[
Date Prev][
Date Next][
Thread Prev][
Thread Next][
Date Index][
Thread Index]
[
List Home]
|
[stem-ebola] PRO/EAFR> Ebola virus disease - West Africa (40): WHO update
|
EBOLA VIRUS DISEASE - WEST AFRICA (40): WHO UPDATE
**************************************************
A ProMED-mail post
<http://www.promedmail.org [1]>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org [2]>
Date: Wed 15 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/10665/136508/1/roadmapsitrep15Oct2014.pdf?ua=1
[3]>
Ebola response roadmap situation report -- 15 Oct 2014
------------------------------------------------------
A total of 8997 confirmed, probable, and suspected cases of Ebola virus
disease (EVD) have been reported in 7 affected countries (Guinea,
Liberia, Nigeria, Senegal, Sierra Leone, Spain, and the United States of
America) up to the end of 12 Oct [2014]. There have been 4493 deaths.
Data for epidemiological week 41 are incomplete, with missing data for
12 Oct [2014] from Liberia. This reflects the challenging nature of data
gathering in countries with widespread and intense EVD transmission.
These challenges remain particularly acute in Liberia, where there
continues to be a mismatch between the relatively low numbers of new
cases reported through official clinical surveillance systems on one
hand, and reports from laboratory staff and 1st responders of large
numbers of new cases on the other. Efforts are ongoing to reconcile
different sources of data, and to rapidly scale-up capacity for
epidemiological data gathering throughout each country with widespread
and intense transmission.
It is clear, however, that the situation in Guinea, Liberia, and Sierra
Leone is deteriorating, with widespread and persistent transmission of
EVD. An increase in new cases in Guinea is being driven by a spike in
confirmed and suspected cases in the capital, Conakry, and the nearby
district of Coyah. In Liberia, problems with data gathering make it hard
to draw any firm conclusions from recent data. There is almost certainly
significant under-reporting of cases from the capital Monrovia. There
does appear to have been a genuine fall in the number of cases in Lofa
district, but a concerted effort will be required to sustain that drop
in cases and translate it into an elimination of EVD in that area. In
Sierra Leone, intense transmission is still occurring in the capital
Freetown and the surrounding districts.
Of the countries with localized transmission, Nigeria and Senegal are
now approaching 42 days since the date of last potential contact with a
probable or confirmed case. Both Spain and the United States continue to
monitor potential contacts.
In response to the unprecedented EVD epidemic, the 1st-ever UN
emergency health mission, the UN Mission for Ebola Emergency Response
(UNMEER) has been set up. Its strategic priorities are to stop the
spread of the disease, treat infected patients, ensure essential
services, preserve stability and prevent the spread to countries
currently unaffected by EVD. WHO will continue to be responsible for
overall health strategy and advice within the Mission, and has now moved
its base of operations from Conakry, Guinea, to the UNMEER Mission
headquarters in Accra, Ghana. A 4-day crisis management and operational
planning meeting will take place in Accra from 15 Oct [2014].
Outline
-------
This is the 8th 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. Because of widespread under-reporting of
confirmed cases in Liberia, suspected cases are now also shown in
country histograms. 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, Spain, and the United
States of America); 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. 8973 probable, confirmed, and suspected cases of EVD and 4484
deaths have been reported up to the end of 12 Oct 2014 by the Ministries
of Health of Guinea and Sierra Leone, and up to the end of 11 Oct [2014]
by the Ministry of Health of Liberia.
Guinea
------
There is evidence of an increase in the intensity of transmission in
Guinea. Compared with the previous week [epidemiological week 40], a
very slight drop in the number of new confirmed cases reported from the
capital Conakry has been more than offset by a sharp rise in the number
of new cases in the neighbouring district of Coyah, with 25 cases
reported between 6 and 12 Oct [2014]. Because laboratory data is
currently well integrated with clinical surveillance in Guinea, many of
the newly reported suspected cases are likely to be reclassified or
discarded in the coming weeks. N'Zerekore (29 cases) and Kerouane (14
cases) have also shown a marked increase in new cases in recent weeks.
Transmission remains intense in Macenta, which reported 51 new cases
between 6 and 12 Oct [2014]. Gueckedou, where the outbreak originated,
reported one suspected case during the same period. In the east of the
country, on the border with Cote d'Ivoire, the districts of Beyla and
Lola both reported new cases, emphasizing the need for active
surveillance at local border crossings. To the North, the district of
Boke, on the border with Guinea-Bissau has reported active transmission
for the 1st time in more than 21 days. The central district of Mamou has
reported a confirmed case for the 1st time.
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 / 1184 / 289 / 24 percent / 653
Probable / 190 / 19 / 10 percent / 190
Suspected / 98 / 89 / 91 percent / 0
All / 1472 / 397 / 27 percent / 843
Liberia
Confirmed / 950 / 66 / 7 percent / no data
Probable / 1923/ 468 / 24 percent / no data
Suspected / 1376 / 555 / 40 percent / no data
All / 4249 / 1089 / 26 percent / 2458
Sierra Leone
Confirmed / 2849 / 1110 / 39 percent / 926
Probable / 37 / 0 / 0 percent / 157
Suspected / 366 / 220 / 60 percent / 100
All / 3252 / 1330 / 41 percent / 1183
All / 8973 / 2816 / 31 percent / 4484
Liberia
-------
Data acquisition continues to be a challenge in Liberia. Evidence
obtained from responders and laboratory staff in the country suggests
that the situation in Liberia is getting worse, and that transmission
remains intense in the capital, Monrovia. As has been the case over the
past 4 weeks, very few confirmed cases were reported from Monrovia
between 6 and 11 Oct [2014], reflecting ongoing delays in matching
laboratory results with clinical surveillance data. By contrast, 138
suspected and probable cases were reported from Monrovia during the same
period, many of which are likely to be genuine cases of EVD. Outside
Monrovia, most newly reported cases have come from the districts of Bong
(75 cases) and Margibi (28 cases). The recent fall in the number of new
cases reported from Lofa, which borders Gueckedou in Guinea, appears to
have continued, with reports from observers in the area suggesting that
there is evidence of a genuine decline. It should be noted, however,
that the 13 new cases that were reported in Lofa between 6 and 11 Oct
[2014] represents a high number in the context of an EVD outbreak, and a
concerted effort will be required to halt all transmission in the area.
Sierra Leone
------------
EVD transmission is rampant in Sierra Leone, with 425 new confirmed
cases reported between 6 and 12 Oct [2014]. The areas hardest hit are
the capital, Freetown, with 172 new cases, along with the neighbouring
western districts of Bombali (94 cases) and Port Loko (67 cases). The
central districts of Bo (22 new cases), and Tonkolili (27 new cases) are
also areas of intense transmission. Transmission appeared to have been
slowing in recent weeks in Kailahun and Kenema. However, this week [week
41 of 2014] has seen an increase in new cases, with 8 new cases in
Kailahun and 16 in Kenema.
Health-care workers
-------------------
427 health-care workers (HCWs) are known to have been infected with EVD
up to the end of 12 Oct [2014]. 236 HCWs have died. WHO is undertaking
extensive investigations to determine the cause of infection in each
case. Early indications are that a substantial proportion of infections
occurred outside the context of Ebola treatment and care. Infection
prevention and control quality assurance checks are now underway at
every Ebola treatment unit in the 3 intense-transmission countries. At
the same time, exhaustive efforts are ongoing to ensure an ample supply
of optimal personal protective equipment to all Ebola treatment
facilities, along with the provision of training and relevant guidelines
to ensure that all HCWs are exposed to the minimum possible level of
risk.
Ebola infections in healthcare workers as of the end of 28 Sep 2014
-------------------------------------------------------------------
Country / case definition / total cases / deaths
Guinea
Confirmed / 68 / 32
Probable / 8 / 8
Suspected / 0 / 0
All / 76 / 40
Liberia
Confirmed / 78 / 64
Probable / 96 / 27
Suspected / 35/ 5
All / 209 / 96
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
Spain
Confirmed / 1 / 0
Probable / no data / no data
Suspected / no data / no data
All / 1 / 0
United States of America
Confirmed / 1 / 0
Probable / no data / no data
Suspected / no data / no data
All / 1 / 0
All / 427 / 236
Geographical distribution and newly affected districts
------------------------------------------------------
In Guinea, the northern district of Boke, on the border with
Guinea-Bissau, has reported active transmission for the 1st time in more
than 21 days. The central district of Mamou has reported one confirmed
for the 1st time.
Response in countries with widespread and intense transmission
--------------------------------------------------------------
The 1st-ever UN emergency health mission, the UN Mission for Ebola
Emergency Response (UNMEER) has been set up to address the unprecedented
EVD epidemic. The strategic priorities of the Mission are be to stop the
spread of the disease, treat infected patients, ensure essential
services, preserve stability, and prevent the spread of EVD to countries
currently unaffected by EVD. WHO will continue to be responsible for
overall health strategy and advice within the Mission, and has now moved
its base of operations from Conakry, Guinea, to the UNMEER Mission
headquarters in Accra, Ghana.
Following the creation of UNMEER, a comprehensive 90-day plan to
control and reverse the epidemic of EVD in West Africa has been put into
action. To rapidly reverse the current crisis, capacity will be put in
place to isolate at least 70 percent of EVD cases and safely bury at
least 70 percent of patients who die from EVD by 1 Dec 2014 (the 60-day
target). The ultimate goal is to have capacity in place for the
isolation of 100 percent of EVD cases and the safe burial of 100 percent
of patients who die from EVD by 1 Jan 2015 (the 90-day target), which is
projected to result in a declining rate of transmission in an estimated
85 percent of affected areas. In accordance with the WHO Ebola Response
Roadmap, the 90-day Ebola Response plan requires that at least 50
percent of major inputs in 5 crucial domains be put in place by 1 Nov
[2014], with 100 percent of inputs in place by 1 Dec [2014]. Progress
towards putting these inputs in place and the attainment of each target
will be assessed through a comprehensive response-monitoring system, and
will be reported in due course. The latest key developments in each
domain are detailed below.
Case management
---------------
Meetings were held this week and last in Geneva to further refine WHO's
existing guidance on personal protective equipment in EVD outbreaks with
a formal WHO Guidelines Development Group, including experts from a wide
range of partners. A final document is expected within the week. A
standing Training Coordination Partners Group met for its 3rd and 4th
calls on 8 and 15 Oct [2014].
Efforts to scale-up the number of available EVD-specific beds have been
intensified in countries with widespread and persistent transmission.
Finding donors to fund the construction of new treatment facilities, and
foreign medical teams to staff them remains an ongoing challenge.
Two of 4 planned ETUs are now fully operation in Guinea. In Liberia,
however, only 6 of a planned 28 ETUs are currently operational,
providing 620 (21 percent) of 2930 planned beds. Health-care partners
able to staff and manage ETUs are yet to be found for 16 of 28 planned
facilities in the country, contributing to a current shortfall of 2310
beds. In Sierra Leone, almost half of the 18 planned ETUs are now
operational. Three facilities accounting for 250 beds require further
support before being brought into use.
In all 3 intense-transmission countries, a lack of available beds in
ETUs forces many families to care for patients at home. In the home
setting, carers are unable to adequately protect themselves from EVD
exposure, and thus the risk of transmission within the family and
throughout the community is greatly increased. As a remedial measure,
Ebola Community Care Units (ECUs)/Community Care Centres (CCCs) are now
being introduced into communities. These facilities will enable newly
detected cases to be isolated, and thus reduce household transmission.
ECUs/CCCs are controlled environments within communities where patients
with EVD can receive supportive and palliative care in close proximity
to their families.
Liberia and Sierra Leone are the 1st countries to implement ECUs/CCCs.
Liberia has opened 2 CCCs in Bong and Montserrado. In Sierra Leone, a
total of 149 CCCs are planned within the next 10 weeks.
Bed capacity and bed requirements for patients with Ebola virus disease
-----------------------------------------------------------------------
Country / Current no. of beds / Est. no. beds required / (Current
capacity/est. demand)
Guinea / 160 / 260 / 50 percent
Liberia / 620 / 2930 / 21 percent
Sierra Leone / 346 / 1198 / 29 percent
Case confirmation
-----------------
The total number of operational laboratories in the 3
intense-transmission countries will increase to 13 in the coming weeks,
as a Russian Mobile Laboratory becomes operational in Macenta, Guinea,
and a Public Health England laboratory begins to provide diagnostic
testing in the Western Rural area of Sierra Leone. At present, overall
testing capacity stands at 200 samples per day in Guinea, 470 in
Liberia, and 300 in Sierra Leone. As ECUs/CCCs are introduced more
widely, it is anticipated that demand for diagnostic capacity will
increase. Currently, specimens from districts without a laboratory are
sent to the nearest laboratory in a neighbouring district.
Surveillance
------------
In Guinea, contact-tracing teams in all districts except Dalaba and
Faranah were able to trace 90 percent of registered contacts each day
during the past week. In Liberia, fewer than 90 percent of registered
contacts were traced in the districts of Bomi, Gbarpolu, Grand Bassa,
Grand Cape Mount, Grand Gedeh, Grand Kru, Maryland, Margibi, Nimba,
Rivercess, River Gee, and Sinoe. In Sierra Leone, teams were able to
trace 82 percent of registered contacts in Monrovia on a daily basis.
Teams in the districts of Bo, Bonthe, Kenema, Kono, Moyemba, Port loko,
Pujehun, and Tonkolili were able to trace more than 90 percent of
registered contacts daily.
Contact-tracing teams in areas of intense transmission are often
overwhelmed by the high volumes of daily contacts to be traced.
Logistical difficulties, community denial of the existence of EVD, and
community resistance can also hamper the ability of teams to trace
contacts effectively.
Safe and dignified burials
--------------------------
Ebola task forces established in all 3 intense-transmission countries
continue to deploy teams trained in the safe management of dead bodies
in response to deaths in treatment facilities and in communities. All
districts in countries with widespread and intense transmission are
equipped with trained dead-body-management teams.
Social mobilization
-------------------
On 8 Oct [2014], the Ebola Communication Network (ECN) was launched.
ECN is an online collection of Ebola resources for Ebola communication
developed by the Health Communication Capacity Collaborative with inputs
from UNICEF, the US Centers for Disease Control and Prevention, USAID,
IFRC, and WHO to strengthen the capacity of countries to implement
state-of-the-art health-communication programs.
A working group of representatives of faith-based organizations was
established to collaborate with WHO, UNICEF and IFRC to ensure that
religious and cultural practices are included as part of the technical
guidelines on safe and dignified burials.
A protocol on community engagement developed by WHO and UNICEF for the
planning and rollout of ECUs/CCCs, has now been finalized. The protocol
will ensure that affected communities are listened to, consulted, and
that they will drive the local-level response to reduce EVD
transmission.
Countries with an initial case or cases, or with localized transmission
-----------------------------------------------------------------------
Four countries, Nigeria, Senegal, Spain, and the United States of
America, 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 1 case, but as yet there have been no deaths or further
suspected cases attributable to EVD. In the United States of America
there have been 2 cases and 1 death. In Spain there has been 1 case.
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] (37
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] (40
days ago). Within a country, an outbreak of EVD is considered to be over
when 42 days (double the 21-day incubation period of the Ebola virus)
has elapsed since the last patient in isolation became laboratory
negative for EVD.
In Spain, 72 people, including 13 high-risk contacts, are being
monitored. In the United States of America, 125 contacts are being
monitored.
Ebola virus disease cases and deaths in Nigeria, Senegal and the USA 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
United States of America
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
----------------------------------------------------------------------------
In accordance with the UNMEER 90-day plan, strengthening the
preparedness of all countries to respond to an initial exposure to EVD
is a mission-critical priority. Accordingly, all countries should have a
protocol for suspect cases, an equipped isolation unit, a minimum stock
of personal protective equipment, a case-management team trained in
infection prevention and control, and a public communications strategy.
All countries bordering affected areas should have active surveillance
in, and weekly reporting from, areas assessed as at the highest risk of
an initial exposure. Countries will be supported with appropriate
technical guidance, simulation and protocol testing, and, in case of the
importation of an EVD case, a rapid response capacity. On 10 Oct [2014],
a meeting between WHO and partner organizations in Brazzaville agreed on
a range of tools to support countries unaffected by Ebola in
strengthening their preparedness in the event of an outbreak. One of
these tools is a comprehensive checklist of core principles, standards,
capacities and practices, which all countries should have or meet.
On 13 Oct [2014], WHO Director General Margaret Chan urged East Asian
and Pacific countries to strengthen defenses against EVD.
Preparations are ongoing for the 3rd meeting of the IHR emergency
committee, which will have a special focus on entry and exit screening
--
Communicated by:
ProMED-EAFR
<promed-eafr@xxxxxxxxxxxxxx>
[The full document, available at the source URL above, includes
additional details, tables, graphs, and maps.
The UN Mission for Ebola Emergency Response (UNMEER) has been
established to streamline the current response to the Ebola outbreak in
West Africa and has rolled out a 90-day plan to reverse the current
trends. Progress is being made to close the gap in response capacities
(especially isolation and laboratory testing capacities). The progress
in closing this gap remains very slow, however, and therefore a major
factor in the current escalating trend. As a stopgap measure for
addressing the gaps in isolation capacities, Ebola Community Care
Centres (ECUs/CCCs) are being rolled out in the 3 countries with intense
transmission. It is, however, not clear who is going to regulate
adherence to protocols on case treatment, barrier nursing, and other
infection prevention and control practices since there is already a
shortage of skilled health workers to man the few established treatment
centres. If this concern is not addressed, the newly established
ECUs/CCCs will only serve to further amplify the current community
transmission.
A HealthMap showing the areas with Ebola virus disease cases and deaths
can be seen at <http://healthmap.org/ebola/ [4]>. - Mod.JFW]
[see also:
Ebola virus disease - West Africa (39): WHO update 20141012.441511
Ebola virus disease - West Africa (38): WHO update 20141011.441443
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/je/be
Links:
------
[1] http://www.promedmail.org
[2] http://www.isid.org
[3]
http://apps.who.int/iris/bitstream/10665/136508/1/roadmapsitrep15Oct2014.pdf?ua=1
[4] http://healthmap.org/ebola/
_______________________________________________
ProMED-EAFR mailing list
ProMED-EAFR@xxxxxxxxxxxxxx
http://eafr.promedmail.org/
