Military officials reported on Monday that two female suicide bombers suspected of belonging to the Boko Haram militant group blew themselves up on Monday near a mosque in Cameroon’s Far North province.
While officials have disclosed that it was not immediately clear if the explosions caused other fatalities, sources are reporting that Boko Haram militants are likely to be behind the latest attack.
Meanwhile in Senegal, officials disclosed on Monday that they have arrested five people suspected of having links to Boko Haram – a development that could mark a significant expansion of the militant group’s operations. According to a senior justice ministry official, the five were arrested last month in the suburbs of Senegal’s capital city Dakar and in the central town of Kaolak, more than 2,500 km (1,500 miles) from the militant’s base in northeastern Nigeria. The official has disclosed that “we believe those arrested have ties with Boko Haram,” adding that a judge charged them on Friday with alleged relations with a terrorism organization, financing of terrorism and money laundering.
In the days leading up to 14 December, there has been a total of 18,603 confirmed, probable and suspected cases of Ebola virus disease (EVD) that have been reported in five affected countries: Guinea, Liberia, Mali, Sierra Leone and the United States; and three previously affected countries: Nigeria, Senegal and Spain. There have been 6,915 reported deaths. Reported case incidence in Guinea is fluctuating and is on the decline in Liberia. In neighbouring Sierra Leone, there are signs that the increase in incidence is beginning to slow. The case fatality rate in the three intense-transmission countries remains at 70%.
In the week leading up to 14 December, a total of 76 new confirmed cases were reported. Since September, the national trend in case reporting across Guinea has been fluctuating, with between 75 and 148 confirmed cases reported each week. World Health Organization (WHO) officials have reported that currently, there is no clear upward or downward trend in national case incidence.
Transmission remains high in the capital city of Conakry, which reported 18 confirmed cases in the week leading up to 14 December. EVD transmission remains high in the neighbouring district of Coyah, with 14 confirmed new cases. South of capital city, in Forecariah, officials have reported a surge in new cases, with 13 new confirmed cases in the past week. The district had reported its first case 12 weeks ago and until now, had reported no more than 4 confirmed cases each week.
Transmission remains persistent in the eastern district of N’Zerekore, with 6 new confirmed cases reported in the week leading up to 14 December. The district of Dubreka reported 3 confirmed cases, while new cases continue to be reported in the outbreak’s epicentre of Gueckedou (2 confirmed cases); Kerouane (5 confirmed cases) and Lola and Kouroussa (2 confirmed cases in each district). In the past week, Macenta reported only three confirmed cases, a sharp decline from the 15 cases that were reported in each of the two previous weeks. WHO officials however have warned that it remains too early to draw conclusions whether this decline in reporting in this district will be sustained. After reporting last week its first case since June, Telimele reported 5 new confirmed cases. While the districts of Kindia and Faranah did not report any new confirmed cases, officials in these two districts reported 21 and 12 probable cases respectively. The northern district of Siguiri reported 4 probable cases. This area requires continued vigilance, particularly due to its proximity to Mali.
Officials in the Guinean capital of Conakry have banned all public Christmas and New Year celebrations in a bid to curb the spread of EVD. A statement issued by Conakry governor Soriba Sorel Camara on 16 December indicated that “large-scale gatherings in public places are suspended for the moment,” adding “beaches will remain closed” and firecrackers and fireworks will also be banned. The capital city’s governor has appealed to residents to “refrain from anything” that would compromise efforts to contain the spread of Ebola. This means avoiding “all gatherings in markets, bus stations, ferry landing stages, hospital and the airport.”
At the national level, case incidence in Liberia has been on the decline, with 6 districts reporting new confirmed or probable cases in the week leading up to 14 December.
Transmission remains intense in Montserrado, which includes the capital Monrovia. The district reported 3 confirmed cases and 9 probable cases. Grand Bassa experienced a decline in cases, reporting only one confirmed case after having reported 7 in the previous week. The other districts to report confirmed cases during this period included Bong (1 confirmed case); Grand Cape Mount (2 confirmed cases) and Marigibi (1 confirmed case). In the northern region of the country, Lofa reported no cases for the seventh consecutive week. This is likely due to the strength of response efforts being carried out across the district.
EVD transmission across Sierra Leone remains intense, with the country reporting 327 new confirmed cases in the week leading up to 14 December. While WHO officials have reported that there are signs that the increase in case incidence has slowed, and that the incidence may no longer be on the rise, the country reported the highest number of confirmed cases in epidemiological week 50.
EVD transmission remains most intense and persistent in the western and northern districts of the country. The capital city Freetown accounted for 125 of all new confirmed cases. Other western districts that reported new confirmed cases include Port Loko (56 cases); Western Rural Area (52 cases); Bombali (23 cases) and Kambia (11 cases).
In the country’s eastern region, the district of Kono, which has experienced high transmission over the past five weeks, reported 12 confirmed cases in the week leading to 14 December. The neighbouring district of Koinadugu in the northeast reported three cases. Although transmission has been intense in Tonkolili for the past three weeks, in recent weeks the number of new weekly cases has declined from a peak of 56 four weeks ago to 14 cases over the past week. In the southern region of the country, the district of Bo continues to report a high number of new cases, with 24 confirmed cases in the week leading up to 14 December. By contrast, the south-eastern districts of Kenema and Kailahun reported 1 and 3 new cases respectively. Only two districts in Sierra Leone did not report any new cases during this reporting period: Bonthe and Pujehun.
Officials in Sierra Leone have banned any public Christmas celebrations in a bid to halt the spread of EVD. According to the government’s Ebola response unit, soldiers will be deployed across the country throughout the holiday period to ensure that all residents remain indoors. Officials in Sierra Leone have also imposed a two-week lockdown on the eastern diamond-mining district of Kono. The lockdown will effectively limit residents’ movements until 23 December.
Countries with an Initial Case/Cases or with Localized Transmission
Five countries: Mali, Nigeria, Senegal, Spain and the United States of America; have reported a case or cases of EVD imported from a country with widespread and intense transmission.
In Mali, a total of 8 cases (7 confirmed and 1 probable) including 6 deaths (5 confirmed and 1 probable) have been reported. The most recent seven cases were reported in the Malian capital Bamako and are not related to the country’s first EVD case, which was reported in Kayes on 24 October. The last confirmed case tested negative for the second time on 6 December and was discharged from hospital on 11 December. All identified contacts of both the initial case and the outbreak in Bamako have now completed the 21-day-follow up. If there are no more reported cases of EVD in Mali, the West African country will be declared Ebola-free by the WHO in mid January.
In the United States, there have been four confirmed cases of EVD and 1 death. All contacts in the country have now completed the 21-day follow-up period. If no further cases are reported in the US, the country will be declared Ebola-free at the end of December.
Nigeria, Senegal and Spain have all been declared Ebola free by the WHO.
Just a week after the World Health Organization (WHO) announced that it would deploy experts to the Ivory Coast and Mali to test their Ebola-preparedness measures, on Thursday, Mali’s Health Minister confirmed the country’s first Ebola case.
Speaking on state television late Thursday, Malian Health Minister Ousmane Kone confirmed that a two-year-old girl has tested positive for the deadly virus, disclosing that she was currently being treated at a hospital in the western town of Kayes, which is located 600 kilometres (375 miles) from the capital city Bamako. According to the Health Minister, the girl was brought to the Fousseyni Daou hospital on Wednesday, where she was immediately tested for the virus, which came back positive. Reports have indicated that the girl had recently returned from Kissidougou, in neighbouring Guinea, where the Ebola outbreak first emerged last December. Her mother died in Guinea several weeks ago, with the girl recently being brought to Bamako by relatives. She stayed in the Malian capital for ten days, in the Bagadadji neighbourhood, before leaving for Kayes. The child and 43 people who have come into contact with her have been put in quarantine, with the health minister urging anyone who may have had contact with the girl to come forward. A source within the health ministry has reported that the child’s condition is said to be improving.
Mali is now the sixth country in West Africa to be affected by the worst-ever Ebola outbreak, however both Senegal and Nigeria have in the past week been declared Ebola-free by WHO officials. Health officials have long viewed Mali as one of the most vulnerable to Ebola’s spread as the West African country borders both Guinea, which has been one of the hardest-hit countries by the current outbreak, and Senegal. The WHO’s list of fifteen African countries that need to be prepared for a possible Ebola case identified both Mali and the Ivory Coast as top priorities. Last week, WHO officials announced that they will deploy experts to both countries in order to test their Ebola-preparedness measures as both countries are currently at the greatest risk of being the next to be affected by the outbreak. Speaking during a news conference in Geneva last week, Isabell Nuttal, the WHO’s health security response chief disclosed, “as the number of cases is increasing, it wouldn’t be a surprise to have a case in neighbouring countries. And its for this very reason that we are working with them so that they are able to detect and take immediate action,” adding, “border checkpoints and health points have been implemented on the major roads that are crossing between the countries, so it provides a level of reassurance in terms of travelling.” On Sunday, a team of ten experts was set to deploy to Mali, with another team set to deploy to the Ivory Coast in the coming days.
An outbreak of the Ebola virus in Mali would likely severely threaten the country’s already fragile security situation, as Mali is continuing to stabilize after a coup and Islamist militant takeover of its northern region. It could also result in a greater risk to healthcare workers deployed in the country. While several teams of health workers have been attacked in Guinea, with several workers killed in September by locals as they attempted to spread awareness about the deadly virus, terrorist groups operating in the northern regions could target health workers for kidnap-for-ransom or could carry out violent attacks similar to those that targeted polio vaccination workers in Nigeria and Pakistan.
New figures released by the WHO on Wednesday indicate that Ebola has now killed 4,877 people and infected 9,936 across West Africa, with most of the deaths and cases occurring in Guinea, Liberia and Sierra Leone. The official number of cases and deaths however remains unknown as under-reporting continues to be a major issue in this outbreak, however the WHO indicated last week that the true death toll may be three times as high as the one currently being reported. A separate and unrelated outbreak in the Democratic Republic of Congo in central Africa currently appears to have been contained.
With six weeks of no new Ebola cases, on Monday officials at the World Health Organization (WHO) declared Nigeria officially free of Ebola, just three days after officials declared Senegal Ebola-free. While it is a containment victory in an outbreak that continues to rage in three West African countries, both states are not immune from another outbreak however their methods of containment may be used in future outbreaks.
On Monday, officials at 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, effectively 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, Patrick Sawyer, flew into Lagos international airport on July 20 and collapsed shortly afterwards. As Nigeria had no previous screening procedures in place, the deadly virus ultimately killed eight people, a low number in comparison to the thousands of cases and deaths in other countries, with the disease spreading from Lagos to Port Harcourt before it was contained. Amongst those who died was Dr Ameyo Stella Adadevo, who diagnosed Mr Sawyer and who is credited with helping to contain the outbreak at its source. The last reported case in Nigeria, which is Africa’s most populous country, was discovered on 5 September.
Speaking to reporters shortly after the declaration, Nigerian Minister of Health Onyebuchi Chukwu disclosed “its possible to control Ebola. Its possible to defeat Ebola. We’ve seen it here in Nigeria,” adding “if any cases emerge in the future, it will be considered – by international standards – a separate outbreak. If that happens, Nigeria will be ready and able to confront it exactly as we have done with this outbreak.”
Nigeria has won praise for its swift response to the outbreak. With the epidemic raging in Western Africa since March, officials knew that there was a likelihood that a case of Ebola could surface within its borders. This prompted officials to train health care workers on how to manage the disease and to disseminate information across the country about the disease and how it spreads. Shortly after Mr Sawyer’s death, the Nigerian government declared a national public health emergency. This effectively enabled the Ministry of Health to set up its Ebola Emergency Operations Centre (EOC), which is an assembly of public health experts within Nigeria, and which includes officials from the WHO, Centres for Disease Control (CDC) and medical aid groups such as Doctors Without Borders. The EOC was tasked with contact tracing, implementing strict procedures for handling and treating patients, screening all individuals arriving or departing the country by land, air and sea and communicating with the community. Some EOC workers were involved in going door-to-door to offer Ebola-related education while others worked with religious and professional leaders to spread information about the disease. While in the beginning, there had been some misinformation about available cures and rumours circulating across the country, Nigerian officials used social media in order to increase awareness efforts and publicized those patients who had been successfully treated and discharged from hospital. While other regional countries opted to close their borders with those affected countries, Nigeria chose to keep its borders open with Guinea, Liberia and Sierra Leone, indicating that such a move would have been counterproductive. According to Dr Faisal Shuaib of the EOC, “closing borders tends to reinforce panic and the notion of helplessness….When you close the legal points of entry, then you potentially drive people to use illegal passages, thus compounding the problem,” adding that if “public health strategies are implemented, outbreaks can be controlled, and that closing borders would only stifle commercial activities in the countries where economies are already struggling due to Ebola.”
Despite being declared Ebola-free, Nigerian authorities are preparing for any additional outbreaks as the current Ebola epidemic in West Africa is far from over and a spread to additional countries, including Nigeria and Senegal, remains possible. Nigeria has not slowed down its training and preparations for the possibility of more cases, with Dr Shuaib disclosing “outbreak response preparedness is a continuous process that requires constant review of the level of the response mechanisms in place to ensure that the health system is ready to jump into action at all levels.”
On Friday, the WHO declared Senegal, which borders with Guinea, clear of the disease. The agency made the assessment after the West African country went forty-two days, without reporting any new cases. The WHO has commended the Senegalese government’s efforts at preventing the spread of the virus. In late August, Senegal had one confirmed 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 points.
In new figures released by the UN health Agency Friday, 4,555 people have died of confirmed, suspected or probable cases of Ebola, with almost all of the deaths occurring in Guinea, Liberia and Sierra Leone. A total of 9,216 cases have been reported. An estimated 70% of those infected with the deadly disease have died in those countries. The situation in all three West African countries has continued to worsen, with deaths attributed to the disease on the rise in all three.
New figures released by the World Health Organisation on Tuesday 14 October revealed that over 8,900 confirmed, probable and suspected cases of the Ebola Virus Disease (EVD) have been reported in seven affected countries: Guinea, Liberia, Nigeria, Senegal, Sierra Leone, Spain and the United States of America. As of 14 October there have been 4,447 deaths. Health workers have been hit hard by the outbreak, with Doctors Without Borders reporting that sixteen of its employees have been infected with Ebola, in which nine of them have died. A top United Nations official warned this week that Ebola was winning the race as the WHO warned that within the next two months, West Africa could face up to 10,000 new Ebola cases per week if the outbreak is not contained.
Speaking at a news conference in Geneva, WHO assistant director-general Dr Bruce Aylward, disclosed that the death rate in the current outbreak had risen to 70 percent, from the previously estimated mortality rate of 50 percent. Acknowledging that Ebola was “a high mortality disease,” Dr Aylward noted that the UN health agency was still focused on getting six people into isolation and providing treatment to them as early as possible, adding that if the global response to the current Ebola outbreak is not stepped up in the coming sixty days, “a lot more people will die” and health workers will be stretched even further.
Experts in the field have indicated that the epidemic is doubling in size about every three weeks, with Dr Aylward indicating that over the last month, there have been about 1,000 new Ebola cases per week. This included confirmed, suspected and probable cases. Guinea, Liberia and Sierra Leone continue to the be the hardest-hit countries in the current epidemic, with WHO officials particularly concerned about the spread of Ebola in their capital cities – Conakry, Monrovia and Freetown – where people move freely across borders. While some regions in these countries have seen the number of Ebola cases either stabilize or fall, this does not mean that the regions are Ebola-free. Neighbouring countries, including Guinea-Bissau, the Ivory Coast and Mali are currently at a high risk of importing the disease.
The WHO also announced Tuesday that Nigeria and Senegal could be declared Ebola-free in the coming days after completing a 42-day period with no new cases. A statement released on Tuesday revealed “if the active surveillance for new cases that is currently in place continues, and no new cases are detected, WHO will declare the end of the outbreak of Ebola virus disease in Senegal on Friday 17 October.” If no new cases are reported in Nigeria, then the WHO will declare it Ebola-free on 20 October.
Senegal had one patient who was confirmed to have EVD. He has since recovered and it does not appear that anyone else was infected with the deadly disease. In Nigeria, one traveller from Liberia triggered an outbreak in which eight people died, most of them health workers. The virus spread from the initial case in Lagos to Port Harcourt however it has since been contained with no new reported cases. The situation in Guinea, Liberia and Sierra Leone however is far different as, according to the WHO, “new cases continue to explode in areas that looked like they were coming under control.” Adding “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.”
Officials at the WHO indicate that waiting for forty-two days from the time when the last person with high risk exposure has tested negative for the disease effectively provides sufficient confidence to declare that the outbreak is over. The 42-day period is twice the generally accepted maximum incubation period of the virus however some incubation periods are longer, with the WHO is indicating that in 95 percent of Ebola cases, the incubation period was between one and 21 days while in 98 percent, it was no longer than 42 days.