Ebola Update (4 June 2015)

On Tuesday, Secretary General Ban Ki-moon warned that as long as there is one Ebola case in the West African region “all countries are at risk,” urging all nations to support the final battles aimed at wiping out the deadly disease in Guinea and Sierra Leone.

Speaking to a General Assembly meeting on efforts to end the Ebola epidemic, which has killed over 11,100 people mainly in Liberia, Guinea and Sierra Leone, the UN chief stated, “we are on the home stretch now and what happens now is critical.” While Liberia, which was once the worst affected country, has now been declared Ebola-free, Ban has warned that in Guinea and Sierra Leone, “the battle has not yet been won,” and “any lapse in vigilance could allow the virus to spread.” Dr David Nabarro, the UN Ebola chief, told the assembly that the priority is to ensure that the outbreak ends as soon as possible, “which will take several weeks and may take a number of months… But everybody should be ready in case the disease recurs and needs to be controlled, especially in the coming 12 months.” Ban also disclosed that UN agencies who will be taking over responsibility for tackling the outbreak as the UN Mission for Ebola Emergency Repose (UNMEER) scales down “will need considerable resources to go the distance and support recovery” in the three hardest-hit countries. UNMEER’s acting chief Peter Jan Graaff has indicated that UNMEER’s office in Mali closed on 31 March while its office in Liberia has handed over its operations to the UN country team. The Sierra Leone office is expected to end operations by the end of June, with Graaff indicating, “UNMEER could complete its transition by July 31 and be closed by the end of August,” noting however that if the situation deteriorates, the timeline could be changed “to ensure that the UN’s political leverage and convening power is maintained.” The UN Secretary General has indicated that he will convene an International Ebola Recovery Conference in New York on 10 July, which will aim to mobilize resources to start early recovery in Guinea, Liberia and Sierra Leone.

On Wednesday, the World Health Organization (WHO) released its latest figures on the Ebola outbreak in West Africa. As of 31 May, there have been a total of 27,145 reported confirmed, probable and suspected cases of EVD in Guinea, Liberia and Sierra Leone, with 11,147 reported deaths. In the seven days leading up to 31 May, a total of 25 confirmed cases of EVD were reported from 4 prefectures in Guinea and 3 districts of Sierra Leone,

According to the WHO, “since the week ending 10 May, when a 10-month low of 9 cases of Ebola Virus Disease (EVD) were reported from 2 prefectures of Guinea and 1 district of Sierra Leone, both the intensity and geographical area of EVD transmission have increased.” In the 7 days leading up to 31 May, a total of 13 new confirmed cases were reported in Guinea and 12 in Sierra Leone, with officials indicating that several cases in both countries arose from unknown sources of infection in areas that have not reported confirmed EVD cases for several weeks. This effectively indicates that chains of transmission continue to go undetected. Officials have noted that “rigours contact tracing, active case finding, and infection prevention and control must be maintained at current intensive levels in order to uncover and break every chain of transmission,” and have warned that the onset of the rainy season will make field operations more difficult from now onwards.

Two response teams from Guinea-Bissau have been deployed to the border with Guinea to assess several points of entry and sensitive communities. This is due to the proximity to Guinea-Bissau of the recent cluster of cases that have been reported in the northwestern Guinean prefecture of Boke. So far, the investigation team has not been able to locate the contact who had attended the funeral of a case in Boke and who is believed to have returned to a fishing community in Guinea-Bissau.

Guinea

In the week leading up to 31 May, a total of 13 cases were reported in 4 western prefectures of Guinea.

Seven of these cases were reported from the prefecture of Forecariah, which borders Sierra Leone. Multiple chains of transmission gave rise to cases in 4 of Forcariah’s 10 sub-prefectures, however all cases were either registered contacts of a previous case or had an established epidemiological link to one. Five cases were concentrated in the central areas of the prefecture where the sub-prefectures of Farmoriah, Kaliah, and Moussayah intersect. The remaining cases were reported from the northwestern prefecture of Boke (1 case), which borders Guinea-Bissau; the west coast prefecture of Dubreka (4 cases), which borders the capital city Conakry; and the western inland prefecture of Fria (1 case). The cases in Boke and Dubreka were all registered contacts of cases linked to localized chains of transmission. The case that was reported in Fria however arose from an unknown source and is suspected to have originated from an as-yet unidentified chain of transmission in the neighbouring prefecture of Telimele. Officials have indicated that investigations into the origin of the case in Fria have been complicated by active and passive resistance from communities both in Fria and neighbouring Telimele.

On the ground sources in Guinea have reported that community engagement continues to prove challenging, particularly in all the 4 affected prefectures. There have been several reported incidents of violence that has been directed at field staff during the past week.

Sierra Leone

In the week leading up to 31 May, Sierra Leone reported a total of 12 cases in three districts.

Eight of these cases were reported from a densely populated area of the Kaffu Bullom chiefdom in the district of Port Loko, which is located just north of the capital, Freetown. All but one of these cases were registered contacts of previous cases within quarantined houses in the chiefdom. The additional case is from the same neighbourhood however it was not on a contact list and was living in a non-quarantined home at the time of symptom onset. The other cases were reported in the following districts: Kambia reported its first case for over 2 weeks on 31 May. The case was identified after a post-mortem test of a community death and was not a known contact of a previous case. The remaining three cases were reported from the capital city, Freetown. Officials in Freetown have indicated that at this time, none of those 3 cases can be linked to previous chains of transmission however investigations are at an early stage.