MS Risk Blog

Ebola Update (18 June 2015)

In the week leading up to 14 June, there was a total of 24 confirmed cases of Ebola virus disease (EVD) reported, compared with 27 cases that were recorded in the previous week. In Guinea, 10 cases were reported during this period in four prefectures: Boke, Conakry, Dubreka and Forecariah. Sierra Leone reported 14 cases in 2 districts, Kambia and Port Loko, during this reporting period.

Of the 76 confirmed cases of EVD that have been reported in Guinea and Sierra Leone over the past 21 days leading up to 14 June, 69 (91%) were reported in 3 prefectures in Guinea (Boke, Dubreka and Forecariah) and 2 districts in Sierra Leone (Kambia and Port Loko).

As of 14 June, there have been a total of 27,305 confirmed, probable and suspected cases of EVD in Guinea, Liberia and Sierra Leone, with 11,169 reported deaths.

Guinea

During this reporting period, a total of 10 confirmed cases of EVD were reported, compared with 12 cases from 4 prefectures that were reported in the previous week.

Cases were reported in 4 prefectures: Boke (2 cases); Conakry (1 case); Dubreka (4 cases); and Forecariah (3 cases). Of these 10 cases, 5 were registered contacts, including all four cases in Dubreka. Of the remaining five cases, 4 arose from an unknown source of infection. This includes both cases from Boke prefecture and 2 of the 3 cases that were reported in Forecariah.

In Guinea, health checkpoints have been set up in the western prefectures of Boke and Coyah. On 7 June officials in Dubreka carried out a 6-day door-to-door case-finding campaign, which led to the discovery of 1 confirmed case. Additionally, intensive investigations are currently underway in order to trace a number of high-risk contacts associated with 3 cases that were reported in the capital, Conakry, over the past two weeks.

Sierra Leone

During this reporting period, a total of 14 confirmed cases were recorded in 2 districts: Kambia and Port Loko, compared to the 15 cases that were reported in the same 2 districts the previous week.

For the third consecutive week, Kaffu Bullom in Port Loko reported the most cases, six in total, of any single chiefdom. According to officials, five of the six cases from Kaffu Bullom were contacts of previous cases in quarantined homes located in a small, densely populated area near the international airport. One case, however, was reported from a new area of the chiefdom, Targrin, and upon further investigation, the case was determined to have acquired infection after sharing a ward with a confirmed case in a privately run health facility. A total of twenty health workers have since been registered as having a medium – high-risk contact with the case and are currently being monitored by officials. The remaining 8 cases that were reported in Sierra Leone were registered contacts of known cases and were reported from quarantined homes in 4 chiefdoms: Magbema (1 case); Samu (1 case); and Tonko Limba (4 cases) in Kambia and Bureh Kasseh Ma (2 cases) in Port Loko. As of 14 June, the Western Urban Area, which includes the capital city Freetown, has reported no cases for over 16 consecutive days.

Officials have disclosed that all 14 cases that were reported in the week leading up to 14 June can be traced back to the secret movement of cases, contacts and secret burials of EVD-related deaths during April. Consequently, officials are planning to carry out a large-scale operation in the districts of Kambia and Port Loko.

On Friday 12 June, Sierra Leone’s President Ernest Bai Koroma announced that he was imposing a three-week daytime curfew in the last Ebola-hit areas in a bid to curb a resurgence of the deadly virus. The curfew announcement comes after the country on Thursday extended its nationwide state of emergency for 90 days, despite calls from opposition politicians to relax restrictions in the country’s Ebola-free districts.

The president made the announcement on state television, stating that he was imposing “with immediate effect a 6:00 AM to 6:00 PM chiefdom-level curfew” in parts of the northwestern districts of Kambia and Port Loko, which are the only areas that are still reporting new infections. The president has indicated that people in the worst-hit chiefdoms, or areas, of those districts will be confined to their homes for 21 days, warning that anyone found flouting the order would find themselves in jail for the same period. Grocery stores and markets, which have been ordered to close at 6:00 PM, will now be allowed to stay open until 9:00 PM in most parts of the country, while restaurants, which also had a 6:00 PM curfew, have been granted an extension until 10:00 PM. Motorbike taxis, which were previously barred from operating after 7:00 PM, have been given an extra two hours.

The latest lockdown has been called over fears that the disease, which has killed about 3,900 people in Sierra Leone, was making a comeback in the northwestern region of the country. Palo Conteh, head of the National Ebola Response Centre, has attributed the recent spike in Port Loko and Kambia to “people just being stubborn and engaged in the wrong things that fuel the transmission,” adding “some washing of bodies and secret burials are going on and people are taking the sick to herbalists.” A lawmaker is on bail awaiting trial for allegedly ordering the washing, dressing and burial of his 106-year-old father in Kambia in May. Amadu Koroma, a local government clerk in Kambia, has disclosed that herbalists were frequently bypassing official entry and exit points to treat patients in southern Guinea, the epicentre of the outbreak, adding “people have also been escaping from quarantined homes at night and ending up in Port Loko where relatives bring in herbalists to threat them in locked rooms.”

While neighbouring Liberia was declared Ebola-free in May, hopes that Sierra Leone and Guinea would quickly follow suit have, in recent weeks, been dashed. On Wednesday, the World Health Organization (WHO) announced that the retreat of the virus “that was apparent throughout April and early May has stalled.”   Sierra Leone’s health ministry has reported that 22 people are in Ebola treatment centres, all in Kambia and Port Loko, while 342 people are in quarantine in those districts and the Western Area, which includes the capital city, Freetown.

Al-Qaeda Leader Believed Killed in Libya…Again

Pentagon officials have indicated that they believe they hit their target – an al-Qaeda-linked commander who led a deadly attack on Algerian gas facility in 2013. However uncertainty surrounds the US airstrike on eastern Libya, and whether Mokhtar Belmokhtar was actually amongst the militants said to have been killed in the bombing, as al-Qaeda and other militants deny that Mokhtar Belmoktar was killed in the US airstrike.

Libyan officials have reported that Sunday’s airstrikes hit a gathering of militants on a farm outside Ajdabiya, a coastal city located about 850 kilometres (530 miles) east of the capital, Tripoli. A US official has indicated that in the airstrikes, two F-15 fighter jets launched multiple 500-pound bombs, with authorities confirming that there were no US personnel on the ground for the assault. However since these reports emerged, there have been conflicting reports on how many were killed, and whether Belmokhtar was amongst them.

An initial assessment indicates that the bombing that targeted Belmokhtar was successful, with Col. Steve Warren, a Pentagon spokesman, disclosing that “post-strike assessments” were still underway on Monday in order to determine whether the Algerian militant was in fact killed. Maj. Mohammed Hegazi, a military spokesman for Libya’s internationally recognized government based in the eastern region of the country, also disclosed Monday that further tests were needed in order to identify the dead, which numbered at least seventeen. He added that amongst those killed were three foreigners – a Tunisian and two unidentified militants. While Hegazi criticized his own government for rushing to confirm late Sunday that Belmokhtar was amongst the dead, he disclosed that the raid was based on solid intelligence, which indicated that militants forced out of the eastern city of Benghazi by fighting there had taken refuge in Ajdabiya. While both the Libyan and US government are leaning towards Belmokhtar having been killed in the strike, conflicting reports from al-Qaeda and Islamists operating in the region have emerged in recent days.

A Libyan Islamist with ties to militants indicated Monday that the airstrikes missed Belmokhtar but that they had killed four members of a Libyan extremist group that is linked to al-Qaeda, Ansar Shariah, in Ajdabiya. The group has been tied to the 11 September 2012 attack on the US Consulate in Benghazi that killed US Ambassador Chris Stevens and three other Americans. Another militant has also reported that Belmokhtar was not at the site of the airstrike. However a news website, which has previously carried statements from Belmokhtar, indicated that he was in Ajdabiya, meeting with affiliates. The Mauritanian website quoted informed sources in Libya stating that six people were killed in the raid and that a Tunisian and Yemeni were wounded.

On Tuesday, Ansar al-Shariah denied that Belmokhtar was killed in the US airstrike. In a statement, the group named seven people it said were killed in the US strike in eastern Libya, however Belmokhtar was not among them, with the statement indicating “no other person was killed.” A second statement released by an umbrella group for militias called the Shura Council of Ajdabiya and its Surroundings also did not list Belmokhtar among the dead.

If officials do confirm Belmokhtar’s death, this would be a major success for US counterterrorism efforts as he is one of the most-wanted militants in the region, with a US $5 million reward for information leading to his capture. However this is not the first time that authorities have claimed to have killed him. He was previously though to have been killed in Mali, however security sources disclosed last year that he had moved to Libya.

Belmokhtar, who is believed to be 43 years old, fought in Afghanistan, where reports emerged that he lost his eye in combat. He was one of a number of fighters who have been battling Algeria’s government since the 1990’s. He later joined al-Qaeda in the Islamic Maghreb (AQIM), before forming his own group, which led the January 2013 attack on Algeria’s Ain Amenas gas complex that killed at least 35 hostages, including three Americans. Reports later emerged that he was in Libya, with US officials believing he was based in the western and southern parts of the country. The US has filed terrorism charges against Belmokhtar in connection to the attack in Algeria, including conspiring to support al-Qaeda, use of a weapon of mass destruction and conspiring to take hostages. Officials maintain that he remains a threat to US and Western interests.

AQAP Confirms Death of Leader

Meanwhile in Yemen, al-Qaeda in the Arabian Peninsula (AQAP) has confirmed that Nasser al-Wuhayshi, the leader of the offshoot militant group, has been killed in a US drone strike in Yemen, in what is the heaviest blow to the jihadist network since the death of Osama Bin Laden in 2011.

His death was announced by AQAP in an online video, with prominent al-Qaeda militant Khaled Omar Batarfi, a senior member of the group, stating Wuhayshi “was killed in a US drone attack that targeted him along with two other mujahedeen,’ who were also killed. The video statement was dated 15 June. The militant group, which has been behind several plots against Western targets including the deadly attack on French magazine Charlie Hebdo in Paris earlier this year, indicated that it has named its military chief Qassem al-Rimi as its new leader.

Confirmation of Wuhayshi’s death comes after US officials had earlier reported that they are reviewing intelligence to confirm that he was killed in a CIA drone strike that was carried out on 9 June. Yemeni officials have reported that Wuhayshi was believed to have been killed last week in a raid in the al-Qaeda-held Mukalla, in the southeastern Yemeni province of Hadramawt. A Yemeni official further disclosed that last week, a drone had fired four missiles at three al-Qaeda militants, including an unnamed “leading figure,” near Mukalla port, adding that all three were killed on the spot. Witnesses also reported an explosion that killed three men on the seafront last Friday, adding that al-Qaeda gunmen had quickly cordoned off the area and gathered the remains, leading them to believe that a leader was amongst those killed.

Wuhayshi, a Yemeni believed to have been in his 30’s, travelled to Afghanistan in the late 1990’s where he attended al-Qaeda’s Al-Farouk training camp, and fought alongside Bin Laden. He would later become Bin Laden’s close confidante. As US forces closed in the battle of Tora Bora in late 2011, he escaped to Iran, where he was later arrested and extradited to Yemen, where he was jailed until escaping in February 2006. He became head of AQAP in 2007. US officials have indicated that he built one of the most active al-Qaeda branches, with Washington considering AQAP to be al-Qaeda’s deadliest branch. As well as the Charlie Hebdo attacks, which killed 12 people, AQAP was also behind an attempt to blow up as US commercial airline on Christmas Day 2009.

The US State Department had previously offered a US $10 million (£6.4 million) reward for anyone who could help bring Wuhayshi to justice, adding that he was “responsible for approving targets, recruiting new members, allocating resources to training and attack planning, and tasking others to carry out attacks.”

Since late January 2015, AQAP has lost a number of high profile figures in US strikes, including religious official Harith al-Nadhari, ideologue and spokesman Ibrahim al-Rubaish and religious and military official Nasser al-Ansi, along with several other lower ranking figures.

Suspected Boko Haram Militants Attack Chadian Capital

On Monday, officials in neighboring Chad reported that at least 23 people have been killed and more than 100 injured in suicide attacks carried out in the capital N’Djamena.

Eyewitnesses reported that attackers on motorcycles blew themselves up outside two police buildings. According to witnesses, one of the bombers on a motorcycle blew himself up after security officers fired at him outside a building where the national police chief is based while the second explosion went off at the headquarters of the national police academy.

The Chadian government has blamed the attacks on Nigerian-based Boko Haram, however the militant group has not commented. Hours after the attack, Communications Minister Hassan Sylla Bakara stated that Boko Haram had “made a mistake targeting Chad,” and that the group would be “neutralized.” The Communications Minister condemned the “appalling and barbaric attack,” stating that it “would not diminish Chad’s determination and commitment to fighting terrorism.” The minister added that all four of the attackers had been killed. On the ground sources have reported that in the wake of the attack, large numbers of troops have been deployed on the streets of the capital and a ban has been imposed on cards with tinted windows.

Chadian forces have played a key role in not only helping Nigeria battle Boko Haram, but also in the fight against other jihadist groups in the region. The Central African nation has been a long-standing adversary of jihadists, with the country’s president Idriss Deby Itno committing troops to combating militants in the region. They first joined French forces in 2013 to counter the advance of jihadists who had occupied the northern regions of Mali the previous year. In August 2014, France reorganized its military presence in the region by launching Operation Barkhane, which aims to fighting terrorism in Africa’s Sahel region. The force is headquartered in the Chadian capital, where France already has a large military base. In February this year, Chad launched a ground offensive in neighboring Nigeria, effectively leading the fight against the militant group. According to military sources, Chad has committed around 5,000 soldiers to this operation. N’Djamena will also host the headquarters of the joint military force that was created on 11 June by Chad, Cameroon, Benin, Niger and Nigeria against Boko Haram.

While the group has never targeted N’Djamena before, this attack should not come as a huge surprise, given the country’s role in fighting the insurgency. Boko Haram has previously criticized and taunted Chadian President Idriss Deby in its videos. In a statement United Nations Secretary General Ban Ki-moon condemned the bombings and praised Chad’s “courageous role” in fighting Boko Haram.

Ebola Cases in Guinea & Sierra Leone Rising Again

Researchers reported Tuesday that the Ebola strain in the current outbreak in West Africa is less virulent than the first one that appeared in 1976. The news comes as the latest figures released by the World Health Organization (WHO) show that the number of Ebola cases reported in Guinea and neighbouring Sierra Leone has risen for a second consecutive week.

According to a recent study, the results of the test on monkeys carried out by scientists at the National Institutes of Health (NIH) are considered important as they suggest that the virus, which has caused at least 11,000 deaths, is not becoming more severe. Instead, “…the new study suggests the current virus has a decreased ability to cause disease in their animal model compared to the 1976 strain.”

The 1976 strain is known as the Mayinga strain while the one that emerged in Guinea, Liberia and Sierra Leone late in 2013 is known as the Makona Strain. The 1976 Ebola outbreak was limited, killing 318 people in the Democratic Republic of Congo, formerly known as Zaire. The deadliest outbreak with this strain occurred in Uganda in 2000, when 425 people died. Both of these outbreaks had a weaker impact as they occurred in rural and sparsely populated areas.

The latest figures released by the WHO on Wednesday indicate that the number of Ebola cases in Guinea and Sierra Leone has risen for the second consecutive week. According to the latest report, in Guinea, 16 new cases were confirmed in the week ending 7 June, with 15 more reported in neighbouring Sierra Leone. In its latest situation report, the WHO indicates that the Ebola virus has infected 27,237 people and killed 11,158.

In the previous week, 13 new cases had been reported in Guinea, which represented a clear increase to the nine that were reported a week before that. The global health agency has voiced concerns that the areas affected in Guinea have increased as in the week leading up to 7 June, two new cases were confirmed in Guinea’s capital city, Conakry, which had been Ebola-free during the previous three weeks. The virus also reappeared in the western Guinean region of Kindia, where three new cases were confirmed during this reporting period. Officials have reported that the pattern is similar in neighbouring Sierra Leone, where 12 new cases were confirmed in the last week of May, compared to just three that were confirmed in the previous week.

MERS Reported in South Korea

As of 11 June 2015, 122 laboratory-confirmed cases of human infection with Middle East Respiratory Syndrome (MERS) Coronavirus have been reported by the South Korean health ministry, including 10 fatalities, making it the largest outbreak of MERS outside the Arabian Peninsula. Over the past three weeks, more than 3,800 people have been placed under quarantine, 641 of whom have been released after testing negative for MERS. For those infected during either the first or the second wave of the outbreak, the virus’s maximum two week incubation period has elapsed, a fact which has caused health officials to speculate that the disease has already peaked. Whether it has or not will depend on whether the containment measures adopted by the South Korean government were able to identify, isolate and treat those who had come into contact with the disease.

First identified in humans in September 2012, MERS is a viral respiratory illness from the same family as Severe Acute Respiratory Syndrome (SARS), the disease that struck China in 2003, infecting more than 5,300 people and killing 349 nationwide. There is no vaccine for MERS and doctors do not entirely understand how it is spread, except that it appears to be a zoonotic disease passed to humans from infected camels and bats. Most people infected with MERS become unwell quickly, experiencing fever, coughing and shortness of breath. Other symptoms may include diarrhoea, vomiting, nausea and muscle pain. Like other respiratory infections, it is not always possible to identify patients who have contracted MERS, as they may present with a range of non-specific symptoms in the early stages of the disease.

President Park Geun-hye’s government has been criticised for its failure to respond more swiftly to the outbreak of the disease and to identify “patient zero”: the 68-year old South Korean who returned home after an eight day trip to the Middle East where he had developed a cough and fever. After seeking treatment from four different health care facilities, the index patient was eventually hospitalised in Pyeongtaek, a city 65 kilometres southwest of Seoul. While refusing to name the specific hospitals and clinics visited by the patient, South Korean health authorities have confirmed that MERS cases were subsequently reported in three of the four institutions in question.

While health officials remain optimistic about containing the outbreak, its effect on South Korea’s economy is likely to have more far-reaching consequences. In what the Bank of Korea Governor Lee Ju-yeol described as a “pre-emptive more to contain the economic fallout from MERS”, interest rates have been lowered by a quarter of a percentage point to 1.5 percent. While precautionary measures such as these are doubtless in order, their effects have yet to be felt. Consumer confidence has been noticeably shaken by the virus’s spread and South Korean businesses, particularly those in hospitality and retail, have reported a sharp decline in sales. Tourism and international business has likewise been effected, with over 54,000 foreign travellers cancelling their plans to visit South Korea this month.

As the situation in South Korea continues to develop, concerns have been raised by health care professionals over MERS potential to become a global threat. While MERS is considered to be a potential pandemic threat, it seems unlikely that this particular outbreak will take on such catastrophic proportions. First, MERS is not a human virus. While it can be contracted by humans from infected animals, it is not highly contagious; in order for it to go pandemic – to pose an existential threat to members of the community – it would need to mutate. Second, the outbreak is comparatively small and mostly centred on hospitals and clinics. Although MERS spreads poorly between people, medical procedures and equipment, such as respirators, may aerosolise the virus from the lungs and infect people nearby. As a situation like this is unlikely to arise outside of a hospital setting, the spread of the disease is likely to be slow and once detected, more easily contained. Third, MERS is not SARS. While related, these two diseases differ in one important respect: SARS had developed the ability to be easily spread between people while MERS has not. Whether MERS will at some point in the future undergo genetic mutation enabling it to infect humans more easily is, at this point, mere speculation.