MS Risk Blog

2014 Ebola Outbreak – October Review

Posted on in West Africa title_rule

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:

  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


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.




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.



  1. 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.


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.


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.




Tagged as: , , , , , , , ,