wuestenschiff.de

EBOLA VIRUS DISEASE - WEST AFRICA (197): MALI, ETHIOPIA, GUINEA
***************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] WHO: Ebola response roadmap situation report 25 Oct 2014
[2] Mali: index case dies, many exposed
[3] Ethiopia sending 200 volunteers
[4] Guinea: AmeriCares donation

******
[1] WHO: Ebola Response Roadmap Situation Report 25 Oct 2014
Date: Sat 25 Oct 2014
Source: WHO Global Alert and Response (GAR), Pandemic and Epidemic Diseases, Situation reports: Ebola response roadmap [summ. edited]
http://apps.who.int/iris/bitstream/1066 ... g.pdf?ua=1


Situation report update -- 25 Oct 2014
--------------------------------------
Summary
-------
A total of 10 141 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in 6 affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain, and the United States of America) and 2 previously affected countries (Nigeria, Senegal) up to the end of [23 Oct 2014]. There have been 4922 reported deaths.

Following the WHO Ebola Response Roadmap structure, country reports fall into 2 categories: 1) those with widespread and intense transmission (Guinea, Liberia, and Sierra Leone); and 2) those with or that have had an initial case or cases, or with localized transmission (Mali, Nigeria, Senegal, Spain, and the USA).

Countries with widespread and intense transmission
--------------------------------------------------
A total of 10 114 confirmed, probable, and suspected cases of EVD and 4912 deaths have been reported up to the end of [18 Oct 2014] by the Ministry of Health of Liberia, [21 Oct 2014] by the Ministry of Health of Guinea, and [22 Oct 2014] by the Ministry of Health of Sierra Leone. All but one district in Liberia and all districts in Sierra Leone have now reported at least one case of EVD since the start of the outbreak. Of the 8 Guinean and Liberian districts that share a border with Cote d'Ivoire, only 2 are yet to report a confirmed or probable case of EVD.

A total of 450 health care workers (HCWs) are known to have been infected with EVD up to the end of [23 Oct 2014]: 80 in Guinea; 228 in Liberia; 11 in Nigeria; 127 in Sierra Leone; one in Spain; and 3 in the USA. A total of 244 HCWs have died.

WHO is undertaking extensive investigations to determine the cause of infection in each case. Early indications are that a substantial proportion of infections occurred outside the context of Ebola treatment and care. Infection prevention and control quality assurance checks are now under way at every Ebola treatment unit in the 3 intense-transmission countries. At the same time, exhaustive efforts are ongoing to ensure an ample supply of optimal personal protective equipment to all Ebola treatment facilities, along with the provision of training and relevant guidelines to ensure that all HCWs are exposed to the minimum possible level of risk.

Country: cases (all) / deaths
Guinea: 1553 / 926
Liberia*: 4665 / 2705
Sierra Leone**: 3896 / 1281
Total: 10 114 / 4912

*For Liberia, 276 more confirmed deaths have been reported than have confirmed cases.
**For Sierra Leone, 127 more probable deaths have been reported than have probable cases. Data are based on official information reported by ministries of health. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results.

Countries with an initial case or cases, or with localized transmission
----------------------------------------------------------
Five countries (Mali, Nigeria, Senegal, Spain, and the USA) have now reported a case or cases imported from a country with widespread and intense transmission.

In Nigeria, there were 20 cases and 8 deaths. In Senegal, there was one case and no deaths. However, following a successful response in both countries, the outbreaks of EVD in Senegal and Nigeria were declared over on [17 Oct and 19 Oct 2014], respectively.

On [23 Oct 2014], Mali reported its 1st confirmed case of EVD. The patient was a 2 year old girl who travelled from the Guinean district of Kissidougou with her grandmother to the city of Kayes in western Mali, which is about 600 km [373 mile] from the Malian capital Bamako and lies close to the border with Senegal. The patient was symptomatic for much of the journey. On [22 Oct 2014], the patient was taken to Fousseyni Daou hospital in Kayes, where she died on [24 Oct 2014]. At present, 43 contacts, of whom 10 are HCWs, are being monitored; efforts to trace further contacts are ongoing. A WHO team was already in Mali to assess the country's state of readiness for an initial case. A rapid response team will also arrive in the coming days.

In Spain, the single case tested negative for EVD on [19 Oct 2014]. A 2nd negative test was obtained on [21 Oct 2014]. Spain will, therefore, be declared free of EVD 42 days after the date of the 2nd negative test if no new cases are reported. A total of 83 contacts are being monitored.

There have now been 4 cases and one death in the USA. The most recent case is a medical aid worker who volunteered in Guinea and returned to New York City on [17 Oct 2014]. The patient was screened and was asymptomatic on arrival but reported a fever on [23 Oct 2014] and tested positive for EVD. The patient is currently in isolation at Bellevue Hospital in New York City, one of 8 hospitals in New York State that have been designated to treat patients with EVD. Possible contacts are being identified and followed up. Two HCWs who became infected after treating an EVD-positive patient at the Texas Presbyterian Hospital of Dallas, Texas, have now tested negative for EVD. Of a total of 176 possible contacts linked with these cases, 109 are currently being monitored; 67 have completed 21-day follow-up. In Ohio, 153 crew and passengers who shared a flight with one of the infected HCWs (prior to the patient developing symptoms) are being followed up, though they are considered low-risk and are not considered to be contacts.

Country: cases (all) / deaths
Mali: 1 / 1
Spain: 1 / 0
USA: 4 / 1
Total: 6 / 2

--
communicated by:
ProMED-SoAs
<promed-SoAs@promedmail.org>

[The full update is available at the source URL above. It includes:
- tables of confirmed, probable, and suspected cases in the 6 currently affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain, and the United States of America).
- map of the geographical distribution of new cases and total cases in Guinea, Liberia, and Sierra Leone.
- Annex 1: Categories used to classify Ebola cases (suspected, probable, confirmed).
- Annex 2: overview of the situation in the Democratic Republic of the Congo, where a separate, unrelated outbreak of EVD is occurring. - Sr.Tech.Ed.MJ]

******
[2] Mali: index case dies, many exposed
Date: 25 Oct 2014
Source: BBC [edited]
http://www.bbc.com/news/world-africa-29755443


The authorities in Mali have confirmed the death of the country's 1st Ebola patient, a 2 year old girl. The World Health Organization said the toddler had travelled hundreds of km by bus from Guinea through Mali showing symptoms of the disease. More than 40 people known to have come into contact with her have been quarantined. The girl was being treated in the western town of Kayes, after arriving at a hospital on Wed [22 Oct 2014].

The child had travelled more than 1000 km (600 miles) from Guinea through the capital, Bamako, to Kayes. "The child's symptomatic state during the bus journey is especially concerning, as it presented multiple opportunities for exposures, including high-risk exposures, involving many people," WHO said. The girl's mother died in Guinea a few weeks ago, and the child was then brought by relatives to Mali...

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[An earlier report said 6 nurses who attended the little girl in Kayes Hospital had been quarantined. This is a disaster for the country and the world. It is not a single, non-fatal case as in Senegal, nor an imported case with few contacts quickly contained, as in Nigeria and the USA, but something very much worse.

For a map of Kayes in Mali, see http://www.solutionsforwater.org/wp-con ... gion-2.jpg. - Mod.JW]

--

Mauritania: closes border with Mali over Ebola fears
--------------------------------------------
25 Oct 2014: Reuters [link]
http://www.reuters.com/article/2014/10/ ... GM20141025

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[Sad to say, but is there any reason to think that this border closure will be any more effective than others in West Africa? In exculpation, governments have to be seen to be taking firm steps. - Mod.JW]

******
[3] Ethiopia sending 200 volunteers
Date: 24 Oct 2014
Source: ReliefWeb [edited]
http://reliefweb.int/report/liberia/eth ... se-efforts


The Ethiopian government has pledged to deploy 200 volunteer health professionals to West Africa and also donated USD 500 000 to Liberia, Guinea and Sierra Leone. The health professionals comprise medical doctors, nurses, field epidemiologists, environmental health personnel and public health specialists. These will engage in Ebola case management/treatment, surveillance, contact tracing, social mobilization, and community engagement, and will also assist national health systems in the affected countries to continue their essential and basic health, food, water and sanitation services.

Making the announcement, the Ethiopia minister of health, Dr Kesetebirhan Admasu, said: "This new commitment of deploying medical staff can be considered as a continuation and commitment of Ethiopia's firm stand for African solidarity. Ethiopia shall and will continue to support all efforts until this dreadful crisis is over."

Welcoming the Ethiopia offer, the commissioner for social affairs, Dr Mustapha Sidiki Kaloko, expressed appreciation to the government and people of Ethiopia for the exemplary contribution and hopes that the positive decision of Ethiopia will encourage other member states to favourably respond to the AU [African Union] chairperson's call for contributions from member states in the fight against Ebola. In response to the Ebola epidemic, the AU has deployed medical volunteers to Liberia and Sierra Leone under its African Union Support to Ebola Outbreak (Operation ASEOWA). The commission is deploying another batch of health experts to Guinea next week...

[byline: Wynne Musabayana <MusabayanaW@africa-union.org>]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[4] Guinea: AmeriCares donation
Date: Source: Relief Web [edited]
http://reliefweb.int/report/guinea/amer ... eak-guinea


Nearly 30 000 lbs [13 600 kg] of safety equipment and medical supplies from AmeriCares is headed to Guinea for health workers fighting the Ebola epidemic. The shipment -- AmeriCares 1st aid delivery to Guinea for the crisis -- includes more than 350 000 masks, 35 000 gowns and other protective equipment to support the Ebola response in Guinea. This personal protective equipment will be distributed to Ebola treatment units and health clinics and will be used to train health workers in infection control procedures.

"There are new cases of the virus reported every week in Guinea," said AmeriCares vice president of emergency response Garrett Ingoglia. "With the proper protective gear, we know we can stop the virus from spreading to health workers, who offer the best hope for containing the epidemic."

The shipment will be delivered on a humanitarian flight organized by Airlink, a Washington DC-based nonprofit that connects aid organizations with free passenger and cargo transportation. Airlink has established an air bridge to streamline transportation of critically needed supplies to combat the Ebola outbreak in West Africa...

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[AmeriCares sent 60 000 lbs of similar Ebola aid to Liberia in September 2014; see ProMED post Ebola virus disease - West Africa (182): vaccine, orphans, S.Leone, prevention 20140930.2817719. Not to denigrate such charity to Guinea, but judging by the latest case figures one might have thought that Sierra Leone, with 2.5 times the number of reported cases, is in greater need, and also, as long as Sierra Leone has cases, Ebola will return to Guinea in cross-border traffic.

Readers, please note: there are items of interest about the US quarantine controversy, insurance rate increases for businesses regarding Ebola, and questions about infection of dogs in other threads: see Hot topics tab on the ProMED home page at http://www.promedmail.org. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at http://healthmap.org/promed/p/50.]

EBOLA VIRUS DISEASE - WEST AFRICA (198): CDC UPDATE, MALI, SIERRA LEONE
***********************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] CDC update, 3 countries
[2] Mali: implications of infection
[3] Sierra Leone: Ebola situation report in pdf chart from Government
[4] Sierra Leone: IBM joins fight against Ebola
[5] Sierra Leone: UK NHS staff will help

******
[1] CDC update, 3 countries
Date: 28 Oct 2014
Source: CDC/MMWR [edited]
http://www.cdc.gov/mmwr/preview/mmwrhtm ... 3e1028a1_e


Charts and pictures at link
Early Release 28 Oct 2014 / 63(Early Release);1-4
------------------------------------------------
By: Incident Management System Ebola Epidemiology Team, CDC; Guinea Interministerial Committee for Response Against the Ebola Virus; CDC Guinea Response Team; Liberia Ministry of Health and Social Welfare; CDC Liberia Response Team; Sierra Leone Ministry of Health and Sanitation; CDC Sierra Leone Response Team; Viral Special Pathogens Branch, National Center for Emerging and Zoonotic Infectious Diseases, CDC
--

CDC is assisting ministries of health and working with other organizations to control and end the ongoing outbreak of Ebola virus disease (Ebola) in West Africa (http://www.cdc.gov/mmwr/preview/mmwrhtm ... m6325a4_w1).

The updated data in this report were compiled from situation reports from the Guinea Interministerial Committee for Response Against the Ebola Virus and the World Health Organization, the Liberia Ministry of Health and Social Welfare, and the Sierra Leone Ministry of Health and Sanitation. Total case counts include all suspected, probable, and confirmed cases as defined by each country. These data reflect reported cases, which make up an unknown proportion of all actual cases and reporting delays that vary from country to country.

According to the latest World Health Organization update as of 22 Oct 2014 (2), a total of 9911 Ebola cases have been reported as of 19 Oct 2014 from 3 highly affected West African countries (Guinea, Liberia, and Sierra Leone) (http://www.cdc.gov/mmwr/preview/mmwrhtm ... 8a1_e#Fig1 Figure 1). The highest reported case counts were from Liberia (4665 cases), followed by Sierra Leone (3706) and Guinea (1540).

The geographic distribution of the number of Ebola cases reported during 28 Sep - 18 Oct 2014 changed from the distribution of cases reported during 31 Aug - 23 Sep 2014 (http://www.cdc.gov/mmwr/preview/mmwrhtm ... m6339a4_w3), when counts were highest in the areas where Liberia, Sierra Leone, and Guinea meet. Counts of Ebola cases reported during 28 Sep - 18 Oct 2014 were highest in the area around Monrovia and in the district of Bong, Liberia; the Freetown area and the northwest districts of Sierra Leone; and the district of Macenta, Guinea (http://www.cdc.gov/mmwr/preview/mmwrhtm ... 8a1_e#Fig2 Figure 2).

The map of the cumulative incidence of Ebola, as of 18 Oct 2014, indicates that the highest incidence rate (over 100 cases per 100 000 population) was reported by 2 districts in Guinea (Guekedou and Macenta), 5 districts in Liberia (Bomi, Bong, Lofa, Margibi, and Montserrado), and 4 districts in Sierra Leone (Bombali, Kailahun, Kenema, and Port Loko) (http://www.cdc.gov/mmwr/preview/mmwrhtm ... 8a1_e#Fig3 Figure 3).

The latest updates on the 2014 Ebola outbreak in West Africa, including case counts, are available at http://www.cdc.gov/vhf/ebola/outbreaks/ ... index.html.
The most up-to-date clinical guidelines on the 2014 Ebola outbreak in West Africa are available at http://www.cdc.gov/vhf/ebola/hcp/index.html.

--
Communicated by:
Ryan McGinnis
<ryan@bigstormpicture.com>

[It should be noted that the case counts reported officially by the 3 countries are well known to be basically unreliable because of the difficulty in finding cases that do not come to a hospital and the impossibility of getting lab confirmation for most of them. - Mod.JW]

******
[2] Mali: implications of infection
Date: 24 Oct 2014
Source: Washington Post [excerpts]
http://www.washingtonpost.com/blogs/wor ... la-in-mali


The baby girl in Mali is reported to have been bleeding from her nose while she traveled from Guinea on a bus that stopped in several towns in Mali. WHO is now warning that a large number of people may have been exposed to the girl while she was infectious. Finding and containing these people may not be a simple task. Like Liberia, Guinea and Sierra Leone, Mali is poor, with a low GDP per capita and a weak health care system. These countries are really fragile and can't absorb these types of cases without causing a lot of calamity to their systems.

Mali has also suffered from serious security problems, and since 2012, the central government has battled an Islamist insurgency in the North of the country. "Access to health care is still a critical issue for people in the north of Mali," Christoph Luedi, head of the Red Cross delegation in Mali, said in November 2013. "Conflict continues to have an effect on the functioning of health facilities, which struggle mightily to meet people's needs without outside support."

WHO is now sending a group of experts to Mali to bolster a team of 3 workers, a representative told The Post. So far, 43 contacts of the infected infant have been isolated, including 10 health-care workers in Kayes. With the aid of international experts, Mali had been preparing for an outbreak in recent months, training staff and readying special facilities. It may well need more help, however. On 10 Oct 2014 , Markatie Daou, a Mali health ministry spokesman, told Bloomberg that his ministry had received USD 672 000 to prepare for Ebola, but added that it wasn't nearly enough...

[Byline: Adam Taylor & Abby Ohlheiser]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[See map of Mali's road and railway network at: http://epmaps.wfp.org/maps/05714_201301 ... y_2013.jpg.
The northern half of the country is Sahara desert. Kayes, where the little girl from Guinea was hospitalized and died, is on the main railway line from Bamako, Mali's capital, to Senegal, and has road connections to a main road in Mauritania. WHO says 82 people are being monitored for Ebola in Mali:
http://www.trust.org/item/2014102809444 ... =spotlight. - Mod.JW]

******
[3] Sierra Leone: Ebola situation report in pdf chart from Government
Date: 25 Oct 2014
Source: ReliefWeb [edited]
http://reliefweb.int/sites/reliefweb.in ... ol-151.pdf

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[4] Sierra Leone: IBM joins fight against Ebola
Date: 26 Oct 2014
Source: BBC news [edited]
http://www.bbc.co.uk/news/technology-29744081


IBM will put its super-computing data crunching to use in Sierra Leone as part of the fight against Ebola. It has launched a system which allows citizens to report Ebola-related issues and allows government health agencies to keep track of the locations of the disease.

Citizens can use SMS or voice calls that are location-specific for reporting, with the data then edited and analysed. It is already functioning in some regions, with numbers of suspected Ebola cases pinpointed, and delivery sped up of urgent supplies. Radio broadcasts are being used to encourage people to use the system, and telco operator Airtel has set up a free number via which citizens are able to send SMS messages. "We saw how this technology could be used to enable communities directly affected by Ebola to provide valuable information to enable effective community effort to fight it," explained Dr Uyi Stewart, chief scientist of IBM Research in Africa.

Khadija Sesay, director of Sierra Leone open government initiative, said it had helped "open up a channel with the general public so that we can learn from their input and create actionable policies in the fight against Ebola. Using mobile technology has given them a new voice and a channel to communicate their experiences directly to the government health services."

--
Communicated by:
Roger Feldman <promedrf@gmail.com>

******
[5] Sierra Leone: UK NHS staff will help
Date: 27 Oct 2014
Source: BBC News [edited]
http://www.bbc.co.uk/news/health-29789065


More than 800 NHS staff have volunteered to help treat those infected with Ebola in West Africa... A 92-bed treatment centre funded by the UK is almost ready to open in Kerry Town in Sierra Leone. It will be run by the charity Save the Children and staffed by British volunteers, each of whom will go out for a stint of several weeks...

[Byline: Branwen Jeffreys]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Also from the BBC: 6 surprising numbers, including 5000 mobile phones needed, USD 61 per PPE outfit, http://www.bbc.co.uk/news/world-africa-29658778. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/46.]

EBOLA VIRUS DISEASE - WEST AFRICA (199): WHO, LIBERIA, ASYMPTOMATIC INFECTION
*****************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] WHO situation report
[2] Liberia: successful strategy
[3] Liberia: infections slowing?
[4] West Africa: asymptomatic infection & acquired immunity

******
[1] WHO situation report
Date: Wed 29 Oct 2014
Source: WHO Ebola Response Roadmap Situation Report [excerpts, edited]
http://apps.who.int/iris/bitstream/1066 ... g.pdf?ua=1


- There have been 13 703 EVD cases, with 4 920 deaths, up to the end of 27 Oct 2014.
- All districts in Liberia and Sierra Leone are now affected.
- Thursday, 30 Oct 2014, marks 30 days since the UN Mission for Ebola Emergency Response [UNMEER] plan was implemented.
- Mali reported its 1st case on 23 Oct 2014.

Total cases 13 703, deaths 4922 [sic].
*The additional 3792 cases have occurred throughout the epidemic period, not only since 22 Oct 2014.
... -- much more

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[There are many detailed histograms, tables and maps -- all unfortunately based on highly unreliable data, but that's all they've been able to get in the circumstances. - Mod.JW]

******
[2] Liberia: successful strategy
Date: Tue 28 Oct 2014
Source: NPR [edited]
http://www.npr.org/blogs/goatsandsoda/2 ... erian-town


An Ebola strategy brings good news to one Liberian town
-------------------------------------------------------
In one corner of Liberia, a community has come together to change the course of the Ebola epidemic. New cases have been brought to a standstill. But this success shows that it's going to take more than extra beds in a ward to stop Ebola.

When Doctors Without Borders [MSF] arrived in the northern district of Foya in early August [2014], Ebola was out of control. Foya was the 1st area in Liberia to report cases, and the community has been hit hard. "At the peak, there were 125 patients in the center," says Katy Athersuch, the local communications officer for Doctors Without Borders." Since then, a lot has changed in this district, which borders Guinea and Sierra Leone. There have been no new cases in Foya for nearly a month -- although patients are still arriving from other areas, including the district of Voinjama only 40 miles up the road.

Health workers say there are 2 main reasons the epidemic here has been brought under control. One is this care center, which means sick people aren't at home infecting other people. The other is a massive campaign to connect with the community and to distribute information. This work has been conducted by both local health leaders and Doctors Without Borders staff.

Before the medical aid group arrived, people were terrified, says Sylvester Seyoe, a health promoter who lives in Foya. "Every day, all day, you [were] seeing people carrying dead body, dead body, dead body," he says. People weren't just afraid of Ebola. They were afraid of the health care workers, who looked like astronauts and took bodies away in ambulances.

Many people thought the workers were collecting bodies to sell the organs, Seyoe says: "'Oh, these guys [are] only coming to slaughter people and conduct ritualistic acts and make money out of us.' Because of that, people resisted."

So Doctors Without Borders and the local Ebola team put in a new system. Every time an ambulance went to collect a patient or body, they sent a health promoter, like Seyoe and Jayah, to stand outside the house and explain to neighbors what was happening.

One of the most important changes was allowing family members to see the body of someone who died of Ebola, says James Timothy Nah, a mental health counselor at the Ebola center. The center even has a viewing area where visitors can see the faces of health care workers before they put on masks, goggles and other protective gear. And just a few weeks ago, the staff at the center installed a cellphone booth where patients can make calls to their friends and relatives. All these changes have made a big difference in stemming the epidemic here.

Ebola appeared to retreat once before in this area, only to return with frightening speed, says Katy Athersuch of Doctors Without Borders. The group is determined to make sure that doesn't happen again.

[Byline: Jon Hamilton]

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

******
[3] Liberia: infections slowing?
Date: Wed 29 Oct 2014
Source: BBC News [edited]
http://www.bbc.co.uk/news/world-africa-29822303


Ebola crisis: Infections slowing in Liberia
-------------------------------------------
The World Health Organization (WHO) says there has been a decline in the [rate of] spread of Ebola in Liberia, the country hardest hit in the outbreak. But WHO's Bruce Aylward said: "A slight decrease in cases ... versus getting this thing closed out is a completely different ball game." But he warned against any suggestion that the crisis was over.

The WHO said the number of cases globally had risen since its last report by more than 3000 to 13 703, but that [much of] this was due to reporting reasons. However, the number of deaths was put at 4920, roughly the same as the last report 4 days ago. All but 10 of the deaths have been in Liberia, Sierra Leone and Guinea.

The latest WHO figure of 13 703 cases is a significant leap on its previous situation report on Saturday [25 Oct 2014], which had showed cases rising above 10 000 for the 1st time -- to 10 141. But Dr Aylward, the WHO's assistant director general, said that [much of] this increase was due to data being updated with old cases, rather than new cases being reported.

Saturday's [25 Oct 2014] situation report put the death toll at 4922. The similar death toll in the latest report was mainly a result of a revision of the Liberian statistics. Cases there rose from 4655 to 6535, but reported deaths dropped from 2705 to 2413. Reported deaths in Guinea rose from 926 to 997 and in Sierra Leone from 1281 to 1500 [a suspiciously round number - Mod.JW].

Dr Aylward said: "It appears that the trend of a slowing in the rate of new case reporting is real in Liberia ... and there had been a huge effort to inform the population about the disease, to change the behaviours that put them at risk. There had been a real step up in the work to put in place safe burials." But the data was still being examined and [he] cautioned against thinking the crisis was over ... -- more

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

******
[4] West Africa: asymptomatic infection & acquired immunity
Date: Sat 25 Oct 2014
Source: The Lancet [edited]
http://www.thelancet.com/journals/lance ... 0/fulltext


Ebola control: effect of asymptomatic infection and acquired immunity
---------------------------------------------------------------------
Evidence suggests that many Ebola infections are asymptomatic, a factor overlooked by recent outbreak summaries and projections. Particularly, results from one post-Ebola outbreak serosurvey showed that 71 percent of seropositive individuals did not have the disease; another study reported that 46 percent of asymptomatic close contacts of patients with Ebola were seropositive. Although asymptomatic infections are unlikely to be infectious, they might confer protective immunity and thus have important epidemiological consequences. Asymptomatic infection contributes to herd immunity and thereby dampens epidemic spread ... -- more

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

[A HealthMap/ProMED-mail map of Liberia is available at http://healthmap.org/promed/p/54.]

EBOLA VIRUS DISEASE - WEST AFRICA (200): MALI, LIBERIA, CREMATION, CASE NUMBERS
*******************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Mali: 2 suspected Ebola cases, 57 contacts sought
[2] Liberia: cremation
[3] West Africa: Ebola epidemic ending?

******
[1] Mali: 2 suspected Ebola cases, 57 contacts sought
Date: Fri 31 Oct 2014
Source: Reuters [edited]
http://af.reuters.com/article/topNews/i ... 5V20141031


WHO says 2 suspected Ebola cases in Mali, 57 contacts sought
------------------------------------------------------------
Two people are suspected of having Ebola after coming into contact with a 2-year-old girl who died of the disease in Mali last week, according to data from the World Health Organization and the U.S. Centers for Disease Control [CDC].

An epidemiological presentation by both agencies, given on Thursday [30 Oct 2014] and seen by Reuters on Friday [31 Oct 2014], breaks down the girl's journey from Guinea to Mali with her grandmother, 5-year-old sister and her uncle, and shows she may have had contact with 141 people in all, 57 of them yet to be identified. One of the 84 contacts who have so far been traced is suspected of having Ebola but has not been tested, the presentation shows. Another 4 suspected cases have been tested; 3 showed negative results, with one result yet to come in.

--
Communicated by:
Ryan McGinnis
<ryan@bigstormpicture.com>

******
[2] Liberia: cremation
Date: Fri 24 Oct 2014
Source: Guardian [edited]
http://www.theguardian.com/world/2014/o ... ls-liberia


Liberia: Ebola cremation ruling prompts secret burials
------------------------------------------------------
Treatment centres are half-empty as families keep infected at home to avoid a presidential decree that Ebola victims must be cremated. President Ellen Johnson Sirleaf decreed in August [2014] that the bodies of Ebola victims in the Monrovia area be cremated. The government brought in a crematorium and hired experts. The order came after people in neighbourhoods of the capital had resisted the burial of hundreds of Ebola victims near their homes.

Even as Liberians fall ill and die of Ebola, many beds in treatment centres are empty because of the governmental order that the bodies of all suspected Ebola victims in the capital be cremated. Cremation violates values and cultural practices in this western African country. The order has so disturbed people that the sick are often kept at home and, if they die, are being secretly buried. Cremations in the capital, and burials of Ebola victims in body bags outside Monrovia without relatives present, means there will not be a place to honour deceased relatives. Decoration days, where people flock to cemeteries to clean and decorate the graves of relatives, will find that many do not [know] the location of the remains of their loved ones. People will find it hard to accept that they will never see the graves of those killed by the disease. We know that cremation is not part of our culture in our country, but now we have this disease, so we have been asked to change our ways, Tolbert Nyenswah said. We understand that there are secret burials taking place in some communities, he said. We must stop that and report sick people and get them treated.

A recent analysis of bed space at Ebola treatment units concluded that out of 742 spaces, only 351 were occupied, said assistant health minister Nyenswah, who heads the governmental Ebola response. Mortuaries and coffin makers have lost business under the new regulations. For the last 2 months it has been difficult to sell even one casket a day, said Titus Mulbah, an owner of the Talented Brothers Casket Centre. And this is because all bodies now are considered Ebola bodies, as if other diseases are not killing people here. There had been complaints that people who died of something other than Ebola had been cremated or buried anonymously. Television journalist Eddie Harmon said the body of his sister-in-law was added to the bodies of Ebola victims and cremated, even though the family believes she died of hypertension. It is still paining us today because it was unjust and unfair, he said.

Sierra Leone different
----------------------
In neighbouring Sierra Leone, where families often picnic in cemeteries and clean graves on New Year's Day, there have been 1259 Ebola deaths, according to the latest WHO count. Unlike Liberia, the government has not ordered cremations. Ebola treatment units in Sierra Leone have often been full. Still, there is the possibility that loved ones might be buried in unmarked graves and some families still observe traditional practices in which mourners wash and lay hands on the body.

Ebola is spread through contact with bodily fluids. Anthony Banbury, head of the UN Mission on Ebola Emergency Response, said people must change. People are dying every day, and there may be unsafe burial practices, he said in Freetown, the Sierra Leone capital. A commentary on a website, Sierra Leone News Hunters, suggested that a memorial site be built to honour Ebola victims not buried traditionally. It said: "The erection of a monument bearing the names of all Ebola victims would not take away the sad memories but it would at least pacify the broken heart somewhat."

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

******
[3] West Africa: Ebola epidemic ending?
Date: Wed 29 Oct 2014
Source: New York Times [edited]
http://well.blogs.nytimes.com/2014/10/2 ... in-africa/


Is the Ebola epidemic ending in Africa?
--------------------------------------
No one knows exactly what is going on in West Africa. Several medical groups, like Doctors Without Borders [MSF], are reporting that they suddenly have far more beds than patients. In some cases, there are empty beds at centers where, just a few weeks ago, people were dying on the streets outside because there was no room.

The trend is especially noted in Liberia, the hardest-hit country. Laboratories are getting fewer samples to test. Ambulance crews are picking up fewer bodies. The World Health Organization confirmed that new cases were dropping. But health authorities are warning that it is too early to celebrate. It is important to remember that this happened once before, on a smaller scale. In March [2014], after alarming reports from Guinea that a rural outbreak had reached the capital, the WHO and the Centers for Disease Control and Prevention [CDC] sent experts in to help. The epidemic spread to Sierra Leone, and then to Liberia. But cases grew only slowly, and by May [2014], most of the experts were withdrawn. In early August [2014], the chief scientist for Britain's foreign aid agency said the "end of the epidemic was in sight." He was optimistic. About 800 people were known to be dead then. Cases had actually begun to explode in July, and now about 5000 are dead.

There are some theories as to why the numbers seem to be going down. The leading one is that more West Africans now believe that Ebola exists, are afraid of it, and are touching each other less. In that way, it is like lung cancer, only on a speeded-up time scale. It took 30 years for Americans to fully accept that smoking caused lung cancer. Once they believed, fewer started smoking. Deaths from lung cancer are now much lower than they used to be because many Americans in their 50's and 60's didn't start as teenagers, or quit. But you wouldn't say that the lung cancer epidemic is over.

Because poor West Africans often have many people sleeping in one room, Ebola spreads in households. Because the incubation period is up to 21 days, it often kills the family slowly, one by one. But for each other family that keeps the virus from entering its household, that can mean 5 or 6 fewer deaths.... [Now] tens of thousands of home-care kits have been handed out. They contain gloves, bleach, a bucket, plastic bags and a bleach sprayer. Using them around the sick, and especially during burials, may have helped. Alternatively, hospitals may be empty because more people are dying at home. In Liberia, it has been reported that families are refusing to bring in their relatives because, if they die, they will be cremated.

Another report is that taxi and minibus drivers are refusing to take passengers who are bleeding or vomiting to hospitals. That forces them to die at home -- which is cruel, but could slow the spread of disease to other passengers. [Somebody must be cleaning contaminated taxis and minibuses, yet we haven't heard of a lot of drivers dying. - Mod.JW]

It is also important to remember that epidemics typically come in waves. The reasons for some are obvious, like the weather: flu cases rise in winter, polio cases rise in summer. Pox diseases like smallpox, measles and chickenpox used to surge every few years after a new set of young children was born. For other diseases, the reasons are not clear. Ebola may simply be having a moment between waves.

[Byline: Donald G. McNeil Jr]

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

[But "MSF warns Liberia Ebola 'progress' could be illusory. 'It is too soon to draw conclusions on the reduction of Ebola cases in Monrovia,' says Fasil Tezera, MSF head of mission in Liberia" (AFP, 30 Oct 2014, http://www.rappler.com/world/regions/af ... s-illusory).

HealthMap/ProMED-mail maps of Mali: http://healthmap.org/promed/p/50; and of Liberia: http://healthmap.org/promed/p/54. - Mod.JW]

EBOLA VIRUS DISEASE - WEST AFRICA (201): WHO UPDATES, LIBERIA NEW HOSPITAL
**************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] WHO Roadmap Sitrep 31 Oct 2014
[2] WHO updates personal protective equipment guidelines
[3] Liberia: 200-bed tent hospital opened

******
[1] WHO Roadmap Sitrep 31 Oct 2014
Date: 31 Oct 2014
Source: WHO Roadmap Sitrep [edited]
http://apps.who.int/iris/bitstream/1066 ... 14_eng.pdf


- There have been 13 567 reported Ebola cases in 8 affected countries since the outbreak began, with 4951 reported deaths.
- Intense transmission continues in Guinea, Liberia and Sierra Leone.
- All 83 contacts of the health-care worker infected in Spain have completed the 21-day follow-up period.

A total of 13 567 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in 6 affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain, and the United States of America) and 2 previously affected countries (Nigeria, Senegal) up to the end of 29 Oct 2014. There have been 4951 reported deaths. The cases reported are fewer than those reported in the Situation Report of 29 Oct 2014, due mainly to suspected cases in Guinea being discarded... - more [With tables & a map.]

--
Communicated by:
Ryan McGinnis
<ryan@bigstormpicture.com>

******
[2] WHO updates personal protective equipment guidelines
Date: 31 Oct 2104
Source: WHO News release [edited]
http://www.who.int/mediacentre/news/rel ... delines/en


As part of WHO's commitment to safety and protection of healthcare workers and patients from transmission of Ebola virus disease, WHO has conducted a formal review of personal protective equipment (PPE) guidelines for healthcare workers and is updating its guidelines in context of the current outbreak... - more

--
Communicated by:
ProMED Rapporteur Kunihiko Iizuka

******
[3] Liberia: 200-bed tent hospital opened
Date: 31 Oct 2014
Source: Big Story AP [edited]
http://bigstory.ap.org/article/6c8d3938 ... aye-layleh


Remembering those who have died in the world's deadliest Ebola outbreak, Liberia's president opened one of the country's largest Ebola treatment centers in Monrovia on Fri [31 Oct 2014] amid hopes that the disease is finally on the decline in this West African country.

American and U.N. officials as well as Cuban doctors were in the crowd as President Ellen Johnson Sirleaf opened the treatment center, which is set up to hold 200 patients and can eventually treat as many as 300. With the opening of the center, an Ebola treatment unit at JFK Medical Center has been closed. Many people with other diseases had been nervous about going to the nation's largest referral hospital, and officials hope they will now come back...

[Byline: Jonathan Paye-Layleh]

--
Communicated by:
Ryan McGinnis
<ryan@bigstormpicture.com>

[A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/54.]

EBOLA VIRUS DISEASE - WEST AFRICA (202): SIERRA LEONE, NORWAY-UK AID, AGE-RELATED CASE FATALITY RATES
*****************************************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Sierra Leone: 200 Norwegian health workers going
[2] Sierra Leone: UK sets up 3 new Ebola Labs
[3] Sierra Leone: Ebola age-related case fatality rates

******
[1] Sierra Leone: 200 Norwegian health workers going
Date: Sun 2 Nov 2014
Source: The Norway Post [edited]
http://www.norwaypost.no/index.php/news ... news/30273


Ebola: 200 Norwegian health workers to West Africa
--------------------------------------------------
Health Minister Bent Hoie has announced that Norway is sending 200 health workers to West Africa to join the fight against the Ebola epidemic. The Health Department had initially asked for 60 volunteers, but more than 300 signed up. The Health Minister says Norway has signed an agreement with Great Britain, and the Norwegian health workers will be working at a British center for Ebola victims in Sierra Leone. Norway already last week sent an advanced team to the area, to prepare for logistics, security and other facilities for the Norwegian health workers. In addition, 6 Norwegian doctors are already in Sierra Leone and Liberia, working for Doctors without Borders ... -- more

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>


******
[2] Sierra Leone: UK sets up 3 new Ebola Labs
Date: Sun 2 Nov 2014
Source: BBC News [edited]
http://www.bbc.com/news/uk-29870109


UK sets up 3 new Ebola Labs in Sierra Leone
-------------------------------------------
The UK Government has pledged new funds of GBP 20 million [about USD 32 million] to build, run and staff the labs, which will be used to test blood samples and swabs for the virus. They will also be used to give the all-clear for Ebola patients who survive the disease.... The 1st laboratory opened in Kerry Town last week [October 2014] next to a UK-funded Ebola treatment centre, doubling the country's testing capacity; 2 more are being built at UK treatment centres in Port Loko and Makeni under the direction of UK Royal Engineers, Public Health England (PHE) and the Department for International Development (DFID). Once operational, the labs will quadruple the number of tests that can be conducted every day and reduce waiting times for results from 5 days to 24 hours. International Development Secretary, Justine Greening said: "Tackling Ebola at the source is key to beating it and stopping the spread...."

The Africa Governance Initiative (AGI) recently found that the Ebola virus is spreading 9 times faster than it was 2 months ago in some rural parts of Sierra Leone. The virus is also increasing in the capital, Freetown, which is recording 6 times more cases per day than it was 2 months ago. In Liberia, however, the rate of new cases appears to have slowed.

So far, the UK has dedicated a total of GBP 225 million [about USD 360 million] to beating Ebola, including the provision of 700 Ebola treatment beds which will provide direct medical care for up to 8800 patients over 6 months. Around 50 volunteers from the NHS [National Health Service], PHE, universities and the Defence Science & Technology Laboratory will arrive in Sierra Leone in the coming weeks to form the lab technician team. A further 800 Ministry of Defence personnel are expected to be deployed to the country to help with the establishment of Ebola treatment centres and an Ebola training academy ... -- more

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

******
[3] Sierra Leone: Ebola age-related case fatality rates
Date: Fri 31 Oct 2014
Source: Daily Mail [edited]
http://www.dailymail.co.uk/health/artic ... vival.html


Ebola age-related case fatality rate; under 21s have the best chance of survival
--------------------------------------------------------------------------------
The Ebola virus is more likely to claim the lives of those aged 45 or older, scientists have claimed. A new study carried out in Sierra Leone -- one of the West African nations worst hit during the outbreak -- has produced a picture of how the virus affects sufferers. A study carried out by health workers and scientists at Sierra Leone's Kenema Government Hospital, has found the younger a patient, the more likely [s/he is] to survive. The fatality rate for patients under age 21 was 57 percent, while for those aged 45 and older, case fatality was 94 percent. 47 doctors and nurses collated the information while caring for 106 patients at Kenema Government Hospital in Sierra Leone -- one of the nations hardest hit by the Ebola outbreak. Fever was the most common symptom when victims 1st sought care, which was when early medical help is crucial.

Fever was the most common symptom reported by over 80 percent of those admitted. The higher the temperature recorded on admission to hospital, the more likely patients were to die from Ebola. One striking finding was how devastating the severe diarrhoea, a symptom of the disease, is for patients. 'If you can keep up with simple hydration during that phase, you can improve survival rate,' Dr. Bruce Farber, chief of infectious diseases at North Shore University Hospital, New York, told CBS News. Basic supportive health care, providing intravenous fluids and nutrients, and maintaining a patient's blood pressure can be the difference between life and death.

For the last 10 years at the Kenema Government Hospital in Sierra Leone, a team of US scientists has been working with staff and the country's health department to establish a new medical records system. It was introduced to help deal with patients suffering Lassa fever. When the Ebola outbreak reached Sierra Leone's 3rd largest city in May [2014], the system in place began to collate a comprehensive set of data on the disease from Ebola virus. The findings, published this week in the New England Journal of Medicine* [see ref. below], have added to knowledge of the disease.

47 doctors and nurses collated the information while caring for 106 patients at Kenema Government Hospital in Sierra Leone. 7 of the health workers conducting the research died -- 6 from Ebola, while one suffered a stroke. Among them was Dr Sheik Humarr Khan, the doctor hailed a hero by his government, having led Sierra Leone's fight against the virus until his death in July [2014].

[Byline: Lizzie Parry MailOnline]

*http://www.nejm.org/doi/full/10.1056/NEJMoa1411680

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

[This accounts for the thousands of children being orphaned. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/46.]

EBOLA VIRUS DISEASE - WEST AFRICA (203): WHO, WIFI, VACCINE, SURVIVORS, SUPPORT
*******************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] WHO: sitrep as of 2 Nov 2014
[2] West Africa: US army Wi-Fi
[3] West Africa: vaccine trials
[4] Liberia: survivors help out
[5] Sierra Leone: Ambulance services
[6] Liberia: US donates thousands of cots
[7] Guinea: South African tycoon donates USD1 million
[8] Sierra Leone: state of emergency extended, journalist jailed

******
[1] WHO: sitrep as of 2 Nov 2014
Date: Wed 5 Nov 2014
Source: WHO [edited]
http://apps.who.int/iris/bitstream/1066 ... g.pdf?ua=1


Ebola Response Roadmap Situation Report 5 Nov 2014
Highlights
-------------
There have been 13 042 reported cases of Ebola, with 4818 reported deaths, up to the end of 2 Nov [2014].

All districts in Liberia and Sierra Leone have been affected.

All 83 contacts of the health-care worker infected in Spain have completed 21-day follow-up [and were negative].

Summary
-------
A total of 13 042 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in 6 affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain and the United States of America) and 2 previously affected countries (Nigeria and Senegal) up to the end of 2 Nov [2014]. There have been 4818 reported deaths.

The outbreaks of EVD in Senegal and Nigeria were declared over on 17 Oct and 19 Oct 2014, respectively.

At the country level, the weekly incidence appears to be stable in Guinea. In Sierra Leone, the weekly incidence continues to rise, while in Liberia, it appears to be declining. In all 3 countries, EVD transmission remains persistent and widespread, particularly in the capital cities. All administrative districts in Liberia and Sierra Leone have reported at least one confirmed or probable case of EVD since the outbreak began. Cases and deaths continue to be under-reported in this outbreak. Of the countries with localized transmission, Mali and the United States of America continue to monitor potential contacts... - more

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[There are many tables and graphs and a map, including: Table 3. Key Performance Indicators for the Ebola Response (preliminary data) - Mod.JW]

******
[2] West Africa: US army Wi-Fi
Date: Wed 29 Oct 2014
Source: DISA [edited]
http://www.nextgov.com/defense/2014/10/ ... ola/97709/


The US Defense Department has started to beef up systems needed to support troops and non-governmental organizations engaged in the Ebola fight in West Africa, including e-mail, video and satellite systems.

The Defense Information Systems Agency [DISA] last week [19-25 Oct 2014] turned on a node of the Blue Force Tracking System [BFT] over West Africa, which transmits feeds from GPS receivers over satellites to a central node to pinpoint locations. This will enable real-time messaging and location-status information for vehicles and individuals.

The system, part of the Army Warrior Information-Tactical battlefield network or WIN-T network, will be used by the 4000 soldiers from the 101st Airborne Division when they deploy to West Africa this month [October 2014], said Lt. Col. Joel Babbitt, the WIN-T product manager. The networks the Army is setting up in West Africa will support both military users and NGOs, such as Doctors without Borders [MSF], Babbit said. WIN-T will provide the NGOs "with the communications reach-back that will allow them to coordinate their efforts as an entire task force," he said. "It will make our response to the Ebola crisis much more coordinated and much more effective."

Lt. Col. Michael Olmstead, product manager for the Joint Battle Command-Platform, which manages BFT, said the Army has set up commercial internet enclaves the NGOs can use with a hub in Landstuhl, Germany. These hubs will provide reach-back access to the Army global information network to transmit voice and data. "Since they are commercial enclaves, you can go and buy commercial items like a WiFi hotspot, plug them in directly, and you instantly have a connection," Babbitt said. "The Army is providing the communications backbone for what is inherently a civil response. As engineers flow in to build treatment facilities, they will be operating directly with these NGOs, so the ability to provide a common backbone via commercial internet is critical to an assistance response task force."

The Army plans to deploy WIN-T in packages to West Africa, including network nodes and command post systems. The Army also accelerated efforts to upgrade units' modems, allowing for higher bandwidth to support the anticipated demand for medical information and other data. The modem upgrade, like the drive to expand commercial Internet capability for expeditionary signal battalions, was already underway prior to Operation United Assistance, so the Army was poised for rapid response. "It highlights the importance of continually modernizing the network so that you can provide these sorts of capabilities when required," Babbitt said.

Tracy Sharpe, a DISA spokeswoman, said the agency is providing long-haul communications capabilities to extend Africa Command networks and DISA Enterprise Services, such as email and video, to West Africa. DISA has also stood up a "community of interest," within its All Partners Access Network to enable unclassified information sharing with other DOD entities, interagency partners, NGOs and coalition partners. APAN is a DISA-managed unclassified collaboration platform accessible via the commercial Internet for groups who do not possess access to traditional DOD systems and networks.

[Byline: Bob Brewin]

--
Communicated by:
Roger Feldman <promedrf@gmail.com>

******
[I apologise for the delay in posting the following reports. They came in on the day of an all-day workshop for ProMED moderators preceding the International Meeting on Emerging Diseases and Surveillance (IMED) in Vienna, Austria -- see http://imed.isid.org -- and slipped off my radar screen. But I believe they are still relevant. - Mod.JW]

[3] West Africa: vaccine trials
Date: Tue 28 Oct 2014 [ProMED regrets the delay in posting]
From: Peter Smith <Peter.Smith@lshtm.ac.uk> [edited]


[Re: comment at the end of ProMED Ebola virus disease - ex Africa (26): USA quarantines, drug, vaccines, WHO 20141027.2906997: A trial of the GSK vaccine was planned for Mali, but now that an unknown number of people there have been exposed to the little girl from Guinea, it may be difficult to find a large group of unexposed people in Mali. - Mod.JW]

The studies, which are ongoing in Mali, are Phase 1 safety studies, similar to the studies that are ongoing in the UK and the US. That there has been a case of Ebola in Mali is unlikely to have any impact on the safety studies there. As far as I am aware, there are certainly no plans for a Phase III study in Mali, but they are planned in the 3 currently affected West African countries.

--
Prof. Peter Smith, MRC Tropical Epidemiology Group,
London School of Hygiene & Tropical Medicine,
Keppel St, London WC1E 7HT
<Peter.Smith@lshtm.ac.uk>

[Many thanks to Prof. Smith for the clarification. - Mod.JW]

******
[4] Liberia: survivors help out
Date: Fri 31 Oct 2014
Source: Bloomberg Business Week [edited]
http://www.businessweek.com/articles/20 ... -they-have superpowers?utm_medium=social&utm_source=facebook&utm_campaign=social


Yesterday [30 Oct 2014], Dr. Darin Portnoy, a family physician from the Bronx, completed his 1st rounds -- 60 patients, 5 of them children -- in an Ebola ward of a treatment center in Paynesville, about 250 miles southeast of Monrovia, Liberia. He's been impressed from the start by the efficiency of the clinic, but what struck him the most was watching as an Ebola survivor, a man he describes as looking a little like Mike Tyson [the champion boxer], scooped up an 11-year-old boy in the infectious stages of the disease, carried him to a washbasin, and gave him a sponge bath, before carefully returning him to his cot.

Survivors, Portnoy says, are playing an increasing role in caring for the sick and the effort outside the wards to halt the epidemic. Ebola survivors are immune to the virus for as long as 3 months or longer. Research indicates immunity to re-infection by the same strain of Ebola virus could last 10 years, according to the Centers for Disease Control and Prevention [CDC]. This means they can risk getting close to those with symptoms, and even touch them, something that's especially helpful with children, a number of whom are separated from their families. "It's kind of like a superpower," Portnoy says of the survivors' immunity. "Even those who are not fully recovered, but that you can tell are going to clear the virus, they'll help other patients before they've finished convalescing," he adds.

This is Week One of Portnoy's 4-week stint at ELWA3, an Ebola treatment center with 250 beds in Paynesville. ELWA3 is operated by Medecins Sans Frontieres/Doctors Without Borders, the privately funded relief organization often known simply as MSF. The staff at the center totals around 700, about 100 of whom are from outside West Africa. MSF has similar, smaller facilities in the neighboring countries of Sierra Leone and Guinea, where Ebola remains out of control.

Portnoy has just arrived as a volunteer. On his rounds, he isn't working solo, of course. A nurse and sanitation aide, also suited head-to-toe in personal protection equipment (PPE), accompany him; assistants are available, as well, to help clean patients and disinfect around them. "I had a couple of dry runs, where we put on the PPEs, took off the PPEs," the 52-year-old doctor says. "Then I did one round where I only spoke to patients."

Portnoy provides his patients with anti-malaria and anti-nausea medicines, generic Tylenol and antibiotics, and hydration salts. Severe dehydration is the underlying, grave danger with Ebola. Via phone, Portnoy confirmed the press reports and World Health Organization figures showing that, for the 1st time in weeks, there are fewer new cases of Ebola in Liberia. At ELWA3, empty beds outnumber the patients, and only about 80 to 85 confirmed cases remain.

Did this decline strike those who'd been there all summer as cause for optimism that there won't be, as the Centers for Disease Control and Prevention warned, as many as 5000 new cases a week by January [2015]?

"It would be great to think so," Portnoy says, but no one at ELWA3 believes it's over yet. "For us, it's more a chance to prepare, build capacity, train as many people as we can, and be ready." To hear him tell it, ELWA3 is becoming an Ebola-treatment teaching hospital.

The reason it was too soon to declare victory, he says, is that "a lot of things that should be working are not. Contact tracing -- tracking those who may have been exposed -- is not working. The ambulances are not fully functioning. It's hard to tell if safe burial practices are really being observed. So we are staying vigilant."

As for the survivors, getting clear of the virus is just part of a long journey. "Some [survivors] want to return to their communities, kind of anonymously, because there's still a lot of stigma," says Athena Viscusi, a New Yorker who ran the mental health intervention center at ELWA3 until last week. (MSF mental health workers provide grief counseling to families and help to caregivers, too, as the work is often traumatic.) "Usually, though, Ebola has affected several members of the family, and the neighbors know there's been an infection in the house, so they can't return quietly," Viscusi says. "And they find they're more comfortable coming back to the Ebola centers, because we're very welcoming of them."

MSF hires some of these returning survivors to work with patients. Of the man who helped the child, says Portnoy: "You know you hear about things like that, but when you see it, that whatever someone is going through, their humanity remains intact, it's magnificent."... - more

[Byline: Brad Wieners]

--
Communicated by:
Roger Feldman <promedrf@gmail.com>

******
[5] Sierra Leone: Ambulance services
Date: Thu 30 Oct 2014
Source: WSJ [edited]
http://online.wsj.com/articles/in-sierr ... 1414686785


Boarding an ambulance in Freetown last Fri [24 Oct 2014], a pair of Ebola patients began what some in Sierra Leone call the journey of no return. On a blazing afternoon, an ambulance transporting a brother and sister arrived at the Red Cross Ebola clinic just outside the town of Kenema, a 4-hour and 190-mile drive from Sierra Leone's capital. A child's wails could be heard while a team of 6 health workers disinfected the vehicle. A naked 14-year-old boy later stepped out, but not his younger sister. "She's dead," shouted one worker near the vehicle. The ambulance then drove slowly to the back of the clinic, where her corpse was unloaded at the morgue.

Sierra Leone's ambulances zip down freeways, blow by crowded street markets, and bob over rutted jungle roads. Yet all that movement has exposed a dangerously disjointed emergency-response system, one that sends gravely ill patients across the country for hospital beds they sometimes don't live to see. That has prompted a rethinking of how the country dispatches its emergency vehicles, in the hope of establishing a template for other countries battling Ebola. "The ambulance link is really important and it's not quite working" said Steve McAndrew, Freetown-based head of emergency operations for the Ebola Virus Response at the International Federation of Red Cross and Red Crescent Societies. "It may be making matters worse."

Until recently, Sierra Leone's ministry of health handled calls for emergency vehicles and then sent word to its local officers to follow up. Now, the nation's president has appointed a former soldier to head its new National Ebola Response Center. District Ebola Response Centers will track the status of patients who need to get to a hospital; or persons who need to be monitored; or bodies that need to be buried. "This new organization is not a talking shop," said retired Maj. Palo Conteh, the new Ebola czar, on Wed [29 Oct 29014]. "It's a place of action." Maj. Conteh said soldiers would be trained as drivers and appealed for more vehicles, but didn't elaborate on why the existing ambulances are traveling so far afield...

Despite having Ebola clinics in Freetown, ambulances often transport suspected patients far beyond the capital, in a sign of the poor coordination matching Ebola patients with available beds. Health workers describe opening ambulance doors and seeing piles of people soaked in vomit, blood and excrement. Not long after the Red Cross opened its 1st Ebola treatment center in Kenema in September [2014], an ambulance arrived with 12 Ebola patients crammed inside the sport-utility vehicle. Other emergency vehicles appear unexpectedly, sometimes not having identification for the patients, sometimes not knowing what hospital dispatched them...

Unlike Liberia and Guinea, where disease is concentrated in pockets, Sierra Leone's Ebola cases stretch across the country, from the metal shacks of coastal Freetown to the mud huts of Kailahun near the eastern border. Some ambulances have showed up at Kailahun from Freetown in search of empty beds at the local Ebola treatment center, said doctors and ambulance drivers. The last stretch of that 250-mile journey is over roads that are little more than brown gashes cut through jungle shrubs and trees. "The distances are too much to take for patients who are very weak," says Mohamed Kamara, a 37-year-old ambulance driver in Kailahun. "Some lose their lives."

Public-health experts said they suspect the shuffle has had as much to do with the search for empty beds as it has with moving those with Ebola away from clinics and hospitals that aren't prepared to treat them. The long ambulance trips, said John Otoo, a World Health Organization official in Kailahun, "puts strain on the system and the patient."...

Kenie Lahi, the 52-year-old chief ambulance driver for Kailahun, said he requires his drivers to don personal protective equipment, including goggles and rubber gloves. That requirement was put in place after 2 of his drivers died of Ebola as the outbreak began to spread out of control in June [2014]. Some ambulance drivers said they face hostile communities, residents of which sometimes throw stones at vehicles to prevent them from taking away neighbors.

Bottles of water are placed in the back for patients to slake their thirst in the scorching heat. But for the very sick, even holding a bottle can prove too difficult. Those who arrive alive at an Ebola clinic may be too drained to put up much of a fight later... - more

[Byline: Peter Wonacott]

--
Communicated by:
ProMED Rapporteur Kunihiko Iizuka

******
[6] Liberia: US donates thousands of cots
Date: Wed 29 Oct 2014
Source: DVIDS [edited]
http://www.dvidshub.net/news/146433/dla ... FJia_SsVuB


More than 2600 cots were sent from US Defense Logistics Agency Disposition Services sites on 9 Oct [2014] to contribute to DLA's effort to provide food, water, cots and tents to support Operation United Assistance, the U.S. effort to stop the spread of Ebola virus in West Africa.

"DLA's job is to use our logistical might to set conditions of success for everyone going into Africa," said Army Col. Eric Sloughfy, chief of the DLA Joint Logistics Operations Center. Personnel from DLA Disposition Services and DLA Distribution in Jacksonville, Florida worked to move out 1728 cots, while people in Gulfport, Mississippi were preparing another 900 they received from the Naval Construction Battalion Center there.

Altogether, 2628 cots were provided... - more

[Byline: Kenneth MacNavin]

--
Communicated by:
Roger Feldman <promedrf@gmail.com>

******
[7] Guinea: South African tycoon donates USD 1 million
Date: 29 Oct 2014
Source: BBC news [edited]
http://www.bbc.co.uk/news/world-africa-29814998


South Africa's 1st black billionaire, Patrice Motsepe, has donated USD one million (GBL 620 000) to Guinea to help the country fight Ebola. ... The mining magnate said he hoped it would assist with clinical management, social mobilisation and other key steps in controlling the deadly virus. His donation was announced as the USA praised the international aid effort.

Mr Motsepe, who is chairman of the mining company African Rainbow Minerals and has set up the charitable Motsepe Foundation, urged other Africans in business to continue making contributions to fight Ebola.

America's UN envoy Samantha Power, on a visit to the region, praised the efforts of Ebola-hit nations and foreign donors and urged them to continue to help.

--
Communicated by:
Roger Feldman <promedrf@gmail.com>

******
[8] Sierra Leone: state of emergency extended, journalist jailed
Date: Tue 4 Nov 2014
Source: Reuters [edited]
http://www.reuters.com/article/2014/11/ ... =worldNews


Police in Sierra Leone have jailed a journalist in the capital Freetown under emergency measures introduced to help the West African country cope with the Ebola epidemic, a senior police source said on Tue [4 Nov 2014].

David Tam-Baryoh was sent to the Pademba Road prison on an executive order from the president, according to Chief Superintendent Ibrahim Koroma. "The powers were derived from the Ebola emergency regulations the country is currently under," Koroma said, without detailing the charges against the journalist or specifying the length of his detention.

The arrest may be linked to comments made by Tam-Baryoh on his popular radio program MONOLGUE in which he appeared to challenge arrests made last week [beginning 26 Oct 2014] in the Kono district after Ebola-linked riots. The Sierra Leone Association of Journalists condemned the arrest.

[Byline: Umaru Fofana, Emma Farge, and Angus MacSwan]

--
Communicated by:
Roger Feldman <promedrf@gmail.com>

[When the 90-day state of emergency in Sierra Leone expired on 31 Oct 2014, the President extended it until the end of June 2015.

"Building on a narrative that western aid workers are deliberately spreading Ebola while claiming to cure it to gain access to Sierra Leone's mineral wealth, deadly riots broke out in a diamond-mining town this week," http://www.breitbart.com/Breitbart-Lond ... aths-Daily. The URL is misleading; the reference to 20 deaths daily is to deaths due to Ebola, not riots. - Mod.JW

ProMED HealthMaps can be accessed at:
Liberia: http://healthmap.org/promed/?p=54,
Sierra Leone: http://healthmap.org/promed/p/46,
Guinea: http://healthmap.org/promed/p/45.]

EBOLA VIRUS DISEASE - WEST AFRICA (204): SIERRA LEONE, REGION, MODELS UNRELIABLE
********************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Sierra Leone: new outbreak
[2] West Africa: faith group awareness initiative
[3] Models overestimate cases & deaths

******
[1] Sierra Leone: new outbreak
Date: Tue 4 Nov 2014
Source: Guardian [edited]
http://www.theguardian.com/world/2014/n ... erra-leone


New Ebola outbreak in Sierra Leone raises fears of new infection chain
----------------------------------------------------------------------
A fresh outbreak of Ebola in a part of Sierra Leone where the virus was thought to have been contained has raised fears of a new, uncontrolled infection chain that could send the death toll soaring. Koinadugu had prided itself on being the only area to have kept Ebola at bay by operating self-imposed quarantine system. A Red Cross ambulance team was sent to the remote district of Koinadugu, which had prided itself on being the only area to have kept Ebola at bay, on Tuesday [4 Nov 2014] to urgently collect 30 corpses for medical burial.

The outbreak is a major setback for the Ebola response force and the district, which 2 weeks ago remained resolved to control the spread of the virus. Koinadugu has been operating a self-imposed quarantine for 4 months, thanks to the intervention of an expat businessman, Momah Konte, who returned from Washington and worked with local officials and tribal chiefs to try to prevent the spread. The Red Cross said the emergency burial team was making the 5-hour journey from Freetown on Tuesday to collect the bodies in the Nenie chiefdom east of the district's capital Kabala. A spokesman said that there were reports of a further 25 ill with Ebola and another 255 being monitored after coming into contact with the dead and the sick.

The district, which is home to more than 260 000 people, borders on Guinea, where the current outbreak started. It is populated by many remote villages with the movement of traders and farmers difficult to control. The disease is widespread in the nearby districts of Bombali and Port Loko, where the Ebola response has been hampered by lack of resources. There are no treatment centres in either district.

There were local reports that Ebola had been brought to the district by an infected man who had travelled to the Eastern Province of Sierra Leone for a funeral. The national Ebola 117 hotline says it is getting reports of 4 cases a day from the district, which is about 5 hours from Freetown. The fresh outbreak comes days after a presidential visit to the neighbouring district of Port Loko, where bodies were left in houses and on verandahs for days before the Red Cross collected them 9 days ago.

A Cuban medical team had been on standby for weeks in Freetown to operate a new clinic in Port Loko but its opening was delayed after an unconnected NGO international pulled out of the plan to manage it.

The emergence of a new outbreak of Ebola comes as fresh figures show that Ebola is spreading 9 times faster in parts of Sierra Leone than it was 2 months ago. A report by the Africa Governance Initiative [AGI], set up by Tony Blair, which is supporting the country's Ebola 117 hotline says there were 12 new cases a day in late October [2014] in the rural areas surrounding the capital Freetown, compared with an average of 1.3 cases in early September [2014]. The head of the call centre told the Guardian the call centre was getting 4 cases a day reported from Koinadugu.

[Byline: Lisa O'Carroll]

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

******
[2] West Africa: faith group awareness initiative
Date: Sun 2 Nov 2014
Source: ReliefWeb [edited]
http://reliefweb.int/report/sierra-leon ... initiative


Ebola awareness initiative
--------------------------
Faith leaders across West Africa are using their unique position of influence within communities to speak out and help stop the spread of the deadly Ebola virus. CAFOD [Catholic Agency For Overseas Development], Christian Aid, Tearfund and World Vision are working through established religious networks across Guinea, Liberia and Sierra Leone to educate communities about the symptoms of Ebola, offer support to people affected by the outbreak and ensure survivors are not stigmatised when they return home.

With most public gatherings banned across the affected countries, places of worship are one of the few locations where people can receive vital information about the Ebola outbreak. The authority of faith leaders allows them to play a vital role in challenging the myths and misinformation surrounding the virus and offer life-saving advice to their church or mosque congregations on Ebola protection and prevention methods. Churches and ecumenical groups have also been donating essential food and hygiene supplies to all at-risk families.

Present traditional funeral practices have been highlighted as one of the activities which increase the rates of the continued spread of the disease. As a result, agencies are working with Christian and Muslim leaders to teach communities what modifications of cultural practices would reduce risks of transmission but allow safe but dignified burials.

CAFOD is working with priests, imams and traditional faith leaders to spread the word about hand-washing and safe sanitation and distribute hygiene kits. Its church partners are promoting safe burials and supplying food to vulnerable families. CAFOD is targeting 54 000 people in Liberia, 129 000 in Sierra Leone, and 28 000 in Guinea....

MCSL [Methodist Church Sierra Leone] and other denominations are members of the Council of Churches in Sierra Leone, which has set up a national Religious Leaders' Taskforce on Ebola. Christian and Muslim leaders on this taskforce are collaborating with other partners to provide food to vulnerable households and offer psychosocial care to health workers, affected families and children under quarantine....

Tearfund is working with over 1000 churches in Sierra Leone to improve awareness of how to stop the virus spreading. Radio stations run by Tearfund partners have been broadcasting life-saving health messages, reaching hundreds of thousands of listeners....

Again, in Sierra Leone, World Vision has reached out to 30 key faith leaders in churches and mosques that serve large local populations to help tackle stigma. Through a consortium with other aid agencies it plans to reach over 8000 faith leaders and key community figures, with a potential to influence over 1.5 million people. As well as providing burial teams that are fully equipped to safely deal with victims, World Vision staff have been advising Christian and Muslim leaders on how to best tailor burial practices to prevent the risk of infection....

David Thomson, Director of Policy and Programming for World Vision UK, said: "We have strong ties to faith communities, having worked with both Christian and Muslim leaders to support our development work in the past. This allows us to disseminate health promotion messages through faith communities more rapidly and more effectively, drawing on the additional influence and trust they have amongst local populations." ... -- more

[Byline: Disasters Emergency Committee]

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

******
[3] Models overestimate cases/deaths
Date: Tue 4 Nov 2014
Source: Nature [edited]
http://www.nature.com/news/models-overe ... es-1.16279


Models overestimate Ebola cases
-------------------------------
Rate of infection in Liberia seems to plateau, raising questions over the usefulness of models in an outbreak. The reality of the Ebola outbreak is not reflected by model projections of high case numbers. The Ebola outbreak in West Africa has infected at least 13 567 people and killed 4951, according to figures released on 31 Oct [2014] by the World Health Organization (WHO). Now, in a rare encouraging sign, the number of new cases in Liberia seems to be flattening after months of exponential growth. Scientists say it is too soon to declare that the disease is in retreat: case data are often unreliable, and Ebola can be quick to resurge. But it is clear that mathematical models have failed to accurately project the outbreak's course.

Researchers are now struggling to understand whether reports of empty beds at treatment centres and declining burial numbers are signs that fewer people are developing Ebola, or whether cases and deaths are going unrecorded. In Liberia's capital, Monrovia, just 80 of 250 beds were filled at the Medecins Sans Frontieres (MSF) centre last week. But Fasil Tezera, who heads MSF's Liberia mission, is cautious: "The present epidemic is unpredictable," he says.

Epidemiologists normally use mathematical models to estimate the trajectory of an outbreak, and to estimate where and how to direct scarce medical resources. But for the current crisis, on-the-ground data contradict the projections of published models, says Neil Ferguson, an epidemiologist at Imperial College London, and a member of the WHO's multidisciplinary Ebola Response Team.

On 7 Oct 2014, for example, modeller Alessandro Vespignani of Northeastern University in Boston, Massachusetts [USA], and his collaborators predicted that Liberia would see 6900-34 400 cases by 24 Oct 2014, and 9400-47 000 by 31 Oct 2014. But the WHO put the number of reported cases in the country at just 6535 as of 25 Oct 2014.

Vespignani says that his model was a worst-case scenario, in which exponential growth of cases continued and containment measures were ineffective. But he and other modellers are also handicapped by incomplete and unreliable data on Ebola epidemiology, especially in the hardest-hit areas. And they have little empirical data on how disease-control measures quantitatively affect Ebola transmission, says ecologist Nick Golding, who studies the spatial distribution of disease at the University of Oxford, UK. Models "are fitted to pretty poor-quality data on case counts, and essentially no data on interventions," he says, making it difficult to generate accurate projections.

2 more-complex models published last month [October 2014] attempted to tease out the effects of various control measures. But their outcomes also do not square with the most recent Liberia data. That does not surprise Alison Galvani, an epidemiologist at Yale University in New Haven, Connecticut [USA], and an author of both studies. "Epidemics are moving targets," she says, adding that her model projections are at best a preliminary outline for public-health intervention. Because the model projections can be easily misunderstood, Ferguson says that modellers "really need to think carefully about what we really know about Ebola transmission and the impact of different interventions, and do our best to communicate the many uncertainties."

In the meantime, Bruce Aylward, a WHO assistant director-general who is coordinating the agency's Ebola efforts, is "terrified" that any plateau in new cases will be misinterpreted as meaning that the problem is going away. There is still a need to greatly increase the resources available to treat infected people and prevent new cases, Aylward says.

But if the slowing rate of infection in Liberia is confirmed, it could suggest that even moderate levels of public-health intervention can pay off, says Golding. For the current Ebola outbreak, the average number of new cases spawned by an infected individual (1.2-2.2) is much lower than that of many other communicable diseases, such as measles (which can spread to between 12 and 18 people per case). As Ebola prevention measures push down this figure, the disease becomes easier to control; when it dips below 1, virus spread stops completely.

Until the West African outbreak is extinguished, there is a real risk that the disease will resurge in areas where it has been stamped out -- or even cover new ground. A stark reminder of this came in the past 2 weeks: a 2-year-old girl with Ebola travelled hundreds of kilometres from Guinea to Mali on a bus -- raising concerns that the many people she came into contact with could spark outbreaks in Mali.

[Byline: Declan Butler]

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

[In normal circumstances, models are useful for projecting future requirements for personnel, equipment and supplies. But in this outbreak, case reporting criteria have been constantly shifting and it hasn't been possible to carry out household surveys with laboratory confirmation of cases and deaths, or even lab confirmation for many of the cases classified as suspicious and probable. Given the high incidence of malaria and other fatal diseases, it has been impossible to arrive at realistic projections of the past and future case loads and mortality.

For a geographical perspective on Ebola, these maps show how small the Ebola-infected part of Africa is compared with much of the rest of the world: http://kuow.org/post/twitter-snark-help ... ark-relief. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/46.]

EBOLA VIRUS DISEASE - WEST AFRICA (205): WHO, NIGERIA, SIERRA LEONE, CRISIS FUND
********************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] WHO Situation Report 7 Nov 2014
[2] WHO safe burials protocol
[3] Nigeria: expert analysis of Africa's response to Ebola
[4] Sierra Leone: Australia to staff UK Ebola hospital
[5] Nigeria: Lagos bus park scare
[6] Africa: USD 28.5m crisis fund

******
[1] WHO Situation Report 7 Nov 2014
Date: Fri 7 Nov 2014
Source: WHO [edited]
http://apps.who.int/iris/bitstream/1066 ... 14_eng.pdf


Ebola Response Roadmap: Situation Report 7 Nov 2014 [up to the end of 4 Nov 2014]
---------------------------------------------------------------------------------------------------
Highlights
----------
There have been 13 268 reported Ebola cases in 8 affected countries since the outbreak began, with 4960 reported deaths.
- Case incidence is declining in some districts in Guinea, Liberia and Sierra Leone, while steep rises persist in other districts.
- Intense transmission in the 3 most affected countries demands widespread rigorous control measures. Preparedness in unaffected neighbouring countries is also critical.
- There have been no new cases in Mali, Spain or the USA, but a high level of vigilance is essential in these countries.

Summary
-------
A total of 13 268 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in 6 currently affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain, and the United States of America) and 2 previously affected countries (Nigeria, Senegal) up to the end of 4 Nov 2014. There have been 4960 reported deaths....

An overview of the situation in the Democratic Republic of the Congo, where a separate, unrelated outbreak of EVD is occurring, is also provided (see Annex 2).

1. Countries With Widespread & Intense Transmission
---------------------------------------------------
A total of 13 241 confirmed, probable, and suspected cases of EVD and 4950 deaths have been reported up to the end of the 4 Nov [2014] by the Ministries of Health of Liberia and Sierra Leone, and 3 Nov [2014] by the Ministry of Health of Guinea (table 1). These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results.

All districts in Liberia and Sierra Leone have reported at least one case of EVD since the start of the outbreak (figure 1). Of the 8 Guinean and Liberian districts that share a border with Cote d'Ivoire, all but one in Guinea have reported a confirmed or probable case of EVD. [See tables and figures at source URL.]

Health-care workers
-------------------
A total of 549 health-care workers (HCWs) are known to have been infected with EVD up to the end of 4 Nov [2014]: 88 in Guinea; 318 in Liberia; 11 in Nigeria; 128 in Sierra Leone; 1 in Spain; and 3 in the United States of America (2 were infected in the USA and one in Guinea). A total of 311 HCWs have died. WHO is undertaking extensive investigations to determine how each HCW became infected. Early indications are that a substantial proportion of infections have occurred outside the context of Ebola treatment and care. Infection prevention and control quality assurance checks are underway at Ebola treatment centres in the 3 intense-transmission countries. At the same time, exhaustive efforts are ongoing to ensure an ample supply of optimal personal protective equipment (PPE) to all Ebola treatment facilities, along with the provision of training and relevant guidelines to ensure that all HCWs are exposed to the minimum possible level of risk. WHO has moved more than 1 million sets of PPE to Guinea, Liberia and Sierra Leone, and continues to work with ministries of health and other partners to procure and distribute PPE where it is most needed....

Mali
----
On 23 Oct [2014], Mali reported its 1st confirmed case of EVD (table 2). The patient was a 2-year-old girl who travelled [by bus] from Guinea with her grandmother [and siblings] to Mali. On 22 Oct [2014] the patient was admitted to Fousseyni Daou hospital in Kayes. She died on 24 Oct [2014]. Samples for laboratory confirmation were sent to SERAFO in Bamako and were positive for EVD. This has been confirmed by laboratory testing conducted by the US Centers for Disease Control and Prevention [CDC] in Atlanta [Georgia, USA]. To date, 108 contacts have been identified and are being followed up.... -- more

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The grandmother and siblings have remained symptom-free during the 2 weeks since 24 Oct 2014. - Mod.JW]

******
[2] WHO safe burials protocol
Date: Fri 7 Nov 2014
Source: Outbreak News Today [edited]
http://outbreaknewstoday.com/ebola-prev ... als-33547/


Ebola prevention: WHO publishes protocol for safe burials
-------------------------------------------------------------------
20 percent of new Ebola infections occur during burials of deceased Ebola patients. This high number and attempting to build trust and respect between burial teams, bereaved families and religious groups has prompted the World Health Organization (WHO) to publish today, "How to conduct safe and dignified burial of a patient who has died from suspected or confirmed Ebola virus disease."

Ebola infections occur during burials when family and community members perform religious rites that require directly touching or washing the body, which still contains high levels of Ebola virus; and when family members distribute personal property of the loved one, which may be infected with the virus.

Developed by an interdisciplinary team at WHO, in partnership with the International Federation of Red Cross and Red Crescent Societies (IFRC) and faith-based organizations including World Council of Churches, Islamic Relief, Caritas Internationalis and World Vision, this updated protocol outlines step-by-step processes for safe and dignified burials. The protocol encourages inclusion of family and local clergy in the planning and preparation of the burial, as well as at the burial event itself, giving specific instructions for Muslim and Christian burials.

"We are becoming known for 'dead body management', but we do not 'manage' dead bodies. We safely, respectfully and in a dignified manner, accompany our deceased fellow human beings and help to prepare them, in accordance with their cultures, for their last resting places. It is in this spirit that our volunteers carry out their difficult work," says Elhadj As Sy, Secretary General, IFRC. "It is clear from Islamic juristic ruling that the necessity of religious washing of the body before burial of patients who die from Ebola is over-ruled," says Rehanah Sadiq, a Muslim chaplain with University Hospitals Birmingham NHS Foundation Trust [UK] who served as consultant to WHO on the protocol. "However, it is vital to help bereaved families grieve and find closure by ensuring that sacred rites, such as performing a dry ablution, shrouding the body, and praying over the deceased are represented in Muslim funerals. Providing safe alternatives for families to maintain deeply-cherished practices helps them be part of the decision-making process, which is critical particularly during a time when they may be feeling helpless."

"Giving the family an opportunity to view the body of the deceased, ensuring that the grave is appropriately labelled, and allowing religious leaders to offer prayers and family members the option to throw the 1st soil -- these are important incentives for encouraging families to continue to find strength in their faith, and to keep other family members safe from becoming infected," said Rev. Msgr. Robert J. Vitillo, Head of Delegation, Caritas Internationalis.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The WHO protocol may be downloaded at: http://www.who.int/csr/resources/public ... rotocol/en. - Mod.JW]

******
[3] Nigeria: expert analysis of Africa's response to Ebola
Date: Mon 3 Nov 2014
Source: Science Magazine, ScienceInsider [edited]
http://news.sciencemag.org/africa/2014/ ... onse-ebola


Nigerian virologist delivers scathing analysis of Africa's response to Ebola
------------------------------------------------------------------------------------
After Oyewale Tomori finished his talk on Ebola here at the International Meeting on Emerging Diseases and Surveillance, there was stunned silence. Tomori, the president of the Nigerian Academy of Science, used his plenary to deliver a scathing critique of how African countries have handled the threat of Ebola and how corruption is hampering efforts to improve health. Aid money often simply disappears, Tomori charged, "and we are left underdeveloped, totally and completely unprepared to tackle emerging pathogens."

Trained as a veterinarian, Tomori was the World Health Organization's (WHO's) regional virologist for the African region in 1995 during the Ebola outbreak in Kikwit in the Democratic Republic of the Congo (DRC). ScienceInsider sat down with him at the meeting in Vienna; questions and answers have been edited for brevity and clarity.

Q: You said in your talk that Ebola was "swimming in an ocean of national apathy, denial, and unpreparedness." What did you mean?

A: We were totally unprepared. After the 1st cases occurred in West Africa, it took almost 3 months for WHO to know. When the 1st patient came to Sierra Leone and died, his son brought him back to Guinea and as far as Sierra Leone was concerned, it was Guinea's problem. People abandoned their duty, they denied the problem, and when it became a big problem they became incapable of handling it.

This is not the 1st time Ebola has appeared in Africa. There have been more than 20 outbreaks since 1976. Not one of them has been declared a global problem. Of course, circumstances are different this time. But if we had been prepared, if we had learned from the past, we wouldn't be where we are today.

Q: You seem angry.

A: Yes, I am, because I know Africa has the capacity and the capability to solve most of her problems, but Africa will not enable her human resources to perform effectively and efficiently. African leaders have little or no respect for their experts and would rather act on advice from external sources. In the end, they become the experts on Africa's problems, not the Africans. This is why I am angry with Africa.

We have seen so many Ebola cases before, in the DRC, in Sudan, in Gabon.... Ebola is Africa's problem. We should have put something in place. I remember in 1995, when we had the Kikwit epidemic, at the end we sat down at a table and discussed what we should do. There was a laboratory in Kinshasa built by the French; it was almost completed, but then abandoned. We had raised almost USD 2 million at the time. And we said: "Why not take a bit of that money and complete this lab and maintain it? Then at least when we have issues like this we can do quick testing." But nothing happened. The carcass is still there. Each time I pass the place, I think: "What a waste."

Q: But your own country seems to have been prepared. Nigeria managed to contain the virus after it was carried to Lagos by a traveler in July [2014]. There were only 19 infections, and WHO called the containment of the virus "a spectacular success story."

A: We were not prepared, we were lucky. PS was already sick when he arrived, so he went straight to the hospital. And because our doctors were on strike, the public hospitals were not open, so he went to a private hospital. If PS had gone into a public hospital, we would have had a bigger problem. But within 2 to 3 days of PS coming in, we knew it was Ebola from laboratory tests done in 2 of our university laboratories, and then action was taken. I praise Nigeria for that. We had this emergency center from the polio network and we brought people in and traced almost 1000 contacts. This was not passive tracing; people went to contacts' homes on a daily basis.

Q: So why are African countries so badly prepared? Is it a question of money?

A: People say African countries are poor. But it's not poverty. It's misuse of what we have. As we are talking, with all the crises that are going on, the presidents of our countries are still traveling in the best of conditions. Some will come to New York in their private jets, although their national airlines collapsed years ago; in addition, they will bring along a long retinue of private, personal, and public assistants, all lodged in the best hotels. I am not saying the president should not be treated well, but these are issues we need to look at. Take my country: We do not have a national airline, but the number of private jets we have is more than all the airlines in Africa have together.

It's a matter of priorities. I do not believe there is an African country that cannot buy gloves for its staff. Personal protective equipment may be very costly, they may need assistance on that. But let us participate. As long as we are wringing hands waiting for the next glove to come, we will never be ready. There are certain things we can do now, with the resources we have.

Q: So African leaders should be held more accountable for what they spend money on?

A: GAVI [a public-private partnership that funds vaccines for low-income countries] just sanctioned Nigeria after a critical audit report. GAVI gave us money to do certain things, and we could not account for USD 2 or 3 million of it. GAVI insisted that Nigeria must pay back that money, and the government agreed. But our government should not just agree to pay back the money, the government should find out who misused the money, get the money back from those persons and not from public coffers. And those people should be brought before the courts to answer for the deaths of the children who did not receive the vaccines that the GAVI money would have provided.

Q: So how should African countries contribute to fighting the Ebola outbreak?

A: To give you one example, there are 600 Nigerian health care workers who want to go to Liberia. But the process of getting them there has been going on for months. If the African team, the African Union, the Economic Community of West African States, and the West African Health Organisation all get their acts together, there are more than enough people in Africa -- health care workers from Gabon, DR Congo, Uganda, Sudan -- who have experience with this.

But we must find the funds to provide insurance for all national and international health workers who are currently working or have volunteered to work in the Ebola-affected areas of Africa. Bear in mind, in Africa we do not have a welfare system. I am the welfare system for my family, my brothers, my uncle. So when I go to an Ebola region, I am thinking of the 23 other people that depend on me. If there is no insurance, I will stay home.

Q: There has been a lot of criticism of the WHO regional office in Africa.

A: I am angry at them, too. They should take the lead of Ebola control efforts -- not Geneva, not Washington, not New York. The [Centers for Disease Control and Prevention (US CDC)] can help, [Doctors Without Borders (MSF)] can assist, but it is WHO's African region that should coordinate and take the lead. It's all meetings and reports. Nothing on the ground.

Q: As it happens, they are meeting in Benin this week; on the agenda is the election of a new regional director.

A: These elections are just horse-trading. If the person who wants to get elected requires the vote from Nigeria for example, because it is the ministers of health who do the voting, [he or she] might say: "OK, I will vote for you, but I need one directorship from my country." If he accepts that, he has to accept whomever I bring, regardless of how competent the person is. That is what has messed up Africa. The WHO regional office has never been able to solve Africa's problems because of this system of electing its leaders. You want to find the most competent person. Vote on that basis. Not because I visited you and I promised you this or that.

Q: Do you think this unprecedented outbreak will change things?

A: I wish I could say with confidence that in 10 years time we will not be where we are now with Ebola. But the countries have totally lost control of what is going on. If you go to Sierra Leone or Liberia today, there must be at least 10 international groups there. At the end of this epidemic, everybody will pack their bags and leave. The African countries will be left not really knowing what has happened to them. Like someone hit them smack in the face, totally disoriented. There will be millions of scandals about how money was misspent and so on. We will focus on those and move on; 10 years from now, people will have forgotten that there was Ebola and we will be back to where we started.

[Byline: Kai Kupferschmidt]

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

[An abstract of my friend Wale's talk is on page 15 of the IMED2014 Final Program at: http://imed.isid.org/downloads/IMED2014FinalProgram.pdf. I haven't been able to find a transcript of his whole presentation online. - Mod.JW]

******
[4] Sierra Leone: Australia to staff UK Ebola hospital
Date: Wed 5 Nov 2014
Source: Stars and Stripes, Associated Press report [edited]
http://www.stripes.com/news/pacific/aus ... e-1.312243


Australia to staff Ebola hospital in Sierra Leone
-------------------------------------------------
Australia's prime minister said Wednesday [5 Nov 2014] that his government expects to staff a British-built Ebola hospital in Sierra Leone by the end of the month [November 2014] after reaching a deal with Britain on treating Australian health workers who might become infected with Ebola. For weeks, Australia has refused requests from the United States and Britain to send health teams to West Africa to fight Ebola, which has killed almost 5000 people, mostly in the worst-hit countries of Sierra Leone, Liberia and Guinea. But Prime Minister Tony Abbott said that while his government would not compel Australian health professionals to go Africa, it was now prepared to pay the way for doctors and nurses who volunteer to go there. Abbott said Australia changed its stance because Britain guaranteed it would treat any Australian health worker infected with Ebola.

"In the last few days, we have had assurances from the United Kingdom they would treat any Australian who is working in the Ebola-impacted parts of West Africa as though he or she were a citizen of the United Kingdom," Abbott told reporters. He said Australians would be among the 240 people required to operate the 100-bed British hospital being built in Sierra Leone, but that most of the staffers would be local.

Australia has contracted an Australian company, Aspen Medical, to staff the hospital with local and international staff. The new commitment increases Australia's contribution to fighting Ebola in Africa from AU 18 million (USD 16 million) to AU 42 million.

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

[I wonder if the UK would give the same guarantee to other British Commonwealth citizens who might wish to volunteer? - Mod.JW]

******
[5] Nigeria: Lagos bus park scare
Date: Sat 1 Nov 2014
Source: The Sun [edited]
http://sunnewsonline.com/new/?p=88917


Ebola scare in Lagos Motor Park
-------------------------------------
The prompt intervention of Chisco transport officials has saved a pregnant woman, who, after alighting from one of the company's buses at its terminal, Jibowu, Lagos, started vomiting blood through her mouth and nose. Scared by the development, other passengers were said to have taken to their heels as one of the passengers screamed that the pregnant woman was displaying Ebola symptoms. It took the timely intervention of Chisco officials who made use of their standby ambulance to rush her to hospital.

Juliet, a staff member from Chisco Transport, that "On 12 Oct 2014 at about 10.15 am, a passenger, who was pregnant, alighted from one of our buses that just arrived from Abuja. Immediately she alighted from the bus, she fell down and started vomiting through the nose and mouth. The Jibowu branch manager called on the medical section, which organised an ambulance and took her to 3 different hospitals, each of which rejected her. She was finally admitted at the Military Hospital, Yaba, Lagos. After several tests, they informed us that she was hypertensive, which led to convulsions. The hospital demanded that an initial deposit of N 36 000 [USD 210] should be paid before they could treat her. The bus company paid the said amount and directed our workers to take turns in taking care of her.

"This became necessary as we could not make contact with anyone who is related to her. We even discovered that she did not fill the next of kin column in the form we give our passengers. She later gave birth to a premature baby, and Chisco Transport paid another N 5000 [USD 29]." According to Juliet, the woman and her child were later brought to the Chisco Transport office as soon as she was discharged on 16 Oct 2014. "We later assisted [the woman] to locate her sister, who resides in the Ikorodu area of Lagos." Elated, [the woman] thanked the management and staff of Chisco Transport for assisting her in such a time of need. "I am okay and so is my little baby. It is only God that will reward them," she prayed.

[Byline: Chioma Igbokwe]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[On the one hand, a heartwarming story of a generous private company; on the other, a frightening report of how deep the fear of Ebola still runs among hospital staff in Lagos. The mother might not have survived being shuttled between hospitals while losing blood. - Mod.JW]

******
[6] Africa: USD 28.5m crisis fund
Date: Sat 8 Nov 2014
Source: BBC [edited]
http://www.bbc.co.uk/news/world-africa-29967124


Ebola outbreak: Africa sets up USD 28.5m crisis fund
-------------------------------------------------------------
Top African business leaders have established an emergency fund to help countries hit by the Ebola outbreak. A pledging meeting in Addis Ababa, Ethiopia, raised USD 28.5m to deploy at least 1000 health workers to Guinea, Sierra Leone and Liberia. Experts say that if the disease is to be speedily contained, it needs to be tackled in these 3 countries. Speaking at the end of the Addis Abada meeting, African Union chairman Dlamini Zuma said the resources mobilised would be part of a longer term programme to deal with such outbreaks in the future.

The chairman of telecommunications giant Econet Wireless, Strive Masiyiwa, said that several companies had pledged money to the emergency fund -- to be managed by the African Development Bank. The Ethiopia meeting took place as Liberia was reported by the medical charity Medecins Sans Frontieres (MSF) on Friday [7 Nov 2014] to have seen a significant reduction in the number of new cases. It warned, however, that Ebola was still on the rise in Guinea and Sierra Leone.

Chris Stokes, the head of MSF's Ebola response, told the BBC that the decrease in the number of cases in Liberia presented an opportunity for health workers to step up their work. The World Health Organization says that at least one in 5 infections occur during the burials of Ebola victims -- it issued a guide this week to how best to conduct funerals. It is not clear why exactly the number of cases in Liberia has dipped -- but it has been running an awareness campaign to advertise best health practices and install hand washing stations. He said the disease could "flare up" again, pointing to Guinea, where the number of cases is rising again despite 2 significant lulls....

Of the West African countries hit by the 11-month outbreak, Liberia has seen the most deaths. But last weekend [1-2 Nocv 2014] its health ministry said 2/3rds of the 696 beds in the country's treatment centres were empty.... -- more

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[A HealthMap/ProMED-mail map is available at http://healthmap.org/promed/p/46.]

EBOLA VIRUS DISEASE - WEST AFRICA (206): SIERRA LEONE, LIBERIA, MORE
********************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Mali: WHO sitrep
[2] Sierra Leone: 111 new cases registered Sun 9 Nov 2014
[3] West Africa: school closings could mean illiteracy tomorrow
[4] Liberia: impact of 21 day quarantine on MSF
[5] Senegal: Ebola awareness through SMS campaign
[6] Guinea: concern about health crisis
[7] European Union: medevac planes from Luxembourg
[8] US opens new Ebola treatment unit in Liberia

******
[1] Mali: WHO sitrep
Date: 10 Nov 2014
Source: WHO Ebola situation assessment [edited]
http://www.who.int/mediacentre/news/ebo ... 14-mali/en


Investigations undertaken by ministries of Health in Mali and Guinea, assisted by WHO, have clarified the early exposure history of Mali's 1st Ebola case.

The index case in Mali, a 2 year old girl who resided with her family in the urban commune of Beyla, Guinea, was diagnosed with Ebola, in Kayes, Mali on 23 Oct [2014] and died on the following day. The child's history while still residing in Guinea strongly suggests that several members of her family died from Ebola virus disease. Most of the patients described below were buried safely by Red Cross volunteers but not tested until late in the transmission chains... [There follows a detailed tracing of a chain of deaths in the extended family. - Mod.JW]

To date, Malian health officials, aided by WHO, the US Centers for Disease Control and Prevention (CDC), Medecins sans Frontieres (MSF), the International Federation of Red Cross and Red Crescent Societies, and several other partners have identified 108 contacts of the symptomatic patient, including 33 health care workers who were exposed. Of the 108 contacts, 25 have been followed for 21 days and have been released from the surveillance system. 79 contacts were at the hospital where the child was treated and in the Kayes community. All have been monitored. To date, no one has shown signs of Ebola or tested positive for the disease...

With persistent and thorough contact tracing, isolation and monitoring in place, confidence is growing that no further spread within Mali followed exposure to the index case, who had haemorrhagic symptoms but no diarrhoea or vomiting during her travels... - more

--
communicated by:
ProMED-mail rapporteur Mary Marshall

******
[2] Sierra Leone: 111 new cases registered Sun 9 Nov 2014
Date: Mon 10 Nov 2014
Source: Guardian [edited]
http://www.theguardian.com/world/2014/n ... sharp-rise


The number of new cases of Ebola in Sierra Leone has jumped dramatically, ending any hopes that the infection rate is slowing [but see comment below]. Official figures released by the minister of health and sanitation show there were 111 new cases registered on Sunday [9 Nov 2014], the highest daily rate since the ministry started publishing figures in August [2014]. Sierra Leone's deadliest day was 5 Oct [2014], when 121 deaths were recorded from Ebola. Daily statistics compiled by Sierra Leone's Emergency Operations Centre for that day showed 81 new cases of the virus, fewer than those registered on Sunday.

There were 45 new cases the day before, including 24 in the capital, Freetown. Laboratory results for patients in Freetown, which include the new British army-built Ebola hospital, showed 40 new cases on Sun 9 Nov [2014]. There was also a spike in the number of cases in Port Loko, a district north of Freetown where there is still no treatment centre and where, until recently, corpses were left lying on verandahs, in hospitals and in houses for days before collection. The figures come days after warnings by the UN that Ebola cases in Sierra Leone are being underreported by up to 50 per cent. MSF is witnessing a decline in patients at its hospitals, with 200 empty beds in its 250-bed Monrovia hospital and no new patients in its Foya hospital in the north of the country.

Fasil Tezera, MSF head of operations in Liberia, said that the international response was finally getting off the ground, with financial support starting to flow into the country, but warned that priority must be given to a "flexible approach" that allows "a rapid response to new outbreaks... - more

[byline: Lisa O'Carroll]

--
communicated by:
Ryan McGinnis
<ryan@bigstormpicture.com>

[Random fluctuations in numbers of new cases are to be expected; it would be most peculiar if the same number of cases were reported every day. Spikes do not necessarily mean the situation is deteriorating. What counts is the average daily number over time, provided the criteria for suspected and probable cases remain the same. - Mod.JW]

******
[3] West Africa: school closures could mean illiteracy tomorrow
Date: 10 Nov 2014
Source: NPR [edited]
http://www.npr.org/blogs/goatsandsoda/2 ... est-africa


Ebola is threatening to reverse years of educational progress in West Africa. The virus has kept school closed for months in a part of the world where literacy rates are low, and school systems are only now recovering from years of civil war.

In Liberia, many children have been put to work while schools are closed, and Ebola is hurting the economy, says Laurent Duvillier, a communication specialist at UNICEF. The fear now, he says, is that many of these children will never return to school.

Linda Barrolle Saygbe says her 2 adolescent daughters study for 2 hours each day while schools are closed. But Barrolle Saygbe is frustrated that the girls' career aspirations have been put on hold. The risk is especially high for girls, who, until recently, received much less schooling than boys, Duvillier says. "Families may be tempted to keep the eldest girl at home to help them or to wash clothes for the neighbors," he says. "We don't want those girls to drop out of school because of Ebola... - more

[byline: Jon Hamilton]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[4] Liberia: impact of 21 day quarantine on MSF
Date: 10 Nov 2014
Source: MSF (Medecins sans Frontieres; Doctors Without Borders) [excerpted, edited]
http://blogs.msf.org/en/staff/blogs/msf ... om-the-usa


...What difference does 21 days make? One colleague, a professor at a prominent [Liberian] medical school, has been disinvited from giving a scheduled lecture (on Ebola and other infectious diseases no less!); another has decided to leave early to accommodate the days in quarantine in order to see his family at Christmas, and 2 colleagues scheduled to present their research at a conference in the USA cancelled their trips knowing they would not get through the airport. Also remember that these 21 days are added onto the time these folks have been away from their families, friends, and jobs. 21 days make a difference.

What difference does the lack of understanding make? One expat has been disinvited from his good friend's wedding, another from a scheduled vacation with friends and family, and another will be forced to remove his child from school for the first 21 days he returns to their home. Others have shared that they have not told their families and friends where they are on mission to avoid causing angst. Most of us have received emails asking us to return home. Finding people to commit to the mission here in Liberia is an issue.

The time a person can be effective in their job in this type of mission is limited. Between the travel time and briefs at HQ, you lose days. The training to become a safe, effective worker in this context takes time... likely 2 days in Brussels and another week working in an Ebola management center with experienced workers. Additionally, these missions are shorter than usual due to the physical and psychological impact of the context. Replacement workers are difficult to find and many are needed. Cutting corners on any of these will cause increased risk for workers, causing increased risk to others... at home and abroad. Adding a 21-day quarantine for healthy individuals only adds to the pressure.

The reality is that aid workers are needed here, and they also need to return home to their lives. We all agree that if a person becomes sick, they should quickly be isolated. Where does that leave us?

[byline: Kimberly Larkins (MSF Ebola blog), American pharmacist in Liberia]

--

[A new focus of cases and deaths has been reported on 10 Nov 2014 in Grand Cape Mount County, 47 miles away from Monrovia, in a small town called Jene-wonde http://frontpageafricaonline.com/index. ... mount-town. - Mod.JW]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[5] Senegal: Ebola awareness through SMS campaign
Date: November 2014
Source: WHO [edited]
http://who.int/features/2014/senegal-ebola-sms/en


Senegal's recent stamping out of Ebola was achieved not only through its rapid infectious disease control work, but also by using a novel short message service [SMS]-driven platform originally designed to help people manage diabetes.

On 29 Aug [2014], Senegal's 1st -- and only -- case of Ebola virus disease was confirmed in a young man who had direct contact with an Ebola patient in Guinea and then travelled, by road, to Dakar. Together with WHO and partners, the government of Senegal launched an immediate, broad-based and well-coordinated response that stopped the virus dead in its tracks.

As part of a massive public awareness effort, Senegal's Ministry of Health sent 4 million SMS messages to the general public warning of the dangers of Ebola and how to prevent it. The messages, driven by the WHO-supported "mDiabetes" platform, were targeted at people living in the capital city of Dakar and St-Louis, a heavily populated region in the country.

Through the SMS campaign, launched in partnership with major mobile phone operators in Senegal, people were encouraged to alert health authorities of anyone showing signs of a fever and bleeding by calling a toll-free number. The messages were shared ahead of large-scale public events, including football matches and rallies... - more

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[6] Guinea: concern about health crisis
Date: 9 Nov 2014
Source: Le Jour Guinee [in French, machine trans. edited]
http://www.lejourguinee.com/index.php/f ... mpuissance


An official from the Guinean Ministry of Health is concerned about the risk of political instability in the country that could lead to a health crisis. "None of us expected this disease, and the weakness of our means of health monitoring has prevented us from reacting faster," Professor Aboubacar Sidiki Diakite, inspector general of the Department of Health of Guinea, conceded on Tue [4 Nov 2014]. Invited by the Academy of Medicine, France, the president of the national committee for the health crisis recounted the distress of his country facing the outbreak of Ebola.

"The disease started with us in late 2013, but was declared on 21 Mar 2014, when the WHO Lyon P4 [highest "pathogen" or "protection level"] laboratory identified the virus," said Diakite. "The disease was probably already present in our neighbors, but it went unnoticed."

Guinea, he has admitted, was initially disappointed in the message issued. "We said there were no drugs against this disease. The African reaction is then the fallback: we prefer to die in our families. Since then, the government is trying to explain that health centers are there primarily to treat patients, not only to isolate the dying. We had to learn to adapt our strategies to the various communities that inhabit Guinea. The secret," according to Professor Diakite, is to "rely on local leaders. The press and radio are not enough. Messages should be delivered by the right people, in whom people have confidence. Especially, he said, a large part of the population is illiterate. People do not understand the health measures."

Following people who have been in contact with a patient during the 21 days that incubation can last is a challenge. "We had over 16 000 contacts in total cases; it makes 3000-4000 people to follow every day! We need resources, vehicles and manpower. If you miss a contact, you create a risk. At one point, we thought we were at the end of the epidemic, and Doctors Without Borders has almost closed a processing center. But cases and contacts of suspected cases have escaped us, and new foci were created."

The 3 affected countries (Guinea, Liberia and Sierra Leone) are, according to Professor Diakite, inseparable. "Our people are made from the same communities, and our countries are linked: the evolution of the epidemic is on the same curve."

As for international mobilization, it is "out of touch" with reality, he modestly stated, a reality that international bodies are far from measuring the extent of. WHO repeated on Wednesday [5 Nov 2014] its latest report (4818 deaths per 13 042 cases); it was well below the truth. "There are many dead missing," a WHO official told AFP, who said that the deaths could actually be twice as many... "Doctors Without Borders [MSF] has been there from the start, but is slowing over time. We, therefore, welcome the French mobilization," said Diakite.

--
communicated by:
ProMED-mail rapporteur Mary Marshall

******
[7] European Union: medevac planes from Luxembourg
Date: 6 Nov 2014
Source: European Commission Press release [edited]
http://europa.eu/rapid/press-release_IP ... ?locale=en


The European Union and its member states have now pledged more than EUR one billion [USD 1.24 billion] in response to the Ebola crisis in West Africa. This means the EU has already gone beyond the target set by the European Council on 24 Oct [2014] for EUR one billion in assistance to stem the epidemic.

The EU is boosting its investment in Ebola research, sending more material aid and providing new capacity for medical evacuations of international aid workers. This announcement comes just ahead of the mission of the European Union's Ebola coordinator and commissioner for humanitarian aid and crisis management, Christos Stylianides, and the commissioner for health, Vytenis Andriukaitis, to the Ebola-affected countries in West Africa...

The European commissioner for research, science and innovation, Carlos Moedas, said: "The EU is determined to help find a solution to Ebola. We are putting our money where our mouth is and boosting EU research on Ebola with an additional EUR 280 million [USD 348 million]. With this funding from Horizon 2020 and our industry partners, we are stepping up the development of new vaccines and medications to help save lives around the world" [See Ebola virus disease - ex Africa (31): Ugandan cured, Texas free, safety, funds 20141107.2938140].

The EU is also beginning its biggest single operation of transporting material assistance to the affected countries. A Dutch ship is sailing today [6 Nov 2014] from the Netherlands, loaded with ambulances, mobile hospitals, laboratories, and other equipment. The cargo has been provided by 9 member states (AT, BE, CZ, FI, HU, NL, RO, SK, UK) and UNICEF. The EU Civil Protection Mechanism is coordinating the operation.

"By pooling our resources, Europe's efforts make a much bigger difference on the ground. At a moment when the availability of medical evacuations is such a crucial factor for encouraging more medical workers to join the Ebola response, I particularly welcome Luxembourg's leadership on this priority with the contribution of [2] specially equipped planes," said commissioner Stylianides.

Luxembourg has become the 1st EU member state to commit aeroplanes for European medical evacuation operations of international humanitarian workers diagnosed with Ebola. The 2 planes are retrofitted for the purpose with co-funding by the European Commission, which will also finance the bulk of the transport costs for evacuations under the EU Civil Protection Mechanism.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[8] US opens new Ebola treatment unit in Liberia
Date: 10 Nov 2014
Source: AP via ABC News [edited]
http://abcnews.go.com/International/wir ... a-26809028


The United States on Mon 10 Nov 2014 opened the 1st of 17 Ebola treatment units it is building in Liberia.

The new clinic opened in Tubmanburg, about 60 km (40 miles) north of the capital, Monrovia. The number of people with Ebola appears to declining in the capital, but more cases are popping up in other areas of the West African country, according to the World Health Organization... - more

[byline: Jonathan Paye-Layleh]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[A ProMED HealthMap for Liberia can be accessed at http://healthmap.org/promed/p/54.]

EBOLA VIRUS DISEASE - WEST AFRICA (207): MALI SUSPECTED NEW CASE REQUEST FOR INFORMATION
****************************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Mali: suspected new case
Date: 11 Nov 2014
Source: Reuters via Boursorama [in French, transl. JW, edited]
http://www.boursorama.com/actualites/no ... 3734be2157


New suspected case of Ebola virus contamination in Mali
-------------------------------------------------------
Health authorities in Mali have identified a new suspected case of Ebola virus contamination in Mali, a spokesperson of the health ministry announced to Reuters on Tue [11 Nov 2014]. No additional information has been provided at this stage.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[Mali was just about to declare itself Ebola-free, so if this case is confirmed it will be a serious setback. ProMED-mail requests further information. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/50.]

EBOLA VIRUS DISEASE - WEST AFRICA (208): WHO, MALI CONFIRMED, DEATHS IN CAPITAL
*******************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] WHO sitrep 12 Nov 2014 as of 9 Dec 2014
[2] Mali: Dozens in quarantine after Mali Ebola deaths
[3] Mali battles Ebola outbreak

******
[1] WHO sitrep 12 Nov 2014
Date: 12 Nov 2014
Source: WHO Situation report [edited]
http://who.int/csr/disease/ebola/situation-reports/en


Ebola response roadmap - situation report 12 Nov 2014
-----------------------------------------------------
There have been 14 098 reported cases of Ebola, with 5160 reported deaths.
Transmission remains intense in Guinea, Liberia and Sierra Leone, and case incidence is still increasing in Sierra Leone.
Interventions to contain the disease include infection prevention and control; diagnosing, isolating and treating patients; contact tracing; and safe and dignified burials.
A total of 4 confirmed and probable cases and 4 deaths have been reported in Mali.
All Ebola patients in the United States of America have been discharged from hospital.

Summary
-------
A total of 14 098 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in 6 affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain and the USA) and 2 previously affected countries (Nigeria and Senegal) up to the end of 9 Nov [2014]. There have been 5160 reported deaths.

Interventions to contain the disease in the 3 most affected countries include isolating and treating patients, identifying their contacts and conducting burials in a safe and dignified manner. In those countries, 19 of 53 planned Ebola Treatment Centres are now open. A total of 140 trained burial teams are on the ground, and more than 4400 burials have reportedly been conducted in a safe and dignified manner since the outbreak began. Samples from all 53 Ebola-affected districts can be sent to a laboratory within 24 hours by road.

Situation reports are now presented in a web-based format to provide detailed information at the country level, including data and maps, in a more interactive way.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[2] Mali: Dozens in quarantine after Mali Ebola death
Date: 12 Nov 2014
Source: Al Jazeera [edited]
http://www.aljazeera.com/news/africa/20 ... 68995.html


Authorities in Mali have placed dozens of people in quarantine at the home of a 25 year old nurse who died from Ebola in the capital, Bamako, and at the clinic where he treated an imam from Guinea who died with Ebola-like symptoms. The government said in a statement on Wed [12 Nov 2014] that the nurse was confirmed to have Ebola on Tue [11 Nov 2014] and died later that evening. All necessary steps to identify people who had come into contact with the nurse had been taken, it said. Ousmane Doumbia, secretary-general of the Health Ministry, said so far 70 people have been placed in quarantine.

The imam from the border town of Kouremale was never tested for the disease, and his body was washed in Mali and returned to Guinea for burial without precautions against the virus, health officials said. Two aid workers said that another person who lived in the house where the imam stayed in Bamako had died this week and was buried without being tested. A doctor at the Pasteur Clinic where the nurse worked -- one of Bamako's top medical centres -- is also suspected to have contracted Ebola. The Pasteur Clinic was locked down by police on Tuesday [11 Nov 2014] night.

Concern is growing at the time it took between the imam dying and the steps needed to contain the deadly disease being put in place. Dr Samba Sow, head of Mali's Ebola response, said the imam died on 27 Oct 2014, 2 days after going to the clinic. "This case shows the lack of training of doctors in Bamako. This training should have been done 6 months ago," one aid worker told Reuters news agency, asking not to be named.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[3] Mali battles Ebola outbreak
Date: 12 Nov 2014
Source: Daily Mail [edited]
http://www.dailymail.co.uk/wires/afp/ar ... nurse.html


In Mali, the latest country to see Ebola infections, Bamako's Pasteur clinic has been quarantined, with around 30 people trapped inside, including medical staff, patients and 15 African soldiers from the United Nations mission in Mali. Teams of investigators are tracing health workers, scouring the capital and the imam's home district in north eastern Guinea for scores of people who could have been exposed.

The deaths have raised fears of widespread contamination as they were unrelated to Mali's only other confirmed fatality, a 2 year old girl who had also arrived from Guinea in October [2014]. A doctor at the clinic is thought to have contracted the virus and is under observation outside the capital, the clinic said. A friend who visited the imam has also died of probable Ebola, the World Health Organization (WHO) said. Mali's health ministry called for calm on Wed 12 Nov 2014, as it led a huge cross-border operation to stem the contagion.

WHO said the 70 year old cleric, GS, from a village on Guinea's porous border with Mali, fell sick and was transferred via several treatment centres to the Pasteur clinic. He had travelled to Bamako by car with 4 family members, all of whom have since gotten sick or died at home in Guinea. Multiple lab tests were performed, WHO said, but, crucially, not for Ebola, and he died of kidney failure on 27 Oct 2014.

The imam's body was transported to a mosque in Bamako for a ritual washing ceremony before being returned to Guinea for burial in his home village. Traditional African funeral rites are considered one of the main causes of Ebola spreading, as it is transmitted through bodily fluids, and those who have recently died are particularly infectious. "Although these events are still under investigation, WHO staff assume that many mourners attended the ceremonies," the agency said. Although the imam cannot now be tested, his 1st wife died of an undiagnosed disease last week, while his 2nd wife and brother are sick at an Ebola treatment centre in southern Guinea, where his son tested positive for the virus on Tue [11 Nov 2014]. All were with him on the car journey to Bamako, the WHO said, adding that his daughter died in Guinea on Mon [10 Nov 2014].

WHO said 28 health care workers who had contact with the imam at the Pasteur clinic had been identified and were under observation. A 2nd team of investigators is scouring Bamako, including the mosque, for possible infections while WHO staff in Guinea trace the man's family history. The nurse who died treating GS, identified by family as 25 year old SD, was the 1st Malian resident to be confirmed as an Ebola victim.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[So now we have 2 confirmed and 2 probable deaths -- of the 2 year old, another visitor from Guinea, a Malian nurse and a contact, and a suspected case in a Malian doctor -- and now at least 70 contacts. There does not seem to have been an adequate level of suspicion in medical circles in Bamako of the risk from visitors from Guinea during the more than 2 weeks since the imam's arrival in Bamako and now.

The new cases in Mali follow WHO's confirmation that 25 of the 100 people who were thought to have come into contact with the 2 year old girl were being released from quarantine... Health department spokesman Markatie Daou said around 50 people were still under observation in Kayes, western Mali, and would be released in a week if they continued to display no symptoms... http://www.bbc.co.uk/news/world-africa-30019895.

A map showing Bamako, close to the borders of several, so far Ebola-free countries, and its road and river connections with them, can be seen at http://www.vidiani.com/maps/maps_of_afr ... f_mali.jpg. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/50.]

EBOLA VIRUS DISEASE - WEST AFRICA (208): MALI UPDATE
****************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Mali: new cases
[2] Mali: border checks

******
[1] Mali: new cases
Date: Fri 14 Nov 2014
Source: Bloomberg [edited]
http://www.bloomberg.com/news/2014-11-1 ... ebola.html


Investigators have identified 5 people infected by Ebola in Mali and have a 6th suspected case as the nation races to contain the virus that has ravaged 3 of its West African neighbors. More than 200 people who had contacts with those individuals have been identified, and new cases will probably be confirmed in the coming days, Hubert Balique, a French public-health expert consulting with the French embassy in Mali, told reporters yesterday [13 Nov 2014] in the capital city, Bamako.

A 25 year old nurse died from Ebola on 11 Nov 2014 at a clinic in Mali, the World Health Organization and Mali health authorities said on 12 Nov 2014. He had treated a 70 year old grand imam from Guinea, who was hospitalized for kidney failure and wasn't tested for Ebola. A worker at the same clinic is in isolation as officials race to prevent the virus from spreading further in a 4th West African nation. Ebola has killed more than 5000 people in Guinea, Liberia, and Sierra Leone since December [2013], making it the worst outbreak since the disease was identified in 1976 in what is now the Democratic Republic of Congo. The Pasteur Clinic in Bamako, where the clinic staff member and the nurse worked, has been quarantined, France's embassy said in a text message to its registered nationals in the country yesterday [13 Nov 2014]. The message asked anyone who had treatment at the clinic or knows someone who did to call a phone line.

Mali is getting help from the US Centers for Disease Control and Prevention to trace people who have had contact with Ebola-infected individuals, Balique said. Senegal and Nigeria have been declared free of the disease. Mali last month [October 2014] became the 6th country in West Africa to confirm a case of Ebola, when a woman brought her infected 2 year old granddaughter from Guinea. The girl died on 24 Oct 2014. WHO now lists 4 deaths in Mali, including the original case, which is unrelated to the current outbreak. Mali's president Ibrahim Boubacar Keita asked prime minister Moussa Mara to take steps to prevent the further spread of the virus, the nation's council of ministers said in an emailed statement.

[byline: Francois Rihouay, Simeon Bennett]

--
communicated by:
ProMED-mail rapporteur Mary Marshall

*******
[2] Mali: border checks
Date: Fri 14 Nov 2014
Source: Reuters [summ., edited]
http://www.reuters.com/article/2014/11/ ... 3?irpc=932


Mali announced tougher health checks at border crossings after registering its 2nd Ebola outbreak...

In Mali, which shares an 800 km (500 mi) border with Guinea, a nurse died of Ebola on [Tue 11 Nov 2014], and on [Thu 13 Nov 2014] a doctor at the same clinic was also revealed to be infected. More than 90 people had already been quarantined in the capital Bamako after the nurse's death, just as a group exposed to Mali's 1st case completed their required 21 days of isolation. "The president of the republic has asked the prime minister to look urgently at the entire system put in place to fight Ebola and to strengthen health controls at the different frontier posts," a government statement said. But officials said there were no plans to close the border, even though the nurse had been infected by a man who arrived from Guinea.

President Ibrahim Boubacar Keita urged WHO and health services in Mali and neighboring states to set up a permanent information exchange to improve awareness about public health and hygiene.

[byline: Tiemoko Diallo, James Harding Giahyue]

--
communicated by
Ryan McGinnis
<ryan@bigstormpicture.com>

[It is somewhat surprising to me that after months of media coverage about the Ebola epidemic in West Africa, countries in that region are still asking for information exchange to improve awareness. Africa has ECOWAS (the Economic Community of West African States), a WHO Regional Office with Country Representatives in nearly all West African countries and national focal points for the IHR (WHO International Health Regulations), the African Union, and numerous other African organizations through which to exchange information. And they could always subscribe to ProMED!

One would have thought that at least in capital cities the authorities would be aware of health events in neighboring states and be on the lookout for imported cases. Mali also has a border with Senegal, which is now once again at risk of infection.

A HealthMap/ProMED-mail map of Mali can be seen at http://healthmap.org/promed/p/14271. A map showing Bamako, close to the borders of several, so far Ebola-free countries, and its road and river connections with them, can be seen at http://www.vidiani.com/maps/maps_of_afr ... f_mali.jpg. - Mod.JW

A HealthMap showing the distribution of EVD cases and deaths can be seen at http://healthmap.org/ebola/. - Sr.Tech.Ed.MJ]

EBOLA VIRUS DISEASE - WEST AFRICA (210): MALI, LIBERIA, WHO
***********************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Mali: new death reported
[2] Liberia won't extend Ebola state of emergency
[3] WHO Ebola response roadmap situation report update

******
[1] Mali: new death reported
Date: Fri 14 Nov 2014
Source: Bloomberg [edited]
http://www.bloomberg.com/news/2014-11-1 ... ebola.html


Mali reported the death of a girl suspected of having Ebola, as the nation races to contain the virus that has ravaged 3 of its West African neighbors. Results from tests to confirm whether the girl had the virus will be known today, Alassane Souleymane, a spokesman for Mali's communication ministry, said by email today [14 Nov 2014].

5 people have been confirmed as having Ebola and a 6th case is suspected, Hubert Balique, a French public health expert consulting with the French embassy in Mali, told reporters yesterday [13 Nov 2014]. It's unclear whether the girl whose death was reported today was one of those cases. Officials have identified more than 200 people who had contact with those individuals, and new cases will probably be confirmed in coming days, he said.... -- more

[byline: Francois Rihouay and Simeon Bennett]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[2] Liberia won't extend Ebola state of emergency
Date: Thu 13 Nov 2014
Source: Reuters [edited]
http://www.reuters.com/article/2014/11/ ... CD20141113


Liberia won't extend Ebola state of emergency, says president
-------------------------------------------------------------
Liberia's president Ellen Johnson Sirleaf said on Thursday [13 Nov 2014] she would not seek an extension to a state of emergency imposed in August [2014] over Ebola, which has hit the country harder than any other this year. Her announcement is a sign of progress in the fight against the disease, which has killed more than 2800 people in Liberia since breaking out in West Africa in March [2014]. The decision effectively ends the state of emergency that officially expired earlier this month [actually at midnight 31 Oct 2014], though Sirleaf said a night curfew remains in force. The emergency had allowed authorities to restrict movement in areas hard hit by the virus. Ebola has hit Liberia harder than Guinea or Sierra Leone, the 2 other countries at the center of the worst outbreak of the disease on record.... -- more

[byline: James Harding Giahyue and Alphonso Toweh]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[3] WHO Ebola response roadmap situation report update
Date: Fri 14 Nov 2014
Source: WHO [edited]
http://apps.who.int/iris/bitstream/1066 ... g.pdf?ua=1


A total of 14 413 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in six affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain, and the United States of America) and two previously affected countries (Nigeria, Senegal) up to the end of 11 November 2014. There have been 5177 reported deaths.

Following the WHO Ebola Response Roadmap structure, country reports fall into two categories: 1) those with widespread and intense transmission (Guinea, Liberia, and Sierra Leone); and 2) those with or that have had an initial case or cases, or with localized transmission (Mali, Nigeria, Senegal, Spain, and the United States of America).

In Mali, there have been 4 reported cases, including 3 reported deaths. The Situation Report of 12 November reported 4 cases (2 confirmed and 2 probable) and 4 deaths in Mali. One probable case and death has been reclassified and is now excluded from the Mali case count.

1) countries with widespread and intense transmission
A total of 14 383 confirmed, probable, and suspected cases of EVD and 5165 deaths have been reported up to the end of the 11 November by the Ministries of Health of Guinea and Sierra Leone, and 10 November by the Ministry of Health of Liberia (table 1 in URL above).

A total of 570 health care workers (HCWs) are known to have been infected with EVD: 93 in Guinea; 332 in Liberia; 2 in Mali; 11 in Nigeria; 128 in Sierra Leone; 1 in Spain; and 3 in the United States of America (2 were infected in the USA and 1 in Guinea). A total of 324 HCWs have died.

WHO is undertaking extensive investigations to determine how each HCW became infected. Early indications are that a substantial proportion of infections have occurred outside the context of Ebola treatment and care. Infection prevention and control quality assurance checks are underway at Ebola treatment centres in the three intense-transmission countries. At the same time, exhaustive efforts are ongoing to ensure an ample supply of optimal personal protective equipment (PPE) to all Ebola treatment facilities, along with the provision of training and relevant guidelines to ensure that all HCWs are exposed to the minimum possible level of risk.

2) countries with or that have had an initial case or cases, or with localized transmission
Five countries (Mali, Nigeria, Senegal, Spain, and the United States of America) have reported a case or cases imported from a country with widespread and intense transmission (table 2 in URL above).

In Mali, there have been 4 reported cases, including 3 reported deaths, as of 13 November. The most recently reported cases in Bamako are not related to the first case in Kayes, who died on 24 October. A total of 251 contacts are being followed-up in Bamako, and 5 in Kourémalé. Twelve contacts related to the first case are still under follow-up in Kayes.

There have been 4 cases and 1 death in the United States of America. All patients have been discharged from hospital, and all contacts in the country have completed the 21-day follow-up period.

In Spain, 24 days have passed since the HCW infected while caring for an Ebola patient in Madrid tested negative twice and was discharged from hospital. Spain will therefore be declared free of EVD 42 days after the date of the second negative test if no new cases are reported. All 83 contacts of the HCW have completed 21-day follow-up.

In Nigeria, there were 20 cases and 8 deaths. In Senegal, there was 1 case and no deaths. However, following a successful response in both countries, the outbreaks of EVD in Senegal and Nigeria were declared over on 17 October and 19 October 2014, respectively.

--
communicated by:
Ryan McGinnis
<ryan@bigstormpicture.com>

[But all emergency regulations have not been entirely lifted; for example, there is still a curfew, but now extended to midnight.

A map showing Bamako, Mali, close to the borders of several, so far Ebola-free countries, and its road and river connections with them, can be seen at http://www.vidiani.com/maps/maps_of_afr ... f_mali.jpg. - Mod.JW]

EBOLA VIRUS DISEASE - WEST AFRICA (211): MALI, LIBERIA, AID, SIERRA LEONE, GUINEA
*********************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Mali: tracing over 300 contacts
[2] Liberia: 2nd batch of AU medical team arrives for Ebola battle
[3] West Africa: annual migration in search of work, threat
[4] Israel: sends medical shipments to fight Ebola
[5] Gambia: re-opens its border to Ebola-affected nations
[6] Sierra Leone: UK lab cuts delay for Ebola test results
[7] Guinea: Ebola sabotages anti-malaria fight
[8] Liberia: new German-funded Ebola center
[9] Liberia: food markets still closed

******
[1] Mali: tracing over 300 contacts
Date: Fri 14 Nov 2014
Source: Reuters [edited]
http://www.reuters.com/article/2014/11/ ... 9A20141114


Mali tries to trace 343 contacts in 2nd Ebola wave
--------------------------------------------------
Mali is trying to trace as many as 343 people linked to confirmed and probable Ebola victims in an effort to control its 2nd Ebola outbreak, health officials said on Friday [14 Nov 2014].

An initial batch of contacts linked to a 2 year old from Guinea who died of Ebola last month [October 2014] were close to the end of their 21-day quarantine period when Mali confirmed a 2nd, separate batch of cases this week. There have been at least 4 more confirmed Ebola cases in this 2nd episode, all linked to an imam who entered Mali from neighboring Guinea and died late last month with Ebola-like symptoms that were not recognized; 3 of these have died so far...

In a sign of growing concern over the new wave of cases, the French government on Friday updated its website to advise against all but essential travel to Bamako and Kayes, the western region where the girl died.

[byline: Tiemoko Diallo and Joe Penney]

--
communicated by:
ProMED-mail rapporteur Kunihiko Iizuka

******
[2] Liberia: 2nd batch of AU medical team arrives for Ebola battle
Date: Fri 14 Nov 2014
Source: AllAfrica, Liberia News Agency report [edited]
http://allafrica.com/stories/201411141406.html


Second batch of AU medical team arrives for Ebola battle
--------------------------------------------------------
A high-powered African Union (AU) Assistance Team has arrived in Liberia from across East and West Africa to assist in the fight against the Ebola disease ravaging West Africa. The team, comprising 28 medical professionals including doctors and clinicians, will serve under the African Union Support to Ebola Outbreak in West Africa (ASEOWA)...

Speaking shortly upon arrival at the weekend at the Roberts International Airport (RIA) in Margibi County, the head of the AU team, Maj Gen Dr Julius F Oketta said the AU team will be deployed in the 3 hardest-hit countries with its headquarters situated in Liberia... Oketta said the team's mission will cover 3 phases, including providing training, epidemiology and psychosocial support to the population...

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[3] West Africa: annual migration in search of work, threat
Date: Fri 14 Nov 2014
Source: CIDRAP (Center for Infectious Disease Research and Policy) News [edited]
http://www.cidrap.umn.edu/news-perspect ... ping-ebola


Migrations in West Africa seen as challenge to stopping Ebola
-------------------------------------------------------------
In much of West Africa, the annual harvest ends around October, and in the following months, countless young men hit the road to look for work elsewhere, such as on cocoa and coffee plantations in Ivory Coast or in fishing ports on the coast, according to people who know the region.

That post-harvest migration is a prime example of the high mobility of the region's population. National borders are porous ... and people cross them freely, by all accounts. And that fact worries some observers who are pondering the challenge of stopping the Ebola epidemic simmering in Guinea, Liberia, and Sierra Leone.

With a high level of travel between the 3 hard-hit countries and their neighbors, these observers reason, there's a very good chance that travelers or migrants will bring more Ebola cases into other countries, such as Senegal, Mali, and Cote d'Ivoire (Ivory Coast), potentially triggering expansion of the epidemic...

It would be good for those [Sahelian] countries to be warning people over the radio not to come down to Liberia this year [2014]. And people do have radios -- it's amazing how much communication there is...

[byline: Robert Roos]

--
communicated by:
Ryan McGinnis
<ryan@bigstormpicture.com>

[This is a long, detailed explanation of the annual migration from Sahelian countries after the harvest [which ended in October 2014] to coastal regions of West Africa by unemployed youth in search of work. They will return home by April [2015], potentially carrying Ebola virus disease with them.

Radio is the most widespread and popular form of media in Liberia and Sierra Leone, where upwards of 80 per cent of households have access to a radio (http://reliefweb.int/report/liberia/sch ... ne-liberia). These are both English-speaking countries. Perhaps radios are not as common in French-speaking countries like Guinea and Mali? In any case, radio does not seem to have raised public awareness about Ebola in Mali. - Mod.JW]

******
[4] Israel: sends medical shipments to fight Ebola
Date: Fri 14 Nov 2014
Source: JTA [edited]
http://www.jta.org/2014/11/14/news-opin ... ht-ebola-1


Israel has sent medical shipments including mobile clinics to 3 African countries to help combat the spread of the Ebola virus. The mobile field hospitals and medical cargo are expected to arrive by ship in Liberia, Sierra Leone and Guinea in about a month. The equipment sent includes protective gear, a treatment cart and the full medical equipment required for setting up the clinics.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[5] Gambia: re-opens its border to Ebola-affected nations
Date: Fri 14 Nov 2014
Source: StarAfrica, APA (Agence Africaine de Presse) report [edited]
http://en.starafrica.com/news/the-gambi ... tions.html


The head of disease control in the Gambia, Sanna Sambou, has confirmed the reopening of the country's border to countries affected by the deadly Ebola virus, APA reported on Friday [14 Nov 2014]. Mr Sambou noted that border closure was not the best solution to contain the virus, hence the need to reopen borders to allow in and out movement of people between the Gambia and countries affected by Ebola. According to media reports, the issue of border closure, as a result of the outbreak of the disease, was deemed discriminatory and unworthy by the World Health Organisation (WHO), adding that it should be considered a global pandemic.

Despite the restoration of the border crossing, however, Sambou said the health authorities are poised to continue on the thorough screening of people moving into the country from Ebola hit nations. It could be recalled the Gambia in September [2014] announced that it would no longer be granting entrance to Guineans, Liberians, Nigerians or Sierra Leoneans, due to fear of the disease getting into the country.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[6] Sierra Leone: UK lab cuts delay for Ebola test results
Date: Fri 14 Nov 2014
Source: Medical Xpress [edited]
http://medicalxpress.com/news/2014-11-b ... leone.html


Britain slashes wait for Ebola test results in Sierra Leone
-----------------------------------------------------------
British scientists in Sierra Leone say they have cut the delay for Ebola test results from 9 days to 2, hailing a significant gain in fighting the outbreak. The poor country is one of the hardest hit in an epidemic that has claimed more than 5000 lives in west Africa. Early diagnosis is deemed a key means of controlling the spread of the virus. The British government opened a laboratory in October [2014] next to a UK-funded treatment centre in Kerry Town, western Sierra Leone, doubling the nation's testing capacity.

"It's making a huge difference for the country. We have 12 people who work hard here every day and others arrive regularly," laboratory head David Simpson told AFP on Thursday [13 Nov 2014] at the tented encampment. "We will have 16 reinforcements in another 2 weeks. Our capacity will increase and this is key in the fight against this disease." Scientists at the site test blood samples and swabs for the virus and can give the all-clear for Ebola patients who survive the disease. Simpson said results for possible Ebola infections used to take up to 9 days but were now being delivered in 48-72 hours thanks to the laboratory....

Britain pledged GBP 20 million (USD 30 million, EUR 25 million) to build and run the Kerry Town laboratory, as well as 2 others being constructed at British treatment centres in Port Loko and Makeni. Once operational, the laboratories will quadruple the number of tests that can be conducted every day, further reducing waiting times. The cash is part of Britain's GBL 225 million [about USD 360 million] commitment to its Ebola response, which includes providing 700 treatment beds across its former colony.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[7] Guinea: Ebola sabotages anti-malaria fight
Date: Fri 14 Nov 2014
Source: ReliefWeb, Voice of America report [edited]
http://reliefweb.int/report/guinea/ebol ... aria-fight


Ebola sabotages Guinea's anti-malaria fight
-------------------------------------------
The Ebola epidemic in Guinea is seriously compromising the fight against malaria, its government said. In scores of cases, doctors are confusing malaria with Ebola, delaying the right life-saving treatment. Guinea's government committee against malaria said many of the undocumented deaths suspected of being from Ebola may actually be from malaria. This presents an even deadlier situation in a country that WHO has ranked among the 10 nations with the highest malaria mortality rates.

Guinea's national coordinator for the fight against malaria, Dr Timothy Guilavogui, said malaria each year affects 44 per cent of Guineans, or about 5 million people. The disease kills at least 10 people in Guinea every week, he said. In contrast, the Ebola outbreak -- which began in Guinea in December [2014] -- has infected fewer than 2000 people in the country and caused close to 1200 deaths, according to WHO. Guilavogui said Ebola is eroding Guinea's recent gains in which the malaria mortality rate had fallen by 50 per cent. The main problem is that malaria and Ebola share similar symptoms initially, including high fever, nausea and vomiting. Only blood tests can distinguish between them. But fear of Ebola is keeping sick people away from needed care, Guilavogui said...

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[8] Liberia: new German-funded Ebola center
Date: Thu 13 Nov 2014
Source: AllAfrica, Deutsche Welle report [edited]
http://allafrica.com/stories/201411140654.html


1st patients being treated in new German-funded Ebola center
------------------------------------------------------------
Ebola patients in Liberia can now be treated in a new center set up in Monrovia with funding from German aid organizations. A German armed forces airlift will keep supplies flowing in. As the battle against Ebola intensifies in Liberia, a new treatment center built largely with funding from German Medical Aid Organization (medeor) has now gone into operation. The organization International Search and Rescue Germany (ISAR Germany) also contributed by taking care of customs formalities and ensuring the facility could be handed over to the Liberian government in full working order. The center expands a Liberian government Ebola treatment unit and adds to the growing number of isolation wards being set up to combat the virus.

Located on the outskirts of the Liberian capital Monrovia, the center -- which consists of 2 isolation wards -- was constructed largely thanks to the efforts of Margret Gieraths-Nimene, a German doctor who has lived and worked in Liberia for many years and is actively engaged in the fight against Ebola. Shortly after the wards were installed, Gieraths-Nimene showed a team of German military and medical staff round the new facility...

[byline: Julius Kanubah]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[9] Liberia: food markets still closed
Date: Thu 13 Nov 2014
Source: ReliefWeb, World Food Programme (WFP) report [edited]
http://reliefweb.int/report/liberia/foo ... ket-region


Food markets still closed in Liberia's bread basket region
----------------------------------------------------------
The main market in Foya, a town in northern Liberia, has been closed for 6 months now. Most of the others in the surrounding Lofa County were also ordered to stop trading in recent months. The scene is heart-breaking. Rotting wooden tables, weeds growing between them, and kids playing in the deserted alleys while singing anti-Ebola songs. Lofa County is considered the epicenter of the Ebola outbreak in Liberia. This region, near the borders with both Sierra Leone and Guinea, is where everything started. It also is considered as Liberia's breadbasket, the main rice-producing region.

The Ebola outbreak hit Liberia in waves. In Foya, the disease came in June [2014], when the farmers should have been planting the rice. "Every day you would see dead bodies being transported on the road," Mary Wagbo says. "We were terribly frightened, we did not get out of the house." As a result, Mary and her family planted late. Now they are busy hand-picking the rice, but this year's crop will not feed the family for a year. "If you plant the rice late in the season, it will be water-stressed and therefore produce less," Alghassim Wurie, WFP Liberia deputy country director, explains. "As most rural farmers rely on rain-fed farming, the yield will be affected." Growing rice is very labour-intensive. In Liberia, many farmers are used to working together, using all available hands to take care of the fields. Once the work -- be it planting, or weeding -- is done on one farm, all the workers move together to the next one. But it didn't happen this year as people were afraid of gathering in large groups...

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[Massive food aid is going to be required in the region. Media are reporting that families are cutting back on meals, which is bound to reduce their resistance to all infections, not just Ebola. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/50.]