Ebola Update (25 June 2015)

Despite hopes rising that the Ebola outbreak in West Africa could soon be contained, after Liberia was declared free of the deadly virus in early May, the latest figures released Wednesday by the World Health Organization (WHO) indicate that the outbreak is showing no signs of abating in Guinea and may be flaring up once again in neighbouring Sierra Leone.

In the week leading up to 21 June, there were 20 confirmed cases of Ebola virus disease (EVD) compared with 24 cases that were recorded the week before. According to officials, while the weekly case incidence has stalled between 20 – 27 cases since the end of May, cases continue to arise from unknown sources of infection and are typically detected only after post-mortem testing.

During this reporting period, only 6 of the 12 cases that were reported in Guinea and 4 of the 8 cases reported in Sierra Leone were registered contacts of previous cases. As of 21 June, there were 2,003 contacts being monitored across 4 prefectures in Guinea and 1,023 contacts were under follow-up in 3 districts in Sierra Leone.

There have been a total of 27,443 reported confirmed, probable and suspected cases of EVD in Guinea, Liberia and Sierra Leone, with 11,207 reported deaths.

Guinea

During this reporting period, Guinea confirmed 12 cases in the same four prefectures as reported cases in the previous week: Boke, Conakry, Dubreka and Forecariah. According to WHO officials, while cases have been reported from the same 4 prefectures over the past three weeks, data indicates that the area of active transmission within these prefectures has changed and in some cases, it has expanded.

In the northern prefecture of Boke, which borders Guinea-Bissau, officials have reported that the main focus of transmission has switched from the coastal sub-prefecture of Kamsar to the more urbanized sub-prefecture of Boke Centre. In the week leading up to 21 June, two cases that were reported in Boke were health workers.

During this reporting period there was one case reported in the capital Conakry. The case was recorded in the Matam area of the city and arose from an unknown source of infection. Three cases that were reported in the capital city in the previous two weeks are suspected to have generated a large number of high-risk, untraced contacts.

In Dubreka, one case was reported during this period in the sub-prefecture of Tanene. While the origin of this case currently remains unknown, officials have disclosed that preliminary investigations indicate that it is linked to previous cases in the same sub-prefecture.

The prefecture of Forecariah continues to be the most complex in terms of transmission, with multiple chains of transmission remaining active across 3 sub-prefectures. This has been an issue that has affected this prefecture over the past several months. In the week leading up to 21 June, three of the 5 cases that were reported in Forecariah arose from an unknown chain or chains of transmission.   Furthermore, two of those three cases were reported from a sub-prefecture, Benty, which has not reported a confirmed case since mid-March. Both cases in Benty and another possible related case from a neighbouring sub-prefecture were identified after post-mortem testing was carried out.

The upcoming election, due to be held in October, is now adding another layer of worry to both Guineans and local health workers, with some residents stating that campaign events, where people crowd together, should not be held yet. 

Sierra Leone 

During this reporting period, Sierra Leone recorded 8 cases in three districts: Kambia, Port Loko and the district that includes the capital city, Freetown, which reported confirmed cases for the first time in over two weeks.

Compared with neighbouring Guinea, transmission in Sierra Leone has been more geographically confined over the past three weeks, with cases remaining clustered in several chiefdoms of the districts of Kambia and Port Loko. However, figures for this reporting period indicated a worrisome development, as 2 cases were reported from the Marampa chiefdom in Port Loko for the first time since the beginning of March. Additionally, two cases were also reported from the area that includes the capital city for the first time in over two weeks.

In Kambia, both cases were reported in the Tonko Limba chiefdom, which has been the primary focus of transmission in Kambia over the past three weeks. According to local officials, both cases are registered contacts and were residing in a quarantined dwelling at the time of symptom onset.

During this reporting period, four cases were recorded in Port Loko. Two cases were reported from the Kaffu Bullom chiefdom, which has been the origin of the majority of cases that have been reported in the West African country over the past three weeks. One of the cases, a health worker, is a registered contact of a previous case while the remaining two cases arose from an as-yet unknown source of transmission.

Officials reported Monday that over the past few days, the country has recorded two new cases of Ebola in the capital Freetown, effectively disproving the assumption that the deadly virus no longer affected the city. According to Sidi Yahya Tunis, a spokesman for the National Ebola Response Centre (NERC), “this is worrisome because we had already closed all Ebola quarantine structures in Freetown since we had gone for weeks without a case.” Tunis further disclosed that there were concerns about further infection as the two cases were reported in Magazine Wharf, which is a densely populated neighbourhood that lacks adequate hygiene facilities. Health officials have disclosed that the first case to be reported in Freetown since 29 May is a fishermen who caught the virus from his girlfriend in the northern district of Port Loko, a northern province that remains affected by Ebola. Shortly afterwards, a family member who lived in the same household also caught the virus.