20): WHO update 20140728.425547
Ebola virus disease - West Africa (19): Nigeria ex Liberia 
20140726.425199
Ebola virus disease - West Africa (15): Liberia 20140616.417173
Ebola virus disease - West Africa (14): WHO 20140615.417103
Ebola virus disease - West Africa (13): WHO 20140609.415783
Ebola virus disease - West Africa (12): WHO 20140606.415289
Ebola virus disease - West Africa (11): WHO 20140529.413537
Ebola virus disease - West Africa (10): WHO 20140514.410493
Ebola virus disease - West Africa (09): WHO 20140512.409992
Ebola virus disease - West Africa (08): Guinea, WHO 20140509.409484
Ebola virus disease - West Africa (07): Guinea, WHO 20140505.408498
Ebola virus disease - West Africa (06): Guinea, WHO 20140430.407581
Ebola virus disease - West Africa (05): Guinea, WHO 20140427.406913
Ebola virus disease - West Africa (04): Guinea, WHO 20140420.401033
Ebola virus disease - West Africa (03): Guinea, WHO 20140415.399945
Ebola virus disease - West Africa (02): Guinea, WHO 20140412.399168
Ebola virus disease - West Africa: Guinea, WHO 20140409.398486
Ebola virus disease - Guinea (13) 20140408.398118
Ebola virus disease - Guinea (12): WHO 20140407.398011
Ebola virus disease - Guinea (11): WHO 20140403.397080
Ebola virus disease - Guinea (08): WHO, spread to Liberia, conf.
20140331.396372
Ebola virus disease - Guinea (07): WHO 20140328.393698
Ebola virus disease - Guinea (06): WHO 20140327.393364
Ebola virus disease - Guinea (05): bats banned, funerals blamed
20140327.393311
Ebola virus disease - Guinea (04): WHO update 20140327.393310
Ebola virus disease - Guinea (03): NOT Conakry 20140326.393026
Ebola virus disease - Guinea (02): spread to Liberia, susp, RFI
20140325.392941
Ebola virus disease - Guinea: (Nzerekore, Conakry), WHO 20140324.392713
Undiagnosed fatal illness - Guinea (03): Ebola conf., spread to Sierra
Leone 20140324.392632
Undiagnosed fatal illness - Guinea (02): viral hemorrhagic fever susp,
RFI 20140322.392298
Undiagnosed fatal illness - Guinea: (Nzerekore) RFI 20140320.391811
2013
----
Ebola virus disease - Congo DR (03): (Orientale) susp., RFI 
20131021.359303
Ebola virus disease - Congo DR (02): (Orientale) NOT, RFI 
20130603.325945
Ebola virus disease - Congo DR: (Orientale) susp., RFI 20130530.325182
Ebola virus disease - Uganda (03): (Luwero) 20130117.298216
Ebola virus disease - Uganda (02): (Mubende) susp. 20130111.297430
Ebola virus disease - Uganda: (Luwero) 20130110.297138]
...................................jfw/mj/be
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