Authorities in Sierra Leone reported Tuesday that three more patients have tested positive for Ebola in a village in the northern region of the country that is already under quarantine in the wake of the death of a 67-year-old woman.
According to the National Ebola Response Centre (NERC), the new cases, which were diagnosed on Monday, bring the total in a recent outbreak in Sella Kafta in the district of Kambia to five. Speaking to reporters in the capital Freetown, NERC spokesman Sidi Yahya Tunis disclosed that the three new cases were amongst the fifty “high risk persons” who have been identified as being close relatives of the food trader, who died on 28 August. He further disclosed that “the development remains a concern for us but since it has taken place within a quarantined home, it can be adequately monitored and further transmission can be contained.”
The latest outbreak brought to an abrupt end the optimism that was fuelled by the release of what had been the West African country’s last known Ebola patient from a hospital in the central city of Makeni in late August. In the wake of the latest Ebola death, Sella Kafta, a village of almost 1,000 people, was placed under a three-week quarantine lockdown.
On Thursday 4 September, the World Health Organization (WHO) announced that Liberia has once again been declared free of the deadly Ebola virus, a move which prompted celebrations in the capital Monrovia.
In a statement released Thursday, the UN health agency indicated “WHO declares Liberia free of Ebola virus transmission in the human population,” adding that it hailed the country’s “successful response” to the recent re-emergence of Ebola. The statement noted that “Liberia’s ability to effectively respond to the outbreak of Ebola virus disease is due to intensified vigilance and rapid response by the government and multiple partners.” While the West African country, where at the height of the epidemic last year thousands died, had already been declared Ebola-free in May, six weeks later the country saw a resurgence of the deadly virus. Six people were infected, including two who died. While many Liberian’s in the capital city welcomed the news, most are taking it with caution, noting that like the last declaration, there may be further smaller outbreaks that continue over the coming weeks and months.
Liberia was long the hardest hit in the West African Ebola outbreak, which began in December 2013 and which infected more than 28,000 people, claiming the lives of more than 11,000 in Liberia as well as in Guinea and Sierra Leone. More than 10,500 of those infections and 4,800 of the deaths occurred in Liberia.
A country is considered free of human-to-human transmission once two 21-day incubation periods have passed since the last known case tested negative for a second time. Experts however have warned that even after 42 days, the danger is not over, particularly with the fact that small numbers of cases continue to surface in neighbouring Guinea and Sierra Leone. Liberia’s Ebola management department, Francis Karteh, has warned that while the Ebola-free announcement was a cause for celebration, complacency could not be allowed as the fight against the virus is “not yet over,” adding, “as long as there is one person with Ebola in our region, Ebola is still a threat.” Karteh further added that “the Ministry of Health and its partners will continue monitoring Liberia’s borders and rebuilding the healthcare system to assure that Liberians remain safe.”
In the seven days leading up to 12 July, there were thirty confirmed cases of Ebola Virus Disease (EVD) reported in Guinea, Liberia and Sierra Leone. While the total number of confirmed cases is the same as during the previous weeks, officials have noted that there has been a shift in the foci of transmission. During this reporting period, Guinea recorded 13 cases; Liberia 3; and Sierra Leone 14.
For the first time in several months, most of the cases that were reported during this period occurred in the capitals of Guinea (Conakry) and Sierra Leone (Freetown).
There have been a total of 27,642 confirmed, probable and suspected cases of EVD in Guinea, Liberia and Sierra Leone and 11,261 reported deaths. As of 12 July, there are 3,552 contacts being monitored across 6 prefectures in Guinea; 2 counties in Liberia and 3 districts in Sierra Leone.
Guinea recorded 13 confirmed cases of EVD in 3 prefectures: Conakry, Forecariah and Fria. For the first time in several months, the majority of the cases reporting during this week, 9, occurred in the capital, with seven of the 9 cases being reported in the Ratoma commune (administrative district). The remaining two were reported from the neighbouring commune of Matam. Officials have indicated that all of the cases are either registered contacts or have an epidemiological link to a known chain of transmission.
The small western prefecture of Fria reported a confirmed case this week for the first time in over forty days. Officials have indicated that the case is a contact of a previous case in the northern prefecture of Boke.
The northern prefecture of Boke, which had been a focus of transmission for several weeks, has not reported a case in eleven consecutive days, however officials have warned that cases may still arise as 125 contacts associated with previous cases are still being monitored.
During the reporting period, there were three new cases recorded in Liberia, bringing the total number of cases sine 29 June to six.
Officials have indicated that all of the three confirmed cases reported in the week leading up to 12 July were registered contacts associated with the same chain of transmission as the three cases reported in the previous week.
During this reporting period, there were 14 confirmed cases recorded in three districts: Freetown, Kambia and Port Loko. This is the highest total since the second week in June.
For the first time in several months, the majority of cases were reported in the capital city, Freetown. According to officials, eight of the 10 cases reported from the capital were registered contacts residing in quarantined homes in the Magazine Wharf area of the city, which has been a focus of transmission for several weeks. The two remaining cases both have an epidemiological link to the Magazine Wharf chain of transmission however they were identified after post-mortem testing and therefore represent a high risk of further transmission.
There were two cases reported in Kambia, in the Samu chiefdom on the northern border with Forecariah, Guinea. Officials have indicated that both cases were known contacts of a previous case. The remaining case was reported from a quarantined home in Tonko Limba chiefdom, and was also a registered contact of a previous case.
There was one case reported in Port Loko, in the chiefdom of Marampa. The source of infection is currently under investigation.
In the week leading up to 5 July, there were a total of 30 confirmed cases of Ebola virus disease (EVD): 18 in Guinea; 3 in Liberia; 9 in Sierra Leone. According to the World Health Organization (WHO), while “this is the highest weekly total since mid-May, improvements to case investigation and contact tracing, together with enhanced incentives to encourage case reporting and compliance with quarantine measures have led to a better understanding of chains of transmission than was the case a month ago.” Consequently, this has resulted in a decreasing proportion of cases arising from as-yet unknown sources of infection. This is especially the case in problematic areas, including Boke and Forecariah in Guinea; and Kambia and Port Loko in Sierra Leone. Officials however have warned that significant challenges remain, specifically a lack of trust in the response amongst some affected communities, which means that some cases still evade detection for too long.
To date, there have been a total of 27,573 reported confirmed, probable and suspected cases of EVD reported in Guinea, Liberia and Sierra Leone, with 11,246 reported deaths.
During this reporting period, a total of 18 cases were reported in Guinea. Cases were reported from the same 3 prefecture as in the previous week: Boke, Conakry and Forecariah.
During the seven days leading up to 5 July, the northern prefecture of Boke, which borders Guinea-Bissau, reported a total of 6 cases, a decline compared with the 10 cases that were reported in the previous week. Accoridng to local medical officials, all but one of the reported cases was a registered contact, with a single cases reported to have arisen from an as-yet unknown source of infection.
There was one case reported in Conakry, with officials indicating that it came from the Matam commune (municipal district) of the city and that it was a known contact of a previous case from Benty sub-prefecture in Forecariah.
The remaining 11 cases were reported in the prefecture of Forecariah, in which 9 of the cases were reported from the sub-prefecture of Benty. All but 2 of the 11 cases reported in the prefecture of Forecariah were known contacts of a previous case or have an established epidemiological link to one.
On 9 May, the WHO declared Liberia Ebola-free, after the West African country reported no new cases for 42 consecutive days. Since being declared free of the deadly virus, the country subsequently entered a 3-month period of heightened surveillance. During this time, there were approximately 30 blood samples and oral swabs collected each day from potential cases and tested for EVD. On 29 June, a confirmed case of EVD was detected in Margibi County, the first new confirmed case to be reported in Liberia since 20 March. The case involved a 17-year-old male who first became ill on 21 June. He died on 28 June and subsequently tested positive for EVD. Two contacts of the first-detected case have since tested positive for EVD. These cases are from the same small community as the first detected case. They are currently being treated in an Ebola Treatment Centre in the capital, Monrovia. Additionally another probable EVD case is currently in isolation.
Officials are currently investigating the origin of infection of this cluster of cases. Currently, these cases are considered to constitute a separate outbreak from that which was declared over on 9 May.
During this reporting period, 9 cases were reported in Sierra Leone. The cases were reported in the same three districts as the previous weeks: Kambia, Port Loko and Western Area Urban, which includes the capital city Freetown.
Three of the cases reported during this period were recorded in the densely populated Magazine Wharf area of Freetown. Officials have disclosed that all three cases were registered contacts of a previous case.
Four chiefdoms in Kambia each reported a single confirmed case of EVD, as did two chiefdoms in the neighbouring district of Port Loko. According to officials, all but one of these cases were known contacts of a previous case or have an established epidemiological link to one.
On 8 July, Sierra Leonean officials reported that they will extend curfews, which were imposed on the worst-affected communities last month, until the deadly virus has been eradicated. While Operation Northern Push, a drive aimed at ending infections in the northwestern region of the country, was due to last 21 days, with residents of chiefdoms subjected to night-time lockdowns expecting the restrictions to end on Tuesday, Palo Conteh, head of the government’s National Ebola Response Centre, told reporters in Freetown that the 6:00 PM to 6:00 AM lockdowns will continue indefinitely. Speaking to reporters, Conteh stated, “I am pleased to announce that due to the successes we are seeing in a number of key areas Operation Northern Push will continue to run until we get to zero (cases),” adding, “curfew times will remain the same and there will be regular reviews so that we can adapt the response to meet the requirements as they change.”
After reporting no confirmed cases of EVD since 20 March, and subsequently being declared Ebola-free by the WHO on 9 May, routine surveillance detected two confirmed cases of EVD in the town of Nedowein, Margibi County.
The initial case is a 17-year-old male who first became ill on 21 June. After checking into a local health facility, the patient was treated for malaria and discharged. He died on 28 June and received a safe burial the same day. An oral swab taken before the burial subsequently tested positive twice for EVD. On Wednesday, workers exhumed the 17-year-olds body. According to an official, new tests will help to determine the mode of transmission.
On 1 July, Liberian officials confirmed a second Ebola case in the same town. According to Deputy Health Minister Tolbert Nyeswah, the infected person has since been moved to Monrovia. Since then, officials have identified 102 contacts, however the number is expected to increase as investigations continue. At this stage, local officials have indicated that the origin of infection is unknown. The initial case reportedly had no recent history of travel, contact with visitors from affected areas, or funeral attendance. The area of Nedowein has since been placed under quarantine.
On Wednesday, more than 100 Ebola centre workers stormed the Ministry of Health in eastern Monrovia, demanding that they be paid hazard pay, which they have indicated they have not received since the country was declared Ebola-free. According to Health Minister Bernice Dahn, Liberia has paid hazard benefits to “99 percent” of people who worked in the Ebola treatment units in addition to their regular salaries, adding that if there are people who feel that they have not been paid, “they should come forward” and make their case with the ministry.