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Ebola Outbreak November Review

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:

1. Those with widespread and intense transmission: Guinea, Liberia and Sierra Leone;
2. Those with either an initial case or cases, or with localized transmission: Mali, Nigeria, Senegal, Spain and the United States
3. 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:

1. In rural communities, which is facilitated by strong cultural practices and traditional beliefs;
2. In densely populated urban communities;
3. Cross-border transmission

1. Countries with Widespread and Intense Transmission

 Guinea

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

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.

Sierra Leone

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.

2. 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.

Mali

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. 

Nigeria

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.

Senegal

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.

Spain

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. 

United States

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.

3. 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.

IS Reportedly Using Iraqi Pilots to Train Militants to Fly

A UK-based activist group, which is monitoring the conflict in Syria and recent territorial gains by Islamic State (IS), reported Friday that Iraqi pilots who have joined IS are now training IS members in Syria to fly three captured fighter jets.

According to the Syrian Observatory for Human Rights (SOHR), witnesses have reported seeing planes being flown around the Al-Jarrah military airport, which is located east of the contested city of Aleppo. Rami Abdul Rahman, head of the SOHR, disclosed Friday that IS militants were using Iraqi officers, who were pilots under ex-Iraqi President Saddam Hussein, to train fighters in Syria. He added, “people saw the flights, they went up many times from the airport and they are flying in the skies outside the airport and coming back.”

While it remains unknown just how many Iraqi pilots have defected and what the trainees’ previous level of familiarity with flight is, it is known that IS has three planes in its possession, which they captured earlier on the ground in Aleppo and Raqqa.

If IS is indeed using Iraqi pilots to train its fighters, such a move could have a major impact on global security, and could see the militant group attempt to hijack planes in Europe and the United States. With officials in Europe already warning that a number of EU nationals have travelled to Syria and Iraq to fight alongside IS militants, the jihadist group could be training militants with EU passports on how to hijack planes and carryout terrorist attacks similar to 9/11.

Meanwhile Iraqi forces have launched an attack on IS militants stationed near Tikrit. The Iraqi government reported Friday that its troops have gained ground to the northern and western regions of Tikrit, effectively cutting an important IS supply route. The city is amongst those areas that were seized by IS in Syria and Iraq earlier this year.

Kurdish forces, backed by US-led air strikes, are continuing to fight the militants in the northern Syrian town of Kobane. On Friday, US-led warplanes targeted jihadists attacking Kobane as Pentagon officials disclosed that despite a recent wave of deadly bombings in Baghdad, there was no imminent threat to the capital city.

Pentagon officials announced Friday that despite recent advances made by the militant group to the west of Baghdad, IS was not poised for an assault on the capital city. The battle for the town of Kobane has been seen as a major test for the US-led coalition’s air campaign and whether it will be able to successfully push back the militant group.

Ebola Cases Continue To Rise; Nigeria and Senegal Could Be Declared Ebola-Free in Days

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.

First Ebola Case Confirmed Outside of Africa

The 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 26^th 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.

Key al-Qaeda Branches Call for Unity Against US-led Strikes on IS

Two of al-Qaeda’s most prominent branches in North Africa and Yemen issued an unprecedented joint statement Tuesday, calling for jihadists operating in Syria and Iraq to join forces against the threat emanating from the US-led coalition that is targeting Islamic State (IS) fighters in the region. The statement comes as a supporter of IS militants warned of attacks against the United States and its allies.

Al-Qaeda Branches Issue Joint Statement

Two of al-Qaeda’s most prominent branches in North Africa and Yemen issued an unprecedented joint statement Tuesday, calling for jihadists operating in Syria and Iraq to join forces against the threat emanating from the US-led coalition that is targeting Islamic State (IS) fighters in the region.

Al-Qaeda in the Arabian Peninsula (AQAP) and al-Qaeda in the Islamic Maghreb (AQIM) urged their “brothers” in Iraq and Syria to “stop killing each other and unite against the American campaign and its evil coalition that threatens us all.” AQIM and AQAP have also called on the citizens of ten Arab countries that have joined the coalition to prevent their governments from acting against the terrorist group, which has recently achieved lightening territorial advances in Iraq and Syria. AQAP and AQIM have also promised “dark days” to the “alliance of infidelity and evil,” and have urged Syrian rebels to keep up their fight against President Bashar al-Assad, warning them to “beware of being tricked by America…and thus being diverted from your path” and becoming its “pawns.”

Tuesday’s joint statement however marked a significant change in al-Qaeda’s strategy as under the leadership of Ayman al-Zawahiri, Osama bin Laden’s successor, al-Qaeda disavowed IS. Both the Yemeni-based AQAP, which is seen by Washington as the network’s most dangerous branch, and AQIM have rejected IS’ June declaration of an Islamic caliphate, adding that they remained loyal to al-Zawahiri. Al-Qaeda also has its own branch, the al-Nursa front, that operates in Syria. While the network’s joint statement called for differences to be set aside in the face of a new growing coalition, the statement did not explicitly offer support for IS. Instead it is likely an attempt by al-Qaeda’s affiliates to maintain relevant in Washington and within IS. Similar statements of solidarity issued by other Islamist militant groups will likely surface as the US continues airstrikes in the region, however such statements do not necessarily mean that global support for IS is growing.

IS Supporter Warns of Attack Against US and Allies

A supporter of IS militants has warned of attacks on the United States and its allies if they continue to carry out military action against the group in Iraq and Syria. The message, which was posted on the Minbar Jihadi Media website, a well-known Islamist militant online forum, is just one of a few responses from supporters of IS to last week’s announcement by Washington indicating that it was preparing to extend airstrikes against the group into Syria.

The message condemned “intervention in the affairs of other peoples,” adding that “it will lead to an equal reaction of the same strength in targeting the American depth and also the nations allied to it and in all aspects.” The posting, by a supporter referred to as “Amir al-Thul,” also stated “I directed a sternly worded warning to each of those nations involved with America, or that are allied with it in their war against the Islamic Caliphate, that their local and international interests will be legitimate targets.”

While the message also called on the public in the US and its allies to oppose government actions against the group, it remains unclear what influence, if any, the author has on the actions of IS.