2014 Ebola Outbreak – October Review
October 11, 2014 in West Africa
Executive Summary
Total Cases and Deaths: As of 23 September 2014 (WHO)
3,083 people have died from Ebola in Guinea, Liberia, Nigeria and Sierra Leone. 6,553 (probable, confirmed and suspected) cases.
The current Ebola Virus Disease (EVD) outbreak in West Africa has not been contained, with transmission continuing to occur in both community and healthcare settings. Resistance to efforts to control the disease, including outright denials that EVD exists and fears that healthcare workers deployed to combat the virus are spreading it, have further hindered efforts to prevent the disease from spreading and have effectively resulted in the region developing into a fertile ground for speculation and mistaken beliefs. This has sparked a rise in attacks on healthcare workers, including the recent death of an eight-member team in Guinea.
Over the past several weeks, the spread of EVD in West Africa has continued to accelerate. As of 23 September 2014, a total of 3,083 people have died of EVD, with another 6,553 reported cases. While the disease remains concentrated in three countries – Guinea, Liberia and Sierra Leone – it has continued to spread to new regions within these affected countries. On 30 September 2014, officials in the United States confirmed the first Ebola case. The current West Africa Ebola outbreak is likely to continue for another six – nine months before it is completely contained, with World Health Organization (WHO) officials predicting upwards of 20,000 cases.
Affected countries currently fall into two categories: Those with widespread and intense transmission – Guinea, Liberia and Sierra Leone – and those with either an initial case or cases, or with localized transmission – Lagos and Port Harcourt in Nigeria; Dakar in Senegal; Dallas, Texas in the United States. The capital cities of Guinea (Conakry), Liberia (Monrovia) and Sierra Leone (Freetown) have all been affected by the current outbreak.
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
Total Cases: As of 23 September 2014
1074 clinical cases (876 confirmed; 162 probable; 36 suspected); 648 deaths (481 confirmed; 162 probable; 5 suspected)
Current Affected Areas: Conakry, Coyah, Forecariah, Gueckedou, Kouroussa, Macenta, Siguiri, Pita, Nzerekore, Dubreka, Youmou, Kerouane.
No Longer Active: Boffa, Dabola, Dinguiraya, Kissidougou, Telimele
In September, the district of Kindia reported its first confirmed case of EVD. While there have been a number of other areas across the country that have not reported any new cases of EVD, currently there is no indication of a sustained reduction in case incidence in Guinea.
In mid-September, eight people, involved in Ebola awareness-raising activities, were killed near Womey, near the town of Nzerekore in the Forest region of Guinea. Police officials in the region have confirmed that the team was targeted on suspicion that they were attempting to spread the virus. In a separate incident on 24 September, a Red Cross team was attacked while collecting bodies believed to be infected with Ebola in south-eastern Guinea. Further such incidents in the coming weeks are likely to occur.
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
Total Cases: As of 23 September 2014
3458 clinical cases (914 confirmed, 1539 probable, 1005 suspected); 1830 deaths (792 confirmed; 623 probably; 415 suspected)
Current Affected Areas: Lofa, Montserrado, Margibi, Bomi, Bong, Grand Cape Mount, Nimba, Grand Bassa, Grand Gedeh, River Cess, River Gee, Sinoe, Gbarpolu, Grand Kru
Liberia remains the most-affected country in the current Ebola outbreak. The number of newly reported cases continues to rise on a week-to-week basis. This is primarily driven by a continuation of a recent surge in cases in the capital city, Monrovia, coupled with a lack of capacity in Ebola treatment centres.
In September, six confirmed cases of EVD and four deaths were reported in the district of Grand Kru, a rural area located near the border with the Ivory Coast. This is the first time the EVD cases have been reported in this area of the country.
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.
Sierra Leone
Total Cases: As of 23 September 2014
2021 clinical cases (1816 confirmed, 37 probable, 168 suspected); 605 deaths (557 confirmed; 37 probable; 11 suspected)
Current Affected Areas: Kailahun, Kenema, Kono, Kambia, Bombali, Tonkolili, Port Loko, Pujehun, Bo, Moyamba, Bonthe, Western Area
EVD cases in Sierra Leone continue to increase. Transmission remains high in the capital city, Freetown, and in the surrounding urban areas. Although over the past several weeks the number of newly reported cases in the districts of Kailahun and Kenema appear to have stabilized, a number of other districts have reported an increase. These include Port Loko, a district adjacent to Freetown, Bo, Bombali and Tonkolili.
Between 19 – 21 September, the Sierra Leonean government imposed a three-day nationwide shutdown. During this period, civilians were required to remain in their homes while Ebola awareness teams were deployed across the country to search for possible EVD patients. The government has since deemed the programme a success, adding that further such shutdowns may be implemented in the near future.
- Countries with Initial Case/Cases or Localized Transmission
Three countries, Nigeria and Senegal and most recently the United States, have reported a case or cases imported from a country with widespread and intense transmission.
Nigeria
Total Cases: As of 23 September 2014
20 clinical cases (19 confirmed; 1 probable; 0 suspected); 8 deaths (7 confirmed; 1 probable)
Current Affected Areas: Lagos and Port Harcourt
While Nigeria has not reported any new EVD cases since the first week of September, the country has not been deemed Ebola-free however the spread of EVD has been contained. All EVD cases in Nigeria occurred in Lagos and Port Harcourt.
Nigeria’s first Ebola case was an imported one and all cases in the transmission chain have been linked to a single person. Contact tracing and follow-up is on-going. In Nigeria, 847 contacts (out of a total of 872) have now completed the 21-day follow-up (349 contacts in Lagos; 498 in Port Harcourt). The last confirmed case in Lagos was reported on 5 September while the last confirmed case in Port Harcourt was reported on 1 September. In Lagos, all contacts have completed the 21-day follow-up.
Senegal
In Senegal, all contacts have now completed the 21-day follow-up and there have been no further reported cases of EVD. The last confirmed case of EVD was reported on 28 August. While the country has not been confirmed to be Ebola-free, the spread of EVD has been contained.
United States
Total Cases: As of 23 September 2014
1 Confirmed Case; 0 deaths
Current Affected Areas: Dakar
On 30 September, officials confirmed the first Ebola case in Dallas, Texas. Officials have confirmed that the unidentified male patient is being kept in isolation at Texas Health Presbyterian Hospital. It is believed that the man contracted the virus in Liberia prior to travelling to the US nearly two weeks ago. He arrived in the US on September 20. Symptoms of the virus became apparent on September 24 and the patient was admitted and placed in isolation on 28 September. While previously US aid workers have come back to the US, after catching Ebola in West Africa, this is the first case of a patient developing the virus on US soil. Health officials are currently identifying all people who came into contact with the unnamed patient while he was infectious. Those people will then be monitored for a period of 21 days.
Ebola Outbreak in Democratic Republic of Congo (DRC)
Total Cases: As of 24 September 2014
70 clinical cases (30 confirmed; 26 probable; 14 suspected); 40 deaths
Current Affected Areas: Equateur province
An epidemic has since been declared in the region of Djera, in the territory of Boende in the province of Equateur. Officials however believe that the infections are of a different strain to those in the outbreak in West Africa. One of the two cases tested positive for the Sudanese strain of the disease, while the other tested positive for a mixture between the Sudanese and the Zaire strain. The outbreak in West Africa is due to the Zaire strain.
Senegalese Peacekeeper Killed in Latest Attack in Mali
October 8, 2014 in SenegalDays after nine Nigerien peacekeepers were killed in northern Mali, on Tuesday a Senegalese United Nations peacekeeper was killed when a joint French-UN military camp in the northern Malian town of Kidal was hit by rocket fire.
Olivier Salgado, spokesman for the UN force, which is known as MINUSMA, confirmed the attack, stating that between six and eight rockets had been fired at the camp. Officials in Senegal later confirmed that the peacekeeper who was killed in the attack was a member of Senegal’s 845-strong contingent deployed in Mali as part of the UN’s peacekeeping mission. Two other Senegalese peacekeepers were lightly injured.
While it remains unclear who is behind the latest attack, sources believe that Iyad Ag Ghaly, who led a Tuareg rebellion in the Sahara before forming Ansar Dine, may be the reason why Islamist insurgents operating in the region have recently increased their attacks on UN peacekeepers operating in Mali. After disappearing in January 2013, shortly after French troops intervened in a bid to drive Islamist insurgents away from the capital Bamako, Iyad Ag Ghaly resurfaced last month, issuing a video message signalling a return to combat. In the video, he indicated that his group was “ready to unite with our brothers on the ground to face up to the crusaders and infidels who have united to fight Islam in our land.” Sources from UN’s MINUSMA force in Mali believe that his militant group is likely behind the recent attacks however the reduction of French troops, coupled with the absence of Malian troops from the region, has also likely contributed to the recent upsurge of militant activity. UN peacekeeping chief Herve Ladsous has also attributed the instability in southern Libya to the recent increase in attacks, stating that it is “a factor that plays a role in the fact that these jihadists…have restarted their activities. They have without doubt re-acquired equipment.”
On Friday, nine UN soldiers, all from neighbouring Niger, were killed in the northeastern desert region when armed men on motorbikes targeted them. That attack was claimed by a militant with links to Movement for Oneness and Jihad in West Africa (MUJAO). Friday’s attack brought the number of deaths in the UN mission since its deployment in July 2013 to thirty. Three Senegalese peacekeepers have now died in northern Mali.
For a period of ten months in 2012, Islamist groups Ansar Dine, al-Qaeda in the Islamic Maghreb (AQIM) and MUJAO occupied the northern desert region of Mali, a region that makes up nearly two thirds of the country, before they were ousted by a French-led military operation launched in January 2013. While stability has generally been brought back to the region, militants have continued to carry out attacks, specifically targeting French troops. UN troops are now trying to stabilize the northern region while peace talks between the Malian government and Tuaregs continue.
First Ebola Case Confirmed Outside of Africa
October 1, 2014 in United StatesThe first case of the deadly Ebola Virus Disease (EVD) diagnosed on US soil has been confirmed in Dallas, Texas. Officials confirmed Tuesday that the unidentified male patient is being kept in isolation at Texas Health Presbyterian Hospital and have pledged to contain the virus that has already killed more than 3,000 people in West Africa.
It is believed that the man contracted the virus in Liberia prior to traveling to the US to visit family members nearly two weeks ago. He arrived in the US on September 20. Symptoms of the virus became apparent on September 24, with the patient being admitted to hospital on the 26th and placed in isolation on September 28. While previously US aid workers have come back to the US, after catching Ebola in West Africa, this is the first case of a patient developing the virus on US soil. It is believed that the patient was not in Liberia as part of on-going efforts to combat the spread of the virus there.
Health officials have disclosed that they are currently identifying all people who came into contact with the unnamed patient while he was infectious however officials at the Centres for Disease Control and Prevention have cautioned that since he was not sick on the plane, he was unlikely to have infected other travellers as Ebola is not contagious until the patient begins to display symptoms, which can include fatigue, fever, muscle aches, vomiting, diarrhoea and bleeding. According to CDC chief Tom Frieden, “at this point there is zero risk of transmission on the flight. The illness of Ebola would not have gone on for 10 days before diagnosis…he was checked for fever before getting on the flight and there is no reason to think that anyone on the flight that he was on would be at risk.” Anyone to have had contact with the patient will be monitored for a period of 21 days. According to Mr Frieden, currently there are only a “handful” of people, mainly family members, believed to have come in contact with the patient while he was sick. While measures, such as checking temperatures, have been implemented at airports and border crossings across the affected countries in West Africa, this case has demonstrated that patients deemed Ebola-free when leaving an infected region may not necessarily be free of the virus, but may only be not displaying any symptoms at the time.
Latest figures released by the World Health Organization (WHO) indicate that the world’s largest outbreak of Ebola has infected more than 6,500 people across five West African countries, killing 3,091 since the start of this year.
The beginning of the West Africa outbreak has been identified as a two-year-old boy in Guinea who became sick with EVD in December 2013. While experts do not know how the child came down with the virus, some believe that he may have come in contact with an infected fruit bat, which are the natural hosts for the virus. Since then, the disease has spread rapidly, primarily affecting Guinea, Liberia and Sierra Leone. In July, Ebola was confirmed in Nigeria when a dual US-Liberian citizen, who flew on a pane from Liberia to Lagos, died days later. The outbreak there killed eight and infected 20 people, however WHO officials have indicated that while Nigeria is not yet Ebola-free, the spread of the deadly virus has been contained, with no new confirmed cases reported since the beginning of September. One patient was also confirmed to have Ebola in Senegal, however like in Nigeria, the spread of the disease has been contained. The last confirmed case of Ebola reported in Senegal occurred on 28 August.
Ebola Death Toll Nears 2,000 Mark
September 5, 2014 in Democratic Republic of the Congo, Guinea, Liberia, Nigeria, Senegal, Sierra Leone, West AfricaAccording to new figures released Thursday by the World Health Organisation (WHO), more than 1,900 people have died in West Africa’s Ebola outbreak. There have also been 3,500 confirmed or probable cases reported in Guinea, Liberia and Sierra Leone. WHO chief Margaret Chan warned Thursday “the outbreaks are racing ahead of the control efforts in these countries,” adding that at least US $600 million (£360 million) is needed in order to fight the virus. Ms Chan has described the current outbreak as “the largest and most severe and most complex we have ever seen.”
The latest statistics represent a significant increase from the 1,552 deaths and 3,069 cases that were reported by the Geneva-based organisation last week. According to the WHO, more than 40% of the deaths have occurred in the three weeks leading up to 3 September. This indicates that the epidemic is fast outpacing efforts to control it. According to Ms Chan, the WHO “…would like to reverse the trend in three months” in those countries where there is a “very tense transmission.” This includes Guinea, Liberia and Sierra Leone. In countries with “localized transmission,” such as Senegal, where so far only one case has been reported, and the Democratic Republic of Congo, which now has reported 31 deaths, the WHO “would like to stop all transmission within eight weeks.”
The speed of the deadly virus has prompted WHO officials to meet on Thursday in order to examine the most promising treatments and to discuss how to fast-track testing and production. According to sources, disease control experts, medical researchers, officials from affected countries and specialists in medical ethics will be represented at the meeting, which will take place in Geneva.
The Ebola virus has continued to spread in Nigeria, despite WHO officials stating that they were hopeful it would remain under control. On Wednesday, Nigerian authorities reported two additional cases in the city of Port Harcourt. Until the Port Harcourt case was announced, Nigeria’s government had indicated that the virus was contained in Lagos. On Thursday, the WHO warned “the outbreak of Ebola virus disease in Port Harcourt has the potential to grow larger and spread faster than the one in Lagos.” The UN health body has disclosed that the virus’ arrival in Port Harcourt, located 435 kilometres (270 miles) east of Lagos and home to oil and gas majors including Chevron, Shell and Total, showed “multiple high-risk opportunities for transmission of the virus to others.” Out of 255 people currently under surveillance for signs of the disease, 60 are considered to have had “high-risk or very high-risk exposure.
WHO Calls for Drastic Action in Ebola Fight
June 27, 2014 in Guinea, Liberia, Sierra LeoneThe World Heath Organization (WHO) on Thursday called for “drastic action” in order to fight the deadliest Ebola outbreak on record, and announced an 11-nation meeting to address the growing crisis.
As of Sunday 22 June, 635 cases of hemorrhagic fever, most confirmed to be Ebola, including 399 deaths, have been reported across Guinea, Liberia and Sierra Leone. This effectively makes the outbreak the largest ever “in terms of the number of cases and deaths as well as geographical spread.” A statement released by the UN agency stressed that “drastic action is needed,” and warned of the danger that the virus could jump to other countries. The WHO’s call for drastic action comes just days after medical charity Doctors Without Borders (MSF) indicated that the virus was now “out of control.’
Since the deadly epidemic emerged in Guinea in January, WHO has deployed more than 150 experts in a bid to tackle the crisis. However despite its efforts, and the efforts of other medical charities, over the past three weeks there has been a “significant increase” in the number of cases and deaths reported each day. According to WHO’s regional director for Africa, Dr Luis Sambo, the agency is now “gravely concerned by the on-going cross-border transmission into neighboring countries as well as the potential for further international spread,” adding “this is no longer a country specific outbreak but a sub-regional crisis that requires firm action by governments and partners.”
WHO’s top Ebola specials Pierre Formenty warned last week that the recent surge in cases had likely come in part because efforts to contain the virus had been relaxed too quickly after the outbreak appeared to have slowed down in April. In order to address the on going crisis, officials at the WHO announced Thursday that they will convene a meeting of the health ministers from 11 countries in Accra, Ghana on July 2 – 3 in order “to discuss the best way of tackling the crisis collectively as well as develop a comprehensive inter-country operation response plan.” Ministers from Guinea, where nearly 400 confirmed, suspected and probably cases have surfaced so far, including 280 deaths; and Liberia, which has 63 cases and 41 deaths, will take part in the meeting. Ministers from Sierra Leone will also be present. Additionally, neighboring countries, including Gambia, Ghana, Guinea Bissau, Ivory Coast, Mali and Senegal, and countries as far afield as the Democratic Republic of Congo and Uganda have also been invited. The meeting will also include a range of UN agencies and other aid organizations including MSF and the Red Cross as well as the Western African, British, EU and US centers for disease control.
Meanwhile on Wednesday, officials from the WHO announced that, at the request of the Sierra Leonean government, they were changing the way it reports fatalities from the Ebola outbreak in the country.
Previously, probable and suspected deaths from Ebola were included in the count however from now on, only laboratory confirmed cases will be reported. Therefore this reduces the death toll in Sierra Leone from 58 to 34 as of 24 June 2014. According to WHO spokeswoman Fadel Chaib, the way that deaths are reported in Guinea and Liberia, which are the other two countries affected by the deadly outbreak, will remain unchanged.
The change comes after Sierra Leone’s press had criticized the government for reporting lower death rates than those reported by the WHO. The changes however now bring the WHO figures inline with those released by the Sierra Leone government. The latest Ebola outbreak has now been named by international organizations as the worst Ebola epidemic ever with 635 cases and 399 fatalities occurring in dozens of sites across the three countries, including in major cities and remote areas. Officials from Doctors Without Borders (MSF) have described the outbreak as “out of control,” adding that it had reports of cases in more than 60 sites and that its resources were now stretched to the limit. In light of the on going outbreak, which has worsened in recent weeks, the European Commission announced Tuesday that it was committing an additional 500,000 euros in funding in order to combat the outbreak. This latest funding brings its total contribution to 1.9 million euros.
