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.
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.
As of the end of 27 October 2014, a total of 13,703 confirmed, probable and suspected cases of EVD have been reported in six countries: Guinea, Liberia, Mali, Sierra Leone, Spain and the United States of America. The figure of confirmed, probable and suspected EVD cases includes cases in previously affected countries: Nigeria and Senegal. A total of 4,922 deaths have been reported. The death rate in the current outbreak has risen to 70 percent from the previously estimated mortality rate of 50 percent.
EVD transmission remains persistent and widespread in Guinea, Liberia and Sierra Leone, with World Health Organization (WHO) officials particularly concerned about the spread of the disease in the capital cities – Conakry, Monrovia and Freetown – where people are able to freely move across borders. All administrative districts in Liberia and Sierra Leone have now reported at least one confirmed or probable case of EVD since the outbreak began. According to WHO officials, “new cases continue to explode in areas that looked like they were coming under control,” noting “an unusual characteristic of this epidemic is a persistent cyclical pattern of gradual dips in the number of new cases, followed by sudden flare-ups.” While some regions in these countries have seen the number of EVD cases either stabilize or decrease, this does not mean that the regions are Ebola-free.
Countries with localized transmission, including Mali, Spain and the United States, are currently continuing to monitor potential contacts. On 23 October, Mali confirmed its first EVD case, a 2-year-old girl who died on 24 October.
On 21 October, the single patient with EVD in Spain tested negative for the disease for a second time. Unless a new case of EVD arises during this period, Spain will be declared Ebola-free 42 days after the date of the second negative test. In the United States, two health-care workers have tested negative for Ebola for the second time. They have both been discharged from hospital. Another health-care worker remains in isolation and is receiving treatment. WHO officials declared Senegal and Nigeria Ebola-free on 17 October and 20 October respectively.
The BBC has launched an Ebola public health information service on WhatsApp. The service will provide audio, text message alerts and images in order to help people living in West Africa get the latest public information on how to combat the spread of Ebola in the region. Content will be limited to three times per day and the service will be available in both French and English. To subscribe to this service, add +44 7702 348 651 to your contacts then send ‘JOIN’ to the number via WhatsApp. To unsubscribe, send ‘STOP’ via WhatsApp to the same number. Due to the large volume of requests, the BBC has warned that it may take a little time to be added or removed from the service.
Affected countries currently fall into three categories:
- Those with widespread and intense transmission: Guinea, Liberia and Sierra Leone;
- Those with either an initial case or cases, or with localized transmission: Mali, Nigeria, Senegal, Spain and the United States
- Those countries that either neighbour or have strong trade ties with areas of active transmission: Benin, Burkina Faso, Cameroon, Central African Republic, Democratic Republic of Congo, Gambia, Ghana, Guinea Bissau, Ivory Coast, Mali, Mauritania, Nigeria, Senegal, South Sudan and Togo.
The World Health Organization (WHO) has identified three patterns of transmission:
- In rural communities, which is facilitated by strong cultural practices and traditional beliefs;
- In densely populated urban communities;
- Cross-border transmission
- Countries with Widespread and Intense Transmission
Guinea currently has 1,906 confirmed, probable and suspected cases of EVD and 997 deaths. While cases of EVD transmission are the lowest in Guinea, transmission across the country continues to be of concern and is being driven by transmission in four key areas:
- The capital city Conakry – Over the past week, there have been six new confirmed cases of Ebola reported in Conakry. The capital city remains a key area of concern with the nearby district of Coyah reporting 8 new confirmed cases.
- N’Zerekore – Located south-east of Macenta, the district of N’Zerekore reported 10 new confirmed cases over the past week.
- Keouane – Transmission remains strong in this district, with 22 new confirmed cases in the last week, effectively continuing a rapid three-week growth in new cases.
- District of Macenta – The most intense transmission in Guinea is occurring in and around Macenta, which is located in the south-west region of Guinea, near the border with Liberia. Over the past week, the district reported 15 new confirmed cases. Transmission in this district has remained intense for the past 10 weeks.
The outbreak’s epicentre Gueckedou has reported few new cases over the past 7 weeks, with 3 confirmed new cases in the past week, however transmission persists. In contrast to the situation in Liberia and Sierra Leone, several areas in Guinea have not reported a single case of Ebola while seven areas have not reported any new cases over 21 days after reporting an initial case/cases.
Two new districts in Guinea reported a case or cases of Ebola for the first time in October. In the eastern region of the country, on the border with the Ivory Coast and on a major trade route with Mali, the previously unaffected district of Kankan reported 1 new confirmed case. In the central region of the country, the previously unaffected district of Faranah reported 1 confirmed case of Ebola. Faranah borders the newly affected Sierra Leonean district of Koinadugu to the southwest. The central district of Mamou is currently classified as unaffected.
Land borders with Liberia, Senegal and Sierra Leone have been closed. Health screenings at all border crossings have been set up and all travellers displaying a fever, or EVD-like symptoms, will be subject to quarantine and/or denied entry/exit, from the country. Expect to experience delays at land border crossings. Enhanced screening measures have been introduced for outbound passengers at Conakry airport.
Liberia has 6,535 confirmed, probable and suspected cases of EVD and remains the worst affected country in the current outbreak. The country has reported 2,413 deaths. All administrative districts in Liberia have now reported at least one confirmed or probable case of EVD since the outbreak began.
The most intense transmission continues to occur in the Montserrado area, where in the past week, 30 new probable cases were reported. This area includes the capital city, Monrovia. While the weekly increase in new cases in this area appears to have halted since mid-September, underreporting of cases remains to be an issue across the country, especially in Monrovia, and therefore it is difficult to capture an accurate picture of the current situation. Beyond the capital city, most new reported cases have occurred in the districts of Bong, Margibi and Bomi, which over the past week have each reported 12 probable cases. The district of Grand Gadeh, which previously was considered the only unaffected area in Liberia, now has 2 confirmed and 2 suspected cases of EVD. It must be noted that these new cases may have not occurred in the past week and that reporting of these cases was delayed.
Since 20 August, a state of emergency has been in place, with security forces enforcing a nationwide curfew. Between 11PM and 6AM every night no movement is allowed anywhere in the entire country. Liberian authorities have set up road blocks in a bid to restrict movement around the country while security forces have been deployed in order to enforce quarantine for certain areas, including Lofa county. In Monrovia, the army and police have sealed off the neighbourhood of West Point with the area being placed under quarantine. There have been a number of outbreaks of violence, with civilians rioting at hospitals and attacking health workers.
All borders of Liberia have been closed, with the exception of major entry points, including the Roberts International Airport and James Spriggs Payne Airport. The Bo Waterside Crossing to Sierra Leone remains closed along with the Foya Crossing to Guinea. Any remaining border crossings may be closed with minimal notice. The Liberia Airport Authority has introduced enhanced screening measures for both inbound and outbound travellers at airport facilities.
The Ministry of Health and Social Welfare has established hotlines for the public to get basic information on Ebola: Call 0770198517 or 0777549805 or 0886530260 or 0886549805.
General medical facilities throughout the country are currently under severe strain as a result of the Ebola outbreak. Dedicated healthcare facilities for Ebola are overwhelmed and may not accept further cases.
EVD transmission remains intense across Sierra Leone, with 5,235 confirmed, probable and suspected cases and 1,500 deaths. All districts in Sierra Leone have now reported at least one case of EVD.
Over the past week, the capital city Freetown reported 63 new confirmed cases and remains one of the country’s worst affected areas. The western rural region of the country reported 81 new cases over the past week, effectively making it the sixth consecutive weekly rise in the number of new cases in the area. The western districts of Bombali, which confirmed 56 new cases in the past week, and Port Loko, with 47 confirmed new cases, continue to be seriously affected by the outbreak. EVD cases in the district of Tonkolili are of increasing concern as over the past week the area reported 36 confirmed new cases. The neighbouring regions of Kenema and Kailahun reported 13 and 5 new confirmed cases respectively over the last week and remain amongst the worst affected areas of the country.
- Countries with Initial Case/Cases or Localized Transmission
Five countries – Mali, Nigeria, Senegal, Spain and the United States – have reported a case or cases of EVD imported from a country with widespread and intense transmission.
On 23 October, Mali confirmed its first EVD case. The patient was a 2-year-old girl who had travelled from the Guinean district of Kissidougou with her grandmother to the city of Kayes, located 600 kilometres (375 miles) from the Malian capital, near the border with Senegal. She had travelled by bus via the capital city Bamako, where she stayed for ten days in the Bagadadji neighbourhood. The patient was symptomatic for much of the journey. On 22 October, the patient was taken to Fousseyni Daou hospital in Kayes, where she died on 24 October.
Currently 82 contacts – 57 in Kayes and 27 in Bamako – are being monitored by officials and efforts to trace additional contacts are on-going. At the time of the confirmation of the first EVD case in Mali, a WHO preparedness team was deployed in the country to assess Mali’s state of readiness for an initial Ebola case. The team was immediately redirected to provide support and expertise to Malian health authorities and to help with contact tracing and the training of healthcare workers.
In the wake of the first confirmed case of Ebola in Mali, neighbouring Mauritania has implemented some border controls.
On 20 October 2014, the WHO declared Nigeria Ebola-free after six weeks of no new reported cases. For officials to declare the country Ebola-free, Nigeria had to make it 42 days with no new cases, which is double the incubation period, verify that it actively sought out all possible contacts, and show negative test results for any remaining suspected cases.
Nigeria had a total of twenty cases after a Liberian-American man flew into Lagos International Airport on July 20 and collapsed shortly afterwards. The disease later spread to Port Harcourt.
While Nigeria has been declared Ebola-free, Nigerian authorities are preparing for any additional outbreaks as the current Ebola epidemic in West Africa is far from over and spread to additional countries, including to Nigeria, remains possible.
On 17 October 2014, the WHO declared Senegal Ebola-free. The assessment was made after the West African country went forty-two days without reporting any new cases. In late August, Senegal confirmed one case of Ebola, an imported one from Guinea, which prompted officials to monitor seventy-four contacts of the patient and increase surveillance at the country’s entry ports.
A single case in Spain tested negative for EVD on 19 October. A second negative test was obtained on 21 October. A total of 83 contacts are currently being monitored. If no new cases are reported, Spain will be declared Ebola-free 42 days after the date of the second negative test.
There have been four confirmed EVD cases and one death in the US. Two health-care workers have now tested negative for Ebola twice and have been released from hospital. Another health-care worker has been placed in isolation in New York and is receiving treatment. Of 176 possible contacts, 92 are being monitored and 84 have completed the 21-day monitoring period.
- Preparedness of Countries to Rapidly Detect and Respond to an Ebola Exposure
The WHO has identified fifteen countries that neighbour countries that either are experiencing widespread and intense EVD transmission or have strong trade and travel ties with countries with current widespread and intense transmission. These countries are: Benin, Burkina Faso, Cameroon, Central African Republic, Democratic Republic of Congo, Gambia, Ghana, Guinea Bissau, Ivory Coast, Mali, Mauritania, Nigeria, Senegal, South Sudan and Togo. The WHO has assessed that Mali and the Ivory Coast are currently at the highest risk of importing the disease.
The WHO and its partners are currently working with these countries in order to help increase their level of preparedness in the event of exposure to EVD. Teams have already been deployed to the Ivory Coast and Mali, where they have been working with health authorities, and over the next week a mission will be deployed to Guinea Bissau. In the remaining countries, WHO teams and partners are working with local authorities to help identify any gaps in their capacity to identify and respond to an initial EVD case.
Ebola Outbreak in Democratic Republic of Congo (DRC)
As of 26 October 2014, there have been 67 cases (38 confirmed, 28 probable, 1 suspected) of Ebola in the Democratic Republic of Congo. The test results for the one suspected case are not yet known. This includes eight cases amongst healthcare workers. In total, there have been 49 deaths reported, including eight healthcare workers. All suspected cases have now been either laboratory confirmed or discarded.
Of a total of 1,121 total contacs, 1,116 have now completed a 21-day follow-up. On 10 October, the last reported cases tested negative for the second time and was discharged. The DRC will thefore be declared Ebola-free 42 days after the date of the second negative test if no new cases are reported. The current outbreak in the DRC is unrelated to that affecting West Africa.
While authorities in Sierra Leone have disclosed that a controversial three-day lockdown, which concluded Sunday, was a “success,” frustrated residents reported food shortages in some neighbourhoods of Sierra Leone’s capital city.
A three-day curfew, which began Friday in a bid to contain the spread of the Ebola outbreak in Sierra Leone, has been declared a success by authorities. According to the head of Sierra Leone’s Emergency Operations Centre Stephen Gaojia, the exercise was largely successful and the compliance and receptiveness of Sierra Leoneans was “overwhelming.” Speaking to reporters, Mr Gaoji further disclosed that officials “…were able to discover quite a lot of people who have been infected…” Deputy Chief Medical Officer Sarian Kamara confirmed that authorities managed to discover 22 new cases of the virus during the curfew, adding that between 60 and 70 Ebola victims had been buried over the past two days. There was only one incident of violence reported over the three-day period. On Saturday, local civilians attacked health workers trying to bury five bodies in a district located 20 kilometres east of the capital city Freetown. Police reinforcements later arrived to the area and the health workers were eventually able to compete the burial.
Although on Sunday rumours had circulated in Freetown that officials were opting to extend the lockdown, a Health Ministry statement issued Sunday evening confirmed that the lockdown had ended. The statement further disclosed that 75 percent of the targeted 1.5 million households had been contacted by outbreak teams, adding that outreach groups would continue to operate in “hot spots” across the country. Some residents also complained of food shortages in some neighbourhoods of Freetown. While the World Food Programme provided food packages including rice, beans and a form of porridge throughout the three-day lockdown, staffers were not going door-to-door and were instead focusing on serving houses placed under quarantine by medical teams. While agency officials confirmed that their workers had distributed two weeks’ worth of rations to 20,000 households, many residents complained that the provisions they received were insufficient.
The West African country announced the extreme measure in early September, announcing that the lockdown would effectively confine its population of six million to their homes for a period of 72 hours in a bid to stem the further spread of the deadly Ebola virus, which has already claimed more than 2,600 lives in Guinea, Liberia, Nigeria and Sierra Leone. Only essential workers, such as health professionals, were exempt from the lockdown, as were some 30,000 volunteers who went door-to-door to provide advice on halting the contagion and handling out bars of soap.
Despite most residents in the capital city welcoming teams of health workers and volunteers bearing information about the deadly virus, rumours continued to persist in some areas of the city, with some believing that soap which was distributed by health teams, was poisoned. Persistent rumours such as this one suggest that public education campaigns have not been entirely successful.
According to new data released by the World Health Organization (WHO) on Friday, the Ebola virus has killed more than 560 people in Sierra Leone and more than 2,600 across West Africa, in what is the largest outbreak of the deadly virus ever recorded. The disease, which is also affecting Guinea, Liberia, Nigeria and Senegal, is believed to have sickened more than 5,500 people. Sierra Leone’s three-day curfew is the most aggressive measure to be taken against the virus by a West African country.
Strict Measures Implemented in Liberia
In a bid to halt the continuing spread of the deadly virus, Liberia’s President Ellen Johnson Sirleaf has ordered the closure of most of Liberia’s border crossings and has ordered strict quarantines for those communities affected by the Ebola outbreak. The latest measures come just one month after the Liberian President warned that anyone caught hiding suspected Ebola patients would be prosecuted.
Liberian President Ellen Johnson Sirleaf has announced the closure of most of Liberia’s land borders adding that stringent medical checks are being increased at those airports and major trade routes that will remain open. A statement released by the government indicated, “all borders of Liberia will be closed with the exception of major entry points,” adding that all these entry points will have preventive and testing centres. Three major border crossings, a provincial airport and Monrovia’s international airport are exempted from the closures. The government has also banned public gatherings of any kind, including events and demonstrations. Authorities have not disclosed how the long these closures will remain in place.
The announcement, which occurred late Sunday, came just one day after the Liberian President formed a new taskforce charged with containing the disease that has already killed 129 in the country and more than 670 in the West African region. According to a statement released by the President’s office, the special Ebola task force will ensure that “communities that are seriously affected will be quarantined and travels in and out of such communities restricted.” The new orders include strict observation at the international airport of all outgoing and incoming passengers, who are now liable for inspection and testing. All government facilities and public places will also install public access for washing of hands while all hotels, restaurants, and film centres are to play a five-minute information clip on Ebola awareness and prevention.
While Guinea has borne the brunt of the outbreak, in recent weeks, Liberia has seen a sharp rise in Ebola cases and deaths. Amongst those killed by the deadly virus is prominent Liberian doctor Samuel Brisbane, who died this past weekend after a three-week battle with the virus. Two American aid workers have also fallen ill. Samaritan’s Purse, a Christian charity, confirmed Sunday that its physician Kent Brantly was in stable condition and had been isolated at the group’s Ebola treatment centre at the ELWA hospital in Liberia’s capital Monrovia. The charity further disclosed that Nancy Writtebol, a missionary with the SIM Christian charity that runs that hospital, is also in stable condition. Ms Writtebol had been working as a hygienist responsible for detoxifying protective suits worn by those entering and exiting Ebola isolation centres. Dr Brantly is the medical director of the Samaritan’s Purse Ebola case management centre in Liberia, where the agency is continuing to work with Liberian and international health officials in a bid to contain the outbreak. He began working with the group’s Liberia team in October and since June, he has been focusing on Ebola patients.
Ebola Virus Spreads to Nigeria with first Confirmed Death in Lagos
On Friday, officials in Nigeria disclosed that the Ebola virus has caused the death of a Liberian national who died while in quarantine in Lagos. The announcement confirms that the worst-ever outbreak of the virus has now spread to Africa’s most populous country, which is already battling a deadly militant insurgency in the north.
Nigeria’s Health Minister Onyebuch Chukwu told journalists that “thorough medical tests” had confirmed “the virus of Ebola” as the cause of death. The 40-year-old Liberian national, who died overnight, had worked for the Liberian government and had travelled to Nigeria from Monrovia by air via Togo’s capital Lome. According to the Liberian government, the man’s final destination had been the southern city of Calabar, where he was scheduled to attend a meeting organized by the west African bloc ECOWAS (Economic Community of West African States).
While fears are growing that the Ebola virus may rapidly spread in the populous city of Lagos, Nigeria’s Health Minister has attempted to calm local citizens, noting that upon the man’s arrival, he was transported directly to hospital, noting that the patient “avoided contact with the general public and that there was no time for him to mingle in Lagos.” According to Chukwu, “all the passengers that the patient came in contact with have been traced and are being investigated,” insisting that health officials have made direct contact with everyone on board the flight and are now monitoring their conditions. The patient had been flying on Togo-based ASKY Airlines.
In the wake of the first Ebola death in Nigeria, the country’s largest airline, Arik Air, has suspended all flights to Liberia and Sierra Leone. The company has disclosed that the decision to halt flights is a precautionary measure. A statement released by the airline, which operates routes across West Africa, indicated “we feel especially compelled to take the business decision to immediately suspend flight services into the two Ebola affected countries due to our interest in the well-being of Nigerians,” adding “we humbly suggest that as a first step, all inbound flights into Nigeria which originate from any of the Ebola affected countries, be immediately suspended.”
Nigeria has put all its entry points on red alert after confirming that a Liberian man died of Ebola after arriving at Lagos airport on Tuesday.
First Ebola Death Confirmed in Freetown
Meanwhile in Sierra Leone, a woman suffering from the first confirmed case of Ebola in the country’s capital city died Saturday after her parents forcibly took her from hospital. According to a statement released by the health ministry, Saudatu Koroma, a 32-year-old trainee hairdresser, was admitted to a clinic on July 23 had tested positive for the disease adding “her farther and mother forcibly took her away from the hospital” just two days after she was admitted.
While her disappearance prompted authorities in Freetown to broadcast a nationwide television and radio alert, which eventually persuaded her to return for treatment, Koroma died on Saturday while on her way to an Ebola treatment centre in the country’s east. According to an official, Koroma “…was severely dehydrated and weak and could hardly speak,” adding, “blood samples taken from both the father and mother are now being tested.” The house where Ms Koroma had lived in, in the eastern area of Freetown, has been quarantined over the past twenty-one days.
Sierra Leone’s health ministry confirmed Monday that an Ebola treatment centre has been established at Lakka Hospital, with health staff trained to handle the disease. Surveillance has also been increased throughout the country, with people now being requested to report all suspected cases to local health authorities.
According to the World Health Organization (WHO), as of July 20, the number of Ebola cases recorded in the months-long epidemic stood at 1,093. This includes more than 660 deaths.