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Ebola Situation Report (17 December 2014)

In the days leading up to 14 December, there has been a total of 18,603 confirmed, probable and suspected cases of Ebola virus disease (EVD) that have been reported in five affected countries: Guinea, Liberia, Mali, Sierra Leone and the United States; and three previously affected countries: Nigeria, Senegal and Spain. There have been 6,915 reported deaths. Reported case incidence in Guinea is fluctuating and is on the decline in Liberia. In neighbouring Sierra Leone, there are signs that the increase in incidence is beginning to slow. The case fatality rate in the three intense-transmission countries remains at 70%.

Guinea

In the week leading up to 14 December, a total of 76 new confirmed cases were reported. Since September, the national trend in case reporting across Guinea has been fluctuating, with between 75 and 148 confirmed cases reported each week. World Health Organization (WHO) officials have reported that currently, there is no clear upward or downward trend in national case incidence.

Transmission remains high in the capital city of Conakry, which reported 18 confirmed cases in the week leading up to 14 December. EVD transmission remains high in the neighbouring district of Coyah, with 14 confirmed new cases. South of capital city, in Forecariah, officials have reported a surge in new cases, with 13 new confirmed cases in the past week. The district had reported its first case 12 weeks ago and until now, had reported no more than 4 confirmed cases each week.

Transmission remains persistent in the eastern district of N’Zerekore, with 6 new confirmed cases reported in the week leading up to 14 December. The district of Dubreka reported 3 confirmed cases, while new cases continue to be reported in the outbreak’s epicentre of Gueckedou (2 confirmed cases); Kerouane (5 confirmed cases) and Lola and Kouroussa (2 confirmed cases in each district). In the past week, Macenta reported only three confirmed cases, a sharp decline from the 15 cases that were reported in each of the two previous weeks. WHO officials however have warned that it remains too early to draw conclusions whether this decline in reporting in this district will be sustained. After reporting last week its first case since June, Telimele reported 5 new confirmed cases. While the districts of Kindia and Faranah did not report any new confirmed cases, officials in these two districts reported 21 and 12 probable cases respectively. The northern district of Siguiri reported 4 probable cases. This area requires continued vigilance, particularly due to its proximity to Mali.

Officials in the Guinean capital of Conakry have banned all public Christmas and New Year celebrations in a bid to curb the spread of EVD. A statement issued by Conakry governor Soriba Sorel Camara on 16 December indicated that “large-scale gatherings in public places are suspended for the moment,” adding “beaches will remain closed” and firecrackers and fireworks will also be banned. The capital city’s governor has appealed to residents to “refrain from anything” that would compromise efforts to contain the spread of Ebola. This means avoiding “all gatherings in markets, bus stations, ferry landing stages, hospital and the airport.”

Liberia

At the national level, case incidence in Liberia has been on the decline, with 6 districts reporting new confirmed or probable cases in the week leading up to 14 December.

Transmission remains intense in Montserrado, which includes the capital Monrovia. The district reported 3 confirmed cases and 9 probable cases. Grand Bassa experienced a decline in cases, reporting only one confirmed case after having reported 7 in the previous week. The other districts to report confirmed cases during this period included Bong (1 confirmed case); Grand Cape Mount (2 confirmed cases) and Marigibi (1 confirmed case). In the northern region of the country, Lofa reported no cases for the seventh consecutive week. This is likely due to the strength of response efforts being carried out across the district.

Sierra Leone

EVD transmission across Sierra Leone remains intense, with the country reporting 327 new confirmed cases in the week leading up to 14 December. While WHO officials have reported that there are signs that the increase in case incidence has slowed, and that the incidence may no longer be on the rise, the country reported the highest number of confirmed cases in epidemiological week 50.

EVD transmission remains most intense and persistent in the western and northern districts of the country. The capital city Freetown accounted for 125 of all new confirmed cases. Other western districts that reported new confirmed cases include Port Loko (56 cases); Western Rural Area (52 cases); Bombali (23 cases) and Kambia (11 cases).

In the country’s eastern region, the district of Kono, which has experienced high transmission over the past five weeks, reported 12 confirmed cases in the week leading to 14 December. The neighbouring district of Koinadugu in the northeast reported three cases. Although transmission has been intense in Tonkolili for the past three weeks, in recent weeks the number of new weekly cases has declined from a peak of 56 four weeks ago to 14 cases over the past week. In the southern region of the country, the district of Bo continues to report a high number of new cases, with 24 confirmed cases in the week leading up to 14 December. By contrast, the south-eastern districts of Kenema and Kailahun reported 1 and 3 new cases respectively. Only two districts in Sierra Leone did not report any new cases during this reporting period: Bonthe and Pujehun.

Officials in Sierra Leone have banned any public Christmas celebrations in a bid to halt the spread of EVD. According to the government’s Ebola response unit, soldiers will be deployed across the country throughout the holiday period to ensure that all residents remain indoors. Officials in Sierra Leone have also imposed a two-week lockdown on the eastern diamond-mining district of Kono. The lockdown will effectively limit residents’ movements until 23 December.

Countries with an Initial Case/Cases or with Localized Transmission

Five countries: Mali, Nigeria, Senegal, Spain and the United States of America; have reported a case or cases of EVD imported from a country with widespread and intense transmission.

In Mali, a total of 8 cases (7 confirmed and 1 probable) including 6 deaths (5 confirmed and 1 probable) have been reported. The most recent seven cases were reported in the Malian capital Bamako and are not related to the country’s first EVD case, which was reported in Kayes on 24 October. The last confirmed case tested negative for the second time on 6 December and was discharged from hospital on 11 December. All identified contacts of both the initial case and the outbreak in Bamako have now completed the 21-day-follow up. If there are no more reported cases of EVD in Mali, the West African country will be declared Ebola-free by the WHO in mid January.

In the United States, there have been four confirmed cases of EVD and 1 death. All contacts in the country have now completed the 21-day follow-up period. If no further cases are reported in the US, the country will be declared Ebola-free at the end of December.

Nigeria, Senegal and Spain have all been declared Ebola free by the WHO.

Guinea-Bissau Confirms Possible Ebola Case While Sierra Leone Cancels Christmas Festivities

A medical official in Guinea-Bissau reported Friday that a man, who had entered the West African country from Guinea one day after the border reopened, is now being treated for suspected Ebola. Meanwhile in Sierra Leone, which recently surpassed Liberia to report the most cases of the deadly disease, officials have banned any Christmas celebrations as the caseload of Ebola infections continues to spread at an alarming rate.

On Friday, a medical official in Guinea-Bissau reported that a traveller was placed under surveillance as he attempted to pass through the Fulamori border crossing on Wednesday. Sources have reported that the traveller, who had a high fever, had taken advantage of the lax security amongst border guards in order to escape observation. He later boarded a bus and headed for the eastern city of Gabu, where he was apprehended. The traveller, along with eight fellow passengers on board the bus, has been quarantined.

On Tuesday, the government in Guinea-Bissau reopened the country’s 300-kilometre (185-mile) land border with Guinea after officials closed it on 12 August due to the Ebola outbreak. In November, a team from the World Health Organization (WHO) included Guinea-Bissau on its list of fifteen countries at risk of an Ebola outbreak, concluding that the West African country had an “inefficient health system, which would not be able to cope with an outbreak of Ebola.” So far, Guinea-Bissau has not reported any cases of Ebola and a confirmed Ebola case would demonstrate that the outbreak is continuing to spread, nearly one year after it was first identified.

Officials in Sierra Leone have banned any public Christmas celebrations as the caseload of Ebola infections continues to spread at an alarming rate. According to the government’s Ebola response unit, soldiers will be deployed across the country throughout the holiday period to ensure that all residents remain indoors. Palo Conteh, head of the department, has not disclosed the exact dates or specified any exceptions however during previous local and nationwide anti-Ebola curfews, people have been allowed out in order to worship and for “essential business.” Under the current emergency regulations, bars and nightspots have been shut down while public gatherings have been outlawed however there is currently no general ban on walking outdoors or working. Sierra Leone, which has now overtaken Liberia to report the most cases of the deadly virus, has in the past three weeks recorded 1,319 new cases.

The WHO Achieves December 1 Ebola Targets

On Monday, World Health Organization (WHO) officials indicated that they have met what they call interim targets that were put in place in October in a bid to end the upward trend in new Ebola cases. While progress has been made, with some countries seeing the spread of the disease either stabilize or decline, reports of new cases in Mali and high transmission levels in some parts of Sierra Leone have shown that more work is required in order to end the worst Ebola outbreak on record.

Two months ago, the WHO launched a plan to stop the Ebola outbreak in West Africa. It aimed to isolate 70 percent of the sick and safely bury 70 percent of the victims in the three hardest hit countries – Guinea, Liberia and Sierra Leone – by 1 December. According to the latest figures released by the UN health agency, both Liberia and Guinea have met the targets, with Sierra Leone likely to fully achieve its goal in the coming weeks.

New figures released Monday indicate that both Liberia and Guinea have met the 1 December target for isolating 70 percent of people infected with Ebola, and have safely buried 70 percent of those who died. Sierra Leone however has not fully met the target. At a news conference in Geneva, the WHO’s Dr Bruce Aylward disclosed that Sierra Leone’s western region probably met the targets and likely will improve to the 70 percent target nationwide “in the coming weeks.” Dr Aylward further disclosed that the WHO’s plan to stop the spread of the deadly Ebola virus had shown that it was possible to quickly reduce the “yawning gap” between disease levels and the capacity to respond.

In recent weeks there have been a number of successes in the fight against Ebola. Amongst these are the fact that Ebola cases in Liberia and Guinea are either stabilizing or are on the decline. The case in Sierra Leone however is quite different as the country’s capital city Freetown and the town of Port Loko are seeing a severe surge in cases. Additionally, a new outbreak in Mali has caused concern that the deadly disease will spread into other West African countries.

When the deadline was first announced in October, Dr. Aylward acknowledged that to reach the 1 December goal would be “really pushing the system hard.” Dr Aylward, who is directing the WHO’s Ebola response, further disclosed “if we don’t do it in 60 days and we take 90 days: No. 1, a lot more people will die that shouldn’t; and No. 2, we will need that much more capacity on the ground to be able to manage the caseload.”

The Ebola outbreak was first reported in Guinea in March of this year. It has since spiralled out of control and was declared a public health emergency in August.   Latest figures released by the WHO indicate that the Ebola virus has sickened more than 16,000 people, of whom 7,000 have died. Tony Banbury, the head of the UN Ebola response mission in West Africa has warned that there is still a “huge risk” that the deadly disease could spread to other parts of the world.

Ebola Outbreak November Review

As of the end of 27 October 2014, a total of 13,703 confirmed, probable and suspected cases of EVD have been reported in six countries: Guinea, Liberia, Mali, Sierra Leone, Spain and the United States of America. The figure of confirmed, probable and suspected EVD cases includes cases in previously affected countries: Nigeria and Senegal. A total of 4,922 deaths have been reported. The death rate in the current outbreak has risen to 70 percent from the previously estimated mortality rate of 50 percent.

EVD transmission remains persistent and widespread in Guinea, Liberia and Sierra Leone, with World Health Organization (WHO) officials particularly concerned about the spread of the disease in the capital cities – Conakry, Monrovia and Freetown – where people are able to freely move across borders. All administrative districts in Liberia and Sierra Leone have now reported at least one confirmed or probable case of EVD since the outbreak began. According to WHO officials, “new cases continue to explode in areas that looked like they were coming under control,” noting “an unusual characteristic of this epidemic is a persistent cyclical pattern of gradual dips in the number of new cases, followed by sudden flare-ups.” While some regions in these countries have seen the number of EVD cases either stabilize or decrease, this does not mean that the regions are Ebola-free.

Countries with localized transmission, including Mali, Spain and the United States, are currently continuing to monitor potential contacts. On 23 October, Mali confirmed its first EVD case, a 2-year-old girl who died on 24 October.

On 21 October, the single patient with EVD in Spain tested negative for the disease for a second time. Unless a new case of EVD arises during this period, Spain will be declared Ebola-free 42 days after the date of the second negative test. In the United States, two health-care workers have tested negative for Ebola for the second time. They have both been discharged from hospital. Another health-care worker remains in isolation and is receiving treatment. WHO officials declared Senegal and Nigeria Ebola-free on 17 October and 20 October respectively.

The BBC has launched an Ebola public health information service on WhatsApp. The service will provide audio, text message alerts and images in order to help people living in West Africa get the latest public information on how to combat the spread of Ebola in the region. Content will be limited to three times per day and the service will be available in both French and English. To subscribe to this service, add +44 7702 348 651 to your contacts then send ‘JOIN’ to the number via WhatsApp. To unsubscribe, send ‘STOP’ via WhatsApp to the same number. Due to the large volume of requests, the BBC has warned that it may take a little time to be added or removed from the service.

Affected countries currently fall into three categories:

1. Those with widespread and intense transmission: Guinea, Liberia and Sierra Leone;
2. Those with either an initial case or cases, or with localized transmission: Mali, Nigeria, Senegal, Spain and the United States
3. Those countries that either neighbour or have strong trade ties with areas of active transmission: Benin, Burkina Faso, Cameroon, Central African Republic, Democratic Republic of Congo, Gambia, Ghana, Guinea Bissau, Ivory Coast, Mali, Mauritania, Nigeria, Senegal, South Sudan and Togo.

The World Health Organization (WHO) has identified three patterns of transmission:

1. In rural communities, which is facilitated by strong cultural practices and traditional beliefs;
2. In densely populated urban communities;
3. Cross-border transmission

1. Countries with Widespread and Intense Transmission

 Guinea

Guinea currently has 1,906 confirmed, probable and suspected cases of EVD and 997 deaths.  While cases of EVD transmission are the lowest in Guinea, transmission across the country continues to be of concern and is being driven by transmission in four key areas:

• The capital city Conakry – Over the past week, there have been six new confirmed cases of Ebola reported in Conakry. The capital city remains a key area of concern with the nearby district of Coyah reporting 8 new confirmed cases.
• N’Zerekore – Located south-east of Macenta, the district of N’Zerekore reported 10 new confirmed cases over the past week.
• Keouane – Transmission remains strong in this district, with 22 new confirmed cases in the last week, effectively continuing a rapid three-week growth in new cases.
• District of Macenta – The most intense transmission in Guinea is occurring in and around Macenta, which is located in the south-west region of Guinea, near the border with Liberia. Over the past week, the district reported 15 new confirmed cases. Transmission in this district has remained intense for the past 10 weeks.

The outbreak’s epicentre Gueckedou has reported few new cases over the past 7 weeks, with 3 confirmed new cases in the past week, however transmission persists. In contrast to the situation in Liberia and Sierra Leone, several areas in Guinea have not reported a single case of Ebola while seven areas have not reported any new cases over 21 days after reporting an initial case/cases.

Two new districts in Guinea reported a case or cases of Ebola for the first time in October. In the eastern region of the country, on the border with the Ivory Coast and on a major trade route with Mali, the previously unaffected district of Kankan reported 1 new confirmed case. In the central region of the country, the previously unaffected district of Faranah reported 1 confirmed case of Ebola. Faranah borders the newly affected Sierra Leonean district of Koinadugu to the southwest.   The central district of Mamou is currently classified as unaffected.

Land borders with Liberia, Senegal and Sierra Leone have been closed. Health screenings at all border crossings have been set up and all travellers displaying a fever, or EVD-like symptoms, will be subject to quarantine and/or denied entry/exit, from the country. Expect to experience delays at land border crossings. Enhanced screening measures have been introduced for outbound passengers at Conakry airport.

Liberia

Liberia has 6,535 confirmed, probable and suspected cases of EVD and remains the worst affected country in the current outbreak. The country has reported 2,413 deaths.  All administrative districts in Liberia have now reported at least one confirmed or probable case of EVD since the outbreak began.

The most intense transmission continues to occur in the Montserrado area, where in the past week, 30 new probable cases were reported. This area includes the capital city, Monrovia. While the weekly increase in new cases in this area appears to have halted since mid-September, underreporting of cases remains to be an issue across the country, especially in Monrovia, and therefore it is difficult to capture an accurate picture of the current situation. Beyond the capital city, most new reported cases have occurred in the districts of Bong, Margibi and Bomi, which over the past week have each reported 12 probable cases. The district of Grand Gadeh, which previously was considered the only unaffected area in Liberia, now has 2 confirmed and 2 suspected cases of EVD. It must be noted that these new cases may have not occurred in the past week and that reporting of these cases was delayed.

Since 20 August, a state of emergency has been in place, with security forces enforcing a nationwide curfew. Between 11PM and 6AM every night no movement is allowed anywhere in the entire country. Liberian authorities have set up road blocks in a bid to restrict movement around the country while security forces have been deployed in order to enforce quarantine for certain areas, including Lofa county. In Monrovia, the army and police have sealed off the neighbourhood of West Point with the area being placed under quarantine. There have been a number of outbreaks of violence, with civilians rioting at hospitals and attacking health workers.

All borders of Liberia have been closed, with the exception of major entry points, including the Roberts International Airport and James Spriggs Payne Airport. The Bo Waterside Crossing to Sierra Leone remains closed along with the Foya Crossing to Guinea. Any remaining border crossings may be closed with minimal notice. The Liberia Airport Authority has introduced enhanced screening measures for both inbound and outbound travellers at airport facilities.

The Ministry of Health and Social Welfare has established hotlines for the public to get basic information on Ebola: Call 0770198517 or 0777549805 or 0886530260 or 0886549805.

General medical facilities throughout the country are currently under severe strain as a result of the Ebola outbreak. Dedicated healthcare facilities for Ebola are overwhelmed and may not accept further cases.

Sierra Leone

EVD transmission remains intense across Sierra Leone, with 5,235 confirmed, probable and suspected cases and 1,500 deaths. All districts in Sierra Leone have now reported at least one case of EVD.

Over the past week, the capital city Freetown reported 63 new confirmed cases and remains one of the country’s worst affected areas. The western rural region of the country reported 81 new cases over the past week, effectively making it the sixth consecutive weekly rise in the number of new cases in the area. The western districts of Bombali, which confirmed 56 new cases in the past week, and Port Loko, with 47 confirmed new cases, continue to be seriously affected by the outbreak. EVD cases in the district of Tonkolili are of increasing concern as over the past week the area reported 36 confirmed new cases. The neighbouring regions of Kenema and Kailahun reported 13 and 5 new confirmed cases respectively over the last week and remain amongst the worst affected areas of the country.

2. Countries with Initial Case/Cases or Localized Transmission

Five countries – Mali, Nigeria, Senegal, Spain and the United States – have reported a case or cases of EVD imported from a country with widespread and intense transmission.

Mali

On 23 October, Mali confirmed its first EVD case. The patient was a 2-year-old girl who had travelled from the Guinean district of Kissidougou with her grandmother to the city of Kayes, located 600 kilometres (375 miles) from the Malian capital, near the border with Senegal. She had travelled by bus via the capital city Bamako, where she stayed for ten days in the Bagadadji neighbourhood. The patient was symptomatic for much of the journey. On 22 October, the patient was taken to Fousseyni Daou hospital in Kayes, where she died on 24 October.

Currently 82 contacts – 57 in Kayes and 27 in Bamako – are being monitored by officials and efforts to trace additional contacts are on-going. At the time of the confirmation of the first EVD case in Mali, a WHO preparedness team was deployed in the country to assess Mali’s state of readiness for an initial Ebola case. The team was immediately redirected to provide support and expertise to Malian health authorities and to help with contact tracing and the training of healthcare workers.

In the wake of the first confirmed case of Ebola in Mali, neighbouring Mauritania has implemented some border controls. 

Nigeria

On 20 October 2014, the WHO declared Nigeria Ebola-free after six weeks of no new reported cases. For officials to declare the country Ebola-free, Nigeria had to make it 42 days with no new cases, which is double the incubation period, verify that it actively sought out all possible contacts, and show negative test results for any remaining suspected cases.

Nigeria had a total of twenty cases after a Liberian-American man flew into Lagos International Airport on July 20 and collapsed shortly afterwards. The disease later spread to Port Harcourt.

While Nigeria has been declared Ebola-free, Nigerian authorities are preparing for any additional outbreaks as the current Ebola epidemic in West Africa is far from over and spread to additional countries, including to Nigeria, remains possible.

Senegal

On 17 October 2014, the WHO declared Senegal Ebola-free. The assessment was made after the West African country went forty-two days without reporting any new cases. In late August, Senegal confirmed one case of Ebola, an imported one from Guinea, which prompted officials to monitor seventy-four contacts of the patient and increase surveillance at the country’s entry ports.

Spain

A single case in Spain tested negative for EVD on 19 October. A second negative test was obtained on 21 October. A total of 83 contacts are currently being monitored. If no new cases are reported, Spain will be declared Ebola-free 42 days after the date of the second negative test. 

United States

There have been four confirmed EVD cases and one death in the US. Two health-care workers have now tested negative for Ebola twice and have been released from hospital. Another health-care worker has been placed in isolation in New York and is receiving treatment. Of 176 possible contacts, 92 are being monitored and 84 have completed the 21-day monitoring period.

3. Preparedness of Countries to Rapidly Detect and Respond to an Ebola Exposure

The WHO has identified fifteen countries that neighbour countries that either are experiencing widespread and intense EVD transmission or have strong trade and travel ties with countries with current widespread and intense transmission. These countries are: Benin, Burkina Faso, Cameroon, Central African Republic, Democratic Republic of Congo, Gambia, Ghana, Guinea Bissau, Ivory Coast, Mali, Mauritania, Nigeria, Senegal, South Sudan and Togo. The WHO has assessed that Mali and the Ivory Coast are currently at the highest risk of importing the disease.

The WHO and its partners are currently working with these countries in order to help increase their level of preparedness in the event of exposure to EVD. Teams have already been deployed to the Ivory Coast and Mali, where they have been working with health authorities, and over the next week a mission will be deployed to Guinea Bissau. In the remaining countries, WHO teams and partners are working with local authorities to help identify any gaps in their capacity to identify and respond to an initial EVD case.

Ebola Outbreak in Democratic Republic of Congo (DRC)

As of 26 October 2014, there have been 67 cases (38 confirmed, 28 probable, 1 suspected) of Ebola in the Democratic Republic of Congo. The test results for the one suspected case are not yet known. This includes eight cases amongst healthcare workers. In total, there have been 49 deaths reported, including eight healthcare workers. All suspected cases have now been either laboratory confirmed or discarded.

Of a total of 1,121 total contacs, 1,116 have now completed a 21-day follow-up. On 10 October, the last reported cases tested negative for the second time and was discharged. The DRC will thefore be declared Ebola-free 42 days after the date of the second negative test if no new cases are reported. The current outbreak in the DRC is unrelated to that affecting West Africa.

Ebola Spreads to Sixth Country as Mali Confirms First Case

Just a week after the World Health Organization (WHO) announced that it would deploy experts to the Ivory Coast and Mali to test their Ebola-preparedness measures, on Thursday, Mali’s Health Minister confirmed the country’s first Ebola case.

Speaking on state television late Thursday, Malian Health Minister Ousmane Kone confirmed that a two-year-old girl has tested positive for the deadly virus, disclosing that she was currently being treated at a hospital in the western town of Kayes, which is located 600 kilometres (375 miles) from the capital city Bamako. According to the Health Minister, the girl was brought to the Fousseyni Daou hospital on Wednesday, where she was immediately tested for the virus, which came back positive. Reports have indicated that the girl had recently returned from Kissidougou, in neighbouring Guinea, where the Ebola outbreak first emerged last December. Her mother died in Guinea several weeks ago, with the girl recently being brought to Bamako by relatives. She stayed in the Malian capital for ten days, in the Bagadadji neighbourhood, before leaving for Kayes. The child and 43 people who have come into contact with her have been put in quarantine, with the health minister urging anyone who may have had contact with the girl to come forward. A source within the health ministry has reported that the child’s condition is said to be improving.

Mali is now the sixth country in West Africa to be affected by the worst-ever Ebola outbreak, however both Senegal and Nigeria have in the past week been declared Ebola-free by WHO officials. Health officials have long viewed Mali as one of the most vulnerable to Ebola’s spread as the West African country borders both Guinea, which has been one of the hardest-hit countries by the current outbreak, and Senegal. The WHO’s list of fifteen African countries that need to be prepared for a possible Ebola case identified both Mali and the Ivory Coast as top priorities. Last week, WHO officials announced that they will deploy experts to both countries in order to test their Ebola-preparedness measures as both countries are currently at the greatest risk of being the next to be affected by the outbreak. Speaking during a news conference in Geneva last week, Isabell Nuttal, the WHO’s health security response chief disclosed, “as the number of cases is increasing, it wouldn’t be a surprise to have a case in neighbouring countries. And its for this very reason that we are working with them so that they are able to detect and take immediate action,” adding, “border checkpoints and health points have been implemented on the major roads that are crossing between the countries, so it provides a level of reassurance in terms of travelling.” On Sunday, a team of ten experts was set to deploy to Mali, with another team set to deploy to the Ivory Coast in the coming days.

An outbreak of the Ebola virus in Mali would likely severely threaten the country’s already fragile security situation, as Mali is continuing to stabilize after a coup and Islamist militant takeover of its northern region. It could also result in a greater risk to healthcare workers deployed in the country. While several teams of health workers have been attacked in Guinea, with several workers killed in September by locals as they attempted to spread awareness about the deadly virus, terrorist groups operating in the northern regions could target health workers for kidnap-for-ransom or could carry out violent attacks similar to those that targeted polio vaccination workers in Nigeria and Pakistan.

New figures released by the WHO on Wednesday indicate that Ebola has now killed 4,877 people and infected 9,936 across West Africa, with most of the deaths and cases occurring in Guinea, Liberia and Sierra Leone. The official number of cases and deaths however remains unknown as under-reporting continues to be a major issue in this outbreak, however the WHO indicated last week that the true death toll may be three times as high as the one currently being reported. A separate and unrelated outbreak in the Democratic Republic of Congo in central Africa currently appears to have been contained.