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.
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.
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.
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.
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.
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.
According to the latest figures released by the World Health Organization (WHO) this week, data shows the lowest weekly cases of Ebola since May 2014.
In the week leading up to 5 April, a total of 30 confirmed cases of Ebola virus disease (EVD) were recorded. This is the lowest weekly total since the third week of May 2014. Of the total 55 districts in Guinea, Liberia and Sierra Leone that have reported at least one confirmed case of EVD since the outbreak began, 35 have not reported a case in over six weeks.
While Liberia and Sierra Leone have begun to decommission some treatment centres, the WHO has warned that there has been an increase in unsafe burials, particularly in Guinea, which could lead to more cases.
There have been a total of 25,515 confirmed, probable and suspected cases of EVD in Guinea, Liberia and Sierra Leone, with 10,572 deaths. In the past 21 days, a total of 191 EVD cases were recorded in the three countries.
Since recording one Ebola case in late March, Liberia has not recorded any new cases of the deadly disease since. The last confirmed case passed away on 27 March and Liberia is currently conducting the 42-day countdown to being officially declared free of the disease.
Guinea recorded 21 cases of EVD during this reporting period, compared to 57 confirmed the previous week. A total of six Guinean prefectures reported at least one confirmed case of EVD during this reporting period, a decline from the 7 prefectures that reported a case in the previous week. Affected prefectures are in the western area and include the capital city Conakry, which recorded 8 confirmed cases during this reporting period. The nearby prefectures of Coyah (1 case), Dubreka (1 case); Forecariah (6 cases), Fria (1 case) and Kindia (4 cases) also reported cases.
Sierra Leone reported a fifth consecutive weekly decrease from 25 confirmed cases in the week leading to 29 March, to 9 during this reporting period. Over this reporting period, Sierra Leone reported zero cases on 3 days.
Cases were reported in four western districts: Kambia (2 cases), Port Loko (1 case), Western Area Rural (1 case) and Western Area Urban (5 cases), which includes the capital city Freetown.
In total, there have been 24,701 confirmed, probable and suspected cases of Ebola Virus Disease (EVD) reported in Guinea, Liberia and Sierra Leone, with 10,194 deaths reported.
In the seven days leading up to 15 March, a total of 150 new confirmed cases of EVD were reported, compared with 116 that were reported in the previous week. Guinea reported 95 new confirmed cases, the highest weekly total for the country this year. Sierra Leone reported 55 new confirmed cases over the same period, which is the country’s lowest weekly total since late June 2014. Liberia reported no new confirmed cases of EVD for the third consecutive week.
A total of twelve districts in Guinea and neighbouring Sierra Leone reported a confirmed case during this reporting period. According to officials, all these districts lie on a “geographically contiguous arc in and around Conakry to the north and Freetown to the south.” While transmission is currently confined to this geographic corridor, the population is this region is highly mobile and there is a great deal of movement throughout the surrounding districts and countries.
In the week leading up to 15 March, 95 confirmed cases of EVD were reported, compared with 58 that were reported in the week before.
According to World Health Organization (WHO) officials, the current transmission has been confined to an area in and around the capital city Conakry (25 confirmed cases) as well as the nearby prefectures of Boffa (3 cases), Coyah (20 cases), Dubreka (2 cases), Forecariah (42 cases), and Kindia (3 cases).
In the seven days leading up to 15 March, Sierra Leone reported a total of 55 confirmed cases of EVD, compared with 58 that were reported in the previous week.
Cases were reported from six northern and western districts in and around the capital city Freetown, which reported 29 new confirmed cases during this reporting period. The following neighbouring districts also reported cases: Bombali (6 cases), Kambia (4 cases), Port Loko (11 cases) and Western Rural (3 cases).
No counties in Liberia have reported a confirmed case of EVD within the past 21 days.
The 15th of March was day 12 since the final patient in Liberia tested negative for EVD for a second time. Forty-two days must pass before transmission can be considered to have ended and Liberia can be declared Ebola-free, however an additional period of heightened vigilance will be required in order to aid in preventing another outbreak.
World Health Organization (WHO) officials disclosed Wednesday that Liberia has not registered any new Ebola cases since 19 February, adding that there have also been some improving signs in neighbouring Guinea and Sierra Leone.
According to latest figures released by the WHO, since the outbreak began in December 2013, 24,282 people in nine countries have been infected with the virus and 9,976 of them have died. All but fifteen of those deaths occurred in the three West African countries. In the week leading up to 8 March, a total of 116 new confirmed cases of Ebola were reported, compared with 132 that were registered in the previous week.
The tide in Liberia, which six months ago was reporting more than 300 new cases per week, appears to have turned. According to Bruce Aylward, who heads the WHO’s Ebola response, Liberia “has now gone well over two weeks without a new reported case.” Last week, the West African nation released its last confirmed Ebola patient, who had tested negative for the deadly virus for the second time on 3 March. On 4 March, Liberia effectively began its 42-day, or two incubation-period, countdown towards being considered Ebola-free. Liberia has been one of the hardest hit countries in the Ebola epidemic and still counts the most deaths in the outbreak, at 4,162.
Guinea and Sierra Leone
While neighbouring Guinea and Sierra Leone continue to report new cases, Aylward has highlighted some positive signs.
In the week leading up to 8 March, Guinea reported 58 new confirmed cases, compared with 51 cases that were reported in the previous week. Cases were clustered in an area in and around the capital city Conakry (13 cases) as well as in the nearby prefectures of Boffa (2 cases), Coyah (8 cases), Dubreka (5 cases); Forecariah (28 cases) and Kindia (2 cases). In the forest region of Guinea, where the deadly outbreak first began 15 months ago, no new cases have been reported in the last ten days.
While in Sierra Leone, which currently counts the most cases of the virus at 11,619, only 58 new confirmed cases were reported over the last week – the lowest number to be reported since June 2014. Eighty-one cases were reported in the previous week. Cases were reported in 5 northern and western districts located around the capital Freetown, which reported 27 new confirmed cases. The neighbouring districts of Bombali (6 cases), Kambia (7 cases), Port Loko (12 cases) and Western Rural (6 cases). With the exception of 4 districts in the southern region of the country, all districts in Sierra Leone have reported a confirmed case of Ebola over the past 21 days.
Officials at the WHO have warned that while they are seeing improvements in Guinea and Sierra Leone, if international attention, determination and funding to end the outbreak declines, “there is a huge risk of failing to do so.” Furthermore, continued resistance within some communities in Sierra Leone and Guinea is also threatening progress. WHO officials have noted that in both countries, some Ebola patients are still not being isolated and treated while some unsafe burials are still going on.