wuestenschiff.de

EBOLA VIRUS DISEASE - WEST AFRICA (37): SIERRA LEONE PREPAREDNESS
******************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: 12 May 2014
Source: Jean Paul Gonzalez <jpgonzalez@metabiota.com> [edited]


Regarding "Mali preparedness" in ProMED-mail post "Ebola virus disease - West Africa (37)," I went to Sierra Leone with Joseph Fair to set up, with the local MOH and in-country WHO office, an emergency preparedness and response to the ebolavirus disease (EVD) outbreak. I think it would be fair to recognize -- as you did for Mali and Senegal -- the amazing work that has been done in Sierra Leone by all MOH health workers in setting up (thanks to their unique expertise on VHF [viral hemorrhagic fevers] with Lassa fever) an emergency sustainable response on EVD preparedness.

For the 1st time in EVD history, that type of wide preparedness, from clinic, to port health officer -- without closing the border -- to epidemiologist, reporting system, and counseling (still ongoing), has been done in heretofore ebolavirus "virgin" territories, but at high risk, regarding the ethnic groups (in the epidemic epicenter of Kisigoudou) shared with Guinea, which have ultimately protected, or at least uniquely prepared, Sierra Leone.

Not only were the RT-PCR [real-time polymerase chain reaction] tests and the other sophisticated equipment we brought in and trained lab workers on useful, but also and essentially, in the matter of preparedness, case management, case surveillance, community counseling, safe burial, etc. were targeted, which are fundamental to apply before "things" happen (and this is quite unique).

--
Jean-Paul J. Gonzalez, M.D., Ph.D.
METABIOTA, Senior Scientist,
Emerging Diseases & Biosecurity, Washington DC, USA
<jpgonzalez@metabiota.com>

[It is a big advance in global public health to have highly trained virologists and other experts available to travel to the world's outbreaks at short notice and donate state-of-the-art lab equipment and expertise to countries afflicted by serious infectious disease outbreaks.

The Program for Monitoring Emerging Diseases (ProMED) was founded 20 years ago with the idea of establishing a chain of microbial diagnostic labs circling the globe, with the equipment and staff to rapidly detect and identify the cause of any outbreak, whether in humans, animals, or crops, of a potentially dangerous pathogen in order to install control and prevention measures. These would supplement the existing labs established by the Institut Pasteur and The Rockefeller Foundation (the latter long ago handed over to the host countries), mostly in tropical regions.

We never dreamed that the answer would be mobile teams "parachuted" into hotspots. But now, with the recognition that microbes cross national frontiers ever more rapidly thanks to air transport, and that animal, plant, and environmental health are inextricably interdependent (see http://www.onehealthinitiative.com), developed country governments need to take notice of what goes on in less fortunate countries, and subsidize the kind of actions that will prevent the arrival of these pathogens on their own shores: The 2nd case of MERS-CoV was reported today [12 May 2014] to have arrived in the USA from Saudi Arabia, see http://www.promedmail.org/direct.php?id=2466912. - Mod.JW, (Co-founder and Assoc. Ed. ProMED-mail)

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

EBOLA VIRUS DISEASE - WEST AFRICA (38): 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] ECDC: epidemiological update
[2] Gambia: flight ban removed

******
[1] ECDC: epidemiological update
Date: Wed 14 May 20144
Source: European Centre for Disease Prevention and Control (ECDC), WHO and UN Office for the Coordination of Humanitarian Affairs (OCHA), ReliefWeb report [edited]
http://ecdc.europa.eu/en/press/news/_la ... 68&ID=1000


Epidemiological update: outbreak of Ebola virus disease in West Africa
----------------------------------------------------------------------
Background: an outbreak of Ebola virus disease (EVD) with onset in December 2013 is still evolving in Guinea. The 1st cases were reported from Gueckedou prefecture, a forested region of south-eastern Guinea near the border with Liberia and Sierra Leone. The alert was issued by the Ministry of Health on 10 Mar 2014.

Guinea
------
As of 10 May 2014, the Ministry of Health of Guinea has reported 233 clinical cases of EVD, including 157 deaths. The cumulative total of clinical EVD cases and deaths since the beginning of the outbreak by location is: Conakry (50 cases, including 24 deaths); Gueckedou (149/106); Macenta (23/17); Kissidougou (6/5), Dabola (4/4), and Djingaraye (1/1). As of 12 May 2014, the number of confirmed cases is 133, including 83 deaths.

There have been no new cases of EVD in Kissidougou since 1 Apr 2014, Macenta since 9 Apr 2014, and in Djingaraye and Dabola since end of March 2014. As of 12 May 2014, there was one patient in isolation in Conakry and 5 in Gueckedou. The date of isolation of the most recent confirmed case is 26 Apr 2014 in Conakry and 7 May 2014 in Gueckedou. 431 contacts are currently followed-up in Gueckedou and 13 in Conakry.

Sierra Leone
------------
As of 7 May 2014, no cases of EVD have been confirmed in Sierra Leone. Among the 106 patients presenting with a viral haemorrhagic fever-like illness between 16 Mar 2014 and 7 May 2014, no cases of EVD have been detected using ebolavirus PCR [polymerase chain reaction] assays and 10 patients with Lassa fever were confirmed.

Liberia
-------
As of 7 May 2014, the number of cases is 12 (6 confirmed, 2 probable, and 4 suspected) and 11 deaths. The most recent confirmed or probable case was on 6 Apr 2014.

WHO and international organisations are supporting the Ministries of Health of Guinea and Liberia in their EVD prevention, contract tracing, health care, and control related activities. No cases have been detected in returning travellers in Europe.

Conclusions: This is the 1st time an Ebola virus disease outbreak is reported in West Africa. The outbreak seems to be slowing down, however still evolving notably in Gueckedou because the last patient was reported in isolation the 7 May 2014, which supports the possibility of a recent chain of transmission. Prevention and control activities will be continued in order to stop the transmission of EVD. Isolation of cases, active monitoring of contacts and other control measures currently being implemented in the affected countries with the support of medical humanitarian organisation such as Medecins Sans Frontieres, EU scientists and an EU funded mobile laboratory in Gueckedou, and WHO.

The risk of infection for travellers visiting Guinea and Liberia is considered very low. Most human infections result from direct contact with bodily fluids or secretions from an infected human, and the highest risks of infection are associated with caring for infected patients, particularly in hospital settings, unsafe medical procedures, including exposure to contaminated medical devices, such as needles and syringes and unprotected exposure to contaminated bodily fluids.

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

******
[2] Gambia: flight ban removed
Date: Wed 14 May 2014
Source: NDTV, Agence France-Presse (AFP) report [edited]
http://www.ndtv.com/article/world/gambi ... wed-523828


The Gambia has lifted a ban on flights from Liberia and Sierra Leone imposed at the peak of the Ebola virus disease outbreak as Guinea said the spread of the deadly virus had "slowed significantly." The outbreak in Guinea is one of the deadliest in history, with 233 cases "clinically compatible" with Ebola virus disease reported, and 157 deaths since the start of the year [2014], according to the World Health Organization. "The general public is hereby informed that airlines serving Banjul and the sub-region can now pick up passengers in Liberia and Sierra Leone," said a statement issued by the Gambian Transport ministry. President Yahya Jammeh ordered airlines to cancel all flights from Guinea, Liberia, and Sierra Leone on [10 Apr 2014] in a bid to prevent the spread of the deadly virus. The new statement, dated Sunday [11 May 2014] made no mention of Guinea, although it said further information would be communicated in due course.

The spread of Ebola virus disease has "slowed significantly", with no new cases in Conakry since 26 Apr 2014, Guinea's health ministry said on [Tue 13 May 2014]. The total number of laboratory-confirmed Ebola cases in Guinea is 133, including 83 deaths, it added. "This is positive news for us. The restriction on the movement of people from Sierra Leone to the Gambia has nearly crippled my business," said a Sierra Leone businesswoman who buys textiles from the Gambia for sale in Freetown.

The Gambian government has not revealed how effective the ban was at keeping out travellers from Liberia and Sierra Leone. "I travel from Freetown to Dakar by flight and from there, I travel by road to the Gambia," a Gambian who asked not to be named told AFP [Agence France-Presse]. "Since Sierra Leone did not register any cases of Ebola, I don't think it was prudent to ask flights servicing the sub-region not to pick up passengers from Freetown to Banjul."

The Ebola virus disease outbreak across west Africa began in the impoverished country's southern forests, spreading to Conakry, a sprawling port city on the Atlantic coast and home to 2 million people. Liberia has reported 6 lab-confirmed cases, 6 probable or suspected cases, and 11 deaths, while Sierra Leone had 2 suspected cases of Ebola, both of which turned out to be Lassa fever.

The Gambia, a country of about 1.8 million, is a finger of territory flanking the Gambia River, with Senegal on either side and a narrow Atlantic coastline.

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

[These reports confirm that the Ebola virus disease outbreak in West Africa appears now to be in decline as a consequence of the public health responses that have developed. It seems unlikely that the imposition and subsequent lifting of the inter-country flight ban, has had any significant influence on the course of the outbreak. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45.]

EBOLA VIRUS DISEASE - WEST AFRICA (39): WHO 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

Date: Thu 15 May 2014
Source: WHO Global Alert and Response, Disease Outbreak News [edited]
http://www.who.int/csr/don/2014_05_15_ebola/en/


Ebola virus disease, West Africa ­- update
------------------------------------------
Guinea
------
As of 15 May 2014, a total of 248 clinical cases of Ebola virus disease (EVD) has been recorded, including 171 deaths. Since the last update of 9 May 2014, there have been 5 new cases confirmed by ebolavirus PCR and no new deaths among the confirmed cases.

Reclassification of cases, retrospective investigation, and harmonization of data have brought the total number of confirmed cases to 138, including 92 deaths; 67 probable cases, 57 deaths (3 new probable deaths in the community); and 43 suspected cases (22 deaths). The geographical distribution of clinical cases of EVD since the beginning of the outbreak is as follows: Conakry (50 cases, including 24 deaths), Guekedou (163/119), Macenta (22/17), Kissidougou (8/6), Dabola (4/4), and Djinguiraye (1/1).

The cumulative total of laboratory confirmed cases and deaths since the beginning of the outbreak is: Conakry (40 cases, including 20 deaths); Guekedou (83/60); Macenta (12/10); Kissidougou (2/1); and Dabola (1/1). There have been no new cases of EVD in Kissidougou since 1 Apr 2014, Macenta since 9 Apr 2014, and Conakry since 26 Apr 2014. In Djinguiraye and Dabola, no new cases have been reported since the end of March 2014. If no additional cases are identified in Conakry, the observation period for those individuals identified through contact tracing will end on 17 May 2014.

In Guekedou, the date of isolation of the most recent cases is 11 May 2014. A total of 480 contacts (5 in Conakry, 475 in Guekedou) are under follow up. The number of cases remains subject to change due to reclassification and consolidation of cases and laboratory data, enhanced surveillance activities, and contact tracing activities. Introduction of ebolavirus serology to test PCR negative clinical cases is also likely to change the final number of laboratory confirmed cases.

Liberia and Sierra Leone
------------------------
There have been no new alerts in both Liberia and Sierra Leone. Liberia is preparing to host a cross-border meeting with Cote d'Ivoire and Sierra Leone and surveillance activities have been enhanced in districts bordering Guinea.

WHO response
------------
WHO continues to support the Ministries of Health of Guinea and Liberia in their EVD prevention and control activities. As of 14 May 2014, 118 experts have been deployed to assist in the response. This includes 56 experts deployed through the global WHO surge mechanism, 35 international experts from among partner institutions of the Global Outbreak Alert and Response Network (GOARN), 10 externally recruited consultants, and 17 WHO staff who were locally repurposed. To date, 90 experts have been deployed to Guinea, 22 to Liberia, 2 to Sierra Leone, and 4 to the WHO Regional Office for Africa. An additional, 7 deployments are planned in the disciplines of medical anthropology, clinical case management, surveillance and epidemiology, laboratory services, logistics, and risk and media communications. WHO does not recommend that any travel or trade restrictions be applied to Guinea or Liberia based on the current information available for this event.

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

[This WHO update confirms that the Ebola virus disease outbreak in West Africa is in decline. Remarkable local and international efforts, without the availability of specific antiviral drugs or vaccines, have been sufficient to contain the disease. Mobilisation of local health services and educational efforts have also played an important role. Hopefully this knowledge will be systematised to contain future outbreaks. Of concern has been the appearance of Ebola virus disease in West Africa for the 1st time. On the debit side, no new knowledge of the source of the filoviruses responsible for this and earlier outbreaks of Ebola disease virus has been obtained. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45.]

EBOLA VIRUS DISEASE - WEST AFRICA (40): WHO 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

Date: Thu 15 May 2014
Source: WHO Global Alert and Response, Disease Outbreak News [edited]
http://www.who.int/csr/don/2014_05_15_ebola/en/


Ebola virus disease, West Africa ­- update
------------------------------------------
Guinea
------
As of 15 May 2014, a total of 248 clinical cases of Ebola virus disease (EVD) has been recorded, including 171 deaths. Since the last update of 9 May 2014, there have been 5 new cases confirmed by ebolavirus PCR and no new deaths among the confirmed cases.

Reclassification of cases, retrospective investigation, and harmonization of data have brought the total number of confirmed cases to 138, including 92 deaths; 67 probable cases, 57 deaths (3 new probable deaths in the community); and 43 suspected cases (22 deaths). The geographical distribution of clinical cases of EVD since the beginning of the outbreak is as follows: Conakry (50 cases, including 24 deaths), Guekedou (163/119), Macenta (22/17), Kissidougou (8/6), Dabola (4/4), and Djinguiraye (1/1).

The cumulative total of laboratory confirmed cases and deaths since the beginning of the outbreak is: Conakry (40 cases, including 20 deaths); Guekedou (83/60); Macenta (12/10); Kissidougou (2/1); and Dabola (1/1). There have been no new cases of EVD in Kissidougou since 1 Apr 2014, Macenta since 9 Apr 2014, and Conakry since 26 Apr 2014. In Djinguiraye and Dabola, no new cases have been reported since the end of March 2014. If no additional cases are identified in Conakry, the observation period for those individuals identified through contact tracing will end on 17 May 2014.

In Guekedou, the date of isolation of the most recent cases is 11 May 2014. A total of 480 contacts (5 in Conakry, 475 in Guekedou) are under follow up. The number of cases remains subject to change due to reclassification and consolidation of cases and laboratory data, enhanced surveillance activities, and contact tracing activities. Introduction of ebolavirus serology to test PCR negative clinical cases is also likely to change the final number of laboratory confirmed cases.

Liberia and Sierra Leone
------------------------
There have been no new alerts in both Liberia and Sierra Leone. Liberia is preparing to host a cross-border meeting with Cote d'Ivoire and Sierra Leone and surveillance activities have been enhanced in districts bordering Guinea.

WHO response
------------
WHO continues to support the Ministries of Health of Guinea and Liberia in their EVD prevention and control activities. As of 14 May 2014, 118 experts have been deployed to assist in the response. This includes 56 experts deployed through the global WHO surge mechanism, 35 international experts from among partner institutions of the Global Outbreak Alert and Response Network (GOARN), 10 externally recruited consultants, and 17 WHO staff who were locally repurposed. To date, 90 experts have been deployed to Guinea, 22 to Liberia, 2 to Sierra Leone, and 4 to the WHO Regional Office for Africa. An additional, 7 deployments are planned in the disciplines of medical anthropology, clinical case management, surveillance and epidemiology, laboratory services, logistics, and risk and media communications. WHO does not recommend that any travel or trade restrictions be applied to Guinea or Liberia based on the current information available for this event.

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

[This WHO update confirms that the Ebola virus disease outbreak in West Africa is in decline. Remarkable local and international efforts, without the availability of specific antiviral drugs or vaccines, have been sufficient to contain the disease. Mobilisation of local health services and educational efforts have also played an important role. Hopefully this knowledge will be systematised to contain future outbreaks. Of concern has been the appearance of Ebola virus disease in West Africa for the 1st time. On the debit side, no new knowledge of the source of the filoviruses responsible for this and earlier outbreaks of Ebola disease virus has been obtained. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45.]

EBOLA VIRUS DISEASE - WEST AFRICA (41): FATAL
*********************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Thu 15 May 2014
Source: Nigeria Tribune & Bulletin, Health News [edited]
http://tribune.com.ng/health-news/item/ ... ers-health


Following the death of 2 health workers in Liberia as a result of exposure to the deadly Ebola virus, the West African Health Sector Union's Network (WAHSUN) has advised all governments and employers in the region to formulate and implement requisite policies and intensify education on occupational health and safety at all levels in the health sector. WAHSUN gave the advice in a communique it issued at the end of its 1st quadrennial sub-regional conference in Abuja. The communique was signed by Nigeria's general secretary, National Association of Nigeria Nurses and Midwives, Comrade Yusuf Badmus, and the general secretary, Health Services Workers Union of Ghana, Comrade Abu Kuntulo.

The group expressed pessimism that the attainment of universal health coverage in the region might, for a long time, remain a mirage, unless governments in the region redouble their efforts in training and re-training of health workers. According to WAHSUN: "All governments, employers and affiliate unions/associations, must formulate/implement requisite policies and intensify education on occupational health and safety at all levels in the health sector to create awareness and provide protective gears and necessary logistics for care providers, to reduce the incidence of such deadly ailments like Ebola, which has claimed the lives of 2 health workers in Liberia. The conference calls for due recognition of this supreme sacrifice foisted on the workers and their families and compensation paid forthwith. The attainment of universal health coverage in Africa is very distant largely because of the qualitative and quantitative shortage of human resources for health. Conference-in-session thus calls for the training/re-training, employment and retention of more health workers towards meeting universally accepted standards of health professionals/patients ratios."

The body, however, condemns in strong terms what it describes as "the unjust dismissal of trade union leaders by the Liberian government for challenging arbitrary deductions from workers' wages in February 2014. WAHSUN demands the immediate reinstatement of the workers and the full payment of their wages till date. "Conference-in-session observed that the Liberian government has consistently shunned voices of reason and international labour standards that guarantee the rights of all workers to organize, in its recent work bill.

WAHSUN thus calls on the Liberian government to address this legitimate concern."

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

[These 2 deaths have been reported previously, but the highlighting of this issue is warranted by the situation in West Africa whereby the prompt provision of aid from international health organisations and the efforts of the local medical services combined to limit the extent of this outbreak. The governments of those countries at risk from Ebola virus disease should endeavour to support their medical staff rather than penalise them, if that is what happened. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/6075.]

EBOLA VIRUS DISEASE - WEST AFRICA (42): WHO 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

Date: Sun 18 May 2014
Source: WHO, Regional Office for Africa [edited]
http://www.afro.who.int/en/clusters-a-p ... -2014.html


Ebola virus disease, West Africa -- update
------------------------------------------
Guinea
------
The overall Ebola virus disease (EVD) outbreak in Guinea continues to improve. No new alerts, cases, nosocomial transmission have been reported from 5 out of the 6 affected prefectures since 26 Apr 2014. Gueckedou remains the only hotspot where community transmission and deaths are still being reported. Surveillance and social mobilization have been intensified to stop community transmission.

As of 18:00 on 18 May 2014, the Ministry of Health (MOH) of Guinea has reported a cumulative total of 253 clinical cases of Ebola virus disease (EVD), including 176 deaths. Since the last update of 12 May 2014, there have been 6 new cases confirmed by ebolavirus PCR and 5 new deaths among the confirmed cases bringing the total number of confirmed cases to 144, including 97 deaths. There have been no changes in the number of suspected cases (42 cases, 22 deaths) and probable cases (67 cases, 57 deaths).

The geographical distribution of the clinical cases of EVD since the beginning of the outbreak is as follows: Conakry (50 cases, including 25 deaths), Gueckedou (168/123), Macenta (22/17), Kissidougou (8/6), Dabola (4/4), and Djinguiraye (1/1). The cumulative total of laboratory confirmed cases and deaths since the beginning of the outbreak is: Conakry (40 cases, including 20 deaths); Gueckedou (89/65); Macenta (12/10); Kissidougou (2/1); and Dabola (1/1).

Since the isolation of the last reported cases in Djinguiraye, Dabola and Kissidougou, 2 incubation periods (42 days) have passed. In Macenta, there have been no new cases since 9 Apr 2014 and Conakry since 26 Apr 2014. In Gueckedou, the date of isolation of the most recent cases is 15 May 2014.

The number of cases remains subject to change due to reclassification, retrospective investigation, consolidation of cases and laboratory data, enhanced surveillance activities, and contact tracing activities.

Liberia and Sierra Leone
------------------------
In Liberia and Sierra Leone, the situation is stable. In Liberia, the date of isolation of the most recent case is 9 Apr 2014. It is therefore projected that EVD outbreak could be declared over on 22 May 2014. Harmonization of data has brought the total number of EVD cases to 12, including 9 deaths. Surveillance activities have been enhanced in districts bordering Guinea.

WHO response
------------
WHO continues to support coordination, resource mobilisation and advocacy, development of proposals, and implementation of epidemic preparedness and response plans. WHO is monitoring closely the needs for human capacity and logistics on the ground. Deployments of different experts under WHO/GOARN and capacity building of local experts to stop community transmission in Gueckedou are ongoing. A large range of medical supplies, including personal protective equipment (PPE) have been distributed.

WHO is also supporting the planning for evaluation of EVD outbreak in West Africa.

WHO does not recommend that any travel or trade restrictions be applied to Guinea or Liberia based on the current information available for this event.

--
communicated by:
ProMED-mail rapporteur Marianne Hopp

[As of today (22 May 2014), the EVD outbreak in Liberia will have been declared over by WHO, and no cases will have been confirmed in Sierra Leone.

The overall Ebola virus disease (EVD) outbreak in Guinea continues to improve. No new alerts, cases, nosocomial transmission have been reported from 5 out of the 6 affected prefectures since 26 April 2014. Gueckedou remains the only hotspot where community transmission and deaths are still being reported. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45.]

EBOLA VIRUS DISEASE - WEST AFRICA (43): GUINEA, NEW CASES
*********************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Fri 23 May 2014
Source: Reuters [edited]
http://www.reuters.com/article/2014/05/ ... Y220140523


Guinean health officials announced 2 new confirmed cases of Ebola virus disease on Friday [23 May 2014] in an area previously untouched by the virus, which has killed more than 100 people in West Africa, but which Guinea's government has said is now under control. West Africa's 1st deadly outbreak of Ebola virus disease spread from a remote corner of the country to the capital, Conakry, and into neighboring Liberia, causing panic across a region struggling with weak healthcare systems and porous borders. "We recorded 2 new cases in Telimele [Telimele Prefecture]. They are the 1st in this locality, which is in fact a new outbreak," said Mamadou Rafi Diallo, a spokesperson for Guinea's Health Ministry, adding that the 2 were being treated in isolation.

Ebola virus disease, a hemorrhagic fever, has a fatality rate of up to 90 per cent and causes symptoms ranging from flu-like pains to internal and external bleeding. It is transmitted between humans by touching victims or through bodily fluids. The new cases may have been due to the 2 coming into contact with the body of another victim at a funeral service. Such contact has been responsible for a number of transmissions since the outbreak was 1st identified in March [2014].

"We're talking about a woman who was buried there without care," Diallo said. The authorities were not considering the dead woman as a confirmed case as she had not been tested for the disease. The government said it was also closely monitoring 41 people who had come into contact with the 2 confirmed sufferers in Telimele, which is about 250 km (160 miles) from the capital Conakry. "The government is working with partners to put in place a treatment center, to identify everyone who has made contact with [these?] Ebola victims as well as raise awareness and distribute hygiene kits," the government said in a statement on Friday [23 May 2014].

Ebola has infected around 170 people elsewhere in Guinea and in Liberia and killed more than 100, although the death toll is likely higher as the government is only counting cases that have been confirmed through laboratory testing.

No new cases of Ebola have been detected since [26 Apr 2014] in Conakry, where an outbreak could pose the biggest threat of an epidemic due to the city's role as an international travel hub.

[byline: Misha Hussain and Saliou Samb]

--
communicated by:
ProMED-mail rapporteur Mary Marshall

[This is an unwelcome development, and more information on any links between this new outbreak and earlier cases at previous locations is awaited.

Telimele is a town in the Fouta Djallon highlands of Guinea. Its population was estimated at 15 973 in 2008. It is the capital of Telimele Prefecture. It is known for the 15th century Gueme Sangan fortress of Koli Tengela. Its location can be seen in the map at http://en.wikipedia.org/wiki/T%C3%A9lim%C3%A9l%C3%A9. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/39246.]

EBOLA VIRUS DISEASE - WEST AFRICA (44): GUINEA, NEW CASES
*********************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Sat 24 May 2014
Source: Guineenews [in French, trans. CopyEd.LMI, edited]
http://guineenews.org/2014/05/alpha-oum ... -sevit-ici


Ebola virus disease (EVD) was discovered earlier this year [2014] in the forest region of Guinea, and it arrived [again] at the beginning of this month [May 2014]. It has already caused 3 suspected deaths, 2 confirmed patients, and [possibly infecting] 41 who had been in contact with them. But the population of Telimele cannot believe the presence of this cursed virus in their prefecture.

"We set up a crisis committee with the missions that arrived to fight Ebola. Besides NGOs such as the Red Cross and others, we are talking with the prefectural authorities and the technical services of health, education, civil society, etc." said the mayor, Elhadj Alpha Oumar Bah Bantayah, on the phone with Guineenews. The mayor mentioned the behavior of the citizens, most of whom still refuse to believe the presence of the ebolavirus in Telimele and he acknowledged that "some believe it is the devil and others think it is the politicians' doing."

As we know, the most popular version in the afflicted village of Sogoroyah (victim) and surroundings is that the head of the family which had victims and patients had cleared a field by burning it and the fire spread out and damaged "the home and property" of an old devil woman, who had then decided to take revenge on the man's family"... "I went to see the field yesterday in Hore Poodhe. Here in town and in all service [institutions], we use bleach everywhere. But, as you know, people do not like to be greeted without shaking hands, otherwise you would be considered standoffish and too proud," confided Mamadou Balde Lamarana, host of the rural radio station in Telimele, on Saturday [24 May 2014].

According to the mayor of Telimele, several committees are now set up to fight the disease, including a commission of communication and awareness. Also, wise men and preachers in mosques will explain to the people in a simple way how to behave and what to do during this outbreak.

--
communicated by:
ProMED-mail rapporteur Mary Marshall

[This is a sad development. All of Guinea was free of EVD after 42 days without a case, except Gueckedou, which has now gone 10 days without a reported case, and it looked as though the epidemic was close to an end.

Denial and attribution to spirits have to be overcome by public education in this new area. It is good that NGOs are there and a rapid response is being organized.

A HealthMap/ProMED-mail map can be accessed at http://healthmap.org/promed/p/39246. A map showing the location of Telimele (red dot) can be seen at http://w0.fast-meteo.com/locationmaps/Telimele.8.gif. - Mod.JW]

EBOLA VIRUS DISEASE - WEST AFRICA (45): SIERRA LEONE, NEW CASE
**************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Mon 26 May 2014
Source: WHO/AFRO, Epidemic & Pandemic Alert and Response (EPR), Outbreak News, Ebola virus disease, West Africa [edited]
http://www.afro.who.int/en/clusters-a-p ... -2014.html


Sierra Leone
------------
The World Health Organization was notified on 25 May 2014 of an Ebola virus disease [EVD] outbreak in Sierra Leone. Preliminary information received from the field indicates that one laboratory confirmed case and 5 community deaths have been reported from Koindu chiefdom. This chiefdom shares border with the current Ebola virus disease hotspot Gueckedou in Guinea. The laboratory analysis of the case was done at the VHF [viral hemorrhagic fever] laboratory in Kenema, Sierra Leone.

While waiting for additional epidemiological information, the following measures have been initiated by national authorities with support from WHO: meeting of the national emergency Ebola task force to discuss the current situation and proposed preventive and response measures to be implemented immediately; deployment of a team to the field to conduct epidemiological investigations and initiation of preliminary response measures and development of funding proposals based on the existing national EVD preparedness and response plan.

WHO held a 3-level coordination meeting to review the current situation, carry out risk assessment based on available data and information, and measures to be taken to control the outbreak. These include among others:
- immediate deployment of 6 international experts in the areas of coordination, epidemiology, social mobilization, case management/infection prevention and control, data management, and logistics;
- provision of catalytic funds by WHO to support initial investigation and response activities;
- development of proposals to access the African Public Health Emergency Fund (funding mechanism established by all the Ministers of Health in the WHO African Region) and other funding sources; and
- deployment of essential supplies and reagents.

WHO does not recommend that any travel or trade restrictions be applied to Sierra Leone based on the current information available for this event.

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

[This is the 1st case in Sierra Leone not imported from Guinea like the previous 2 in April 2014 -- see ProMED-mail Ebola virus disease - West Africa (05): Guinea, Liberia, Sierra Leone WHO update 20140401.2373662.

Koindu Town, Kailahun district [not to be confused with Koidu Town, Kono District, also in the Eastern Province of Sierra Leone] is about 70 km (44 mi) across the border as the crow flies from Gueckedou, the original and still active focus of EVD in Guinea, see map at http://maps.maphill.com/sierra-leone/ea ... ilahun.jpg. But there is no direct road. Koindu is much closer to the border of the Foya area in Liberia, which had a fatal case of EVD in early April 2014.

This is a serious set-back for the effort to control the outbreak in the forested area where 3 countries meet -- see map at http://bit.ly/1jmMo8n.

It is very fortunate that Sierra Leone already had a VHF lab set up for diagnosing Lassa fever cases, which had been provided with ebolavirus diagnostic lab equipment and training on its use by Metabiota. Let us hope all contacts have agreed not to leave the area -- above all, not to go to the capital, Freetown (except for the international experts who will have taken strict precautions to avoid infection). - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/39272.]

EBOLA VIRUS DISEASE - WEST AFRICA (46): GUINEA WHO 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

Date: Sat 24 May 2014
Source: WHO Global Alert and Response (GAR), Disease Outbreak News [edited]
http://who.int/csr/don/2014_05_24_ebola/en


Ebola virus disease, West Africa -- update
------------------------------------------
Guinea
------
Cases and deaths attributable to Ebola virus disease (EVD) continue to occur in Guinea. As of 23 May 2014, 8 new cases and 3 new deaths were reported from one newly affected district, Telimele (3 cases and 0 deaths) and 2 existing affected areas, Gueckedou (2 cases and 0 deaths) and Macenta (3 cases and 3 deaths).

Since the beginning of the outbreak, the cumulative total number of clinical cases of EVD is 258, including 174 deaths. The classification of these cases and deaths is as follows:
- confirmed (146 cases and 95 deaths);
- probable (67 cases and 57 deaths); and
- suspected (67 cases and 57 deaths)
[These last 2 sets of numbers are identical, which seems rather unlikely. - Mod.JW]

The geographical distribution of the clinical cases of EVD is as follows:
- Conakry (50 cases, including 25 deaths),
- Gueckedou (170/121),
- Macenta (22/17),
- Kissidougou (8/6),
- Dabola (4/4),
- Djinguiraye (1/1), and
- Telimele (3/0).

- Currently hospitalized: 9 (6 in Gueckedou and 3 in Telimele);
- Contacts being actively followed-up: 153 (132 in Gueckedou and 41 in Telimele) [which totals 173. - Mod.JW]

The number of cases remains subject to change due to reclassification, retrospective investigation, consolidation of cases and laboratory data, enhanced surveillance, and contact tracing activities.

Liberia and Sierra Leone
------------------------
In Liberia and Sierra Leone, the situation continues to be stable with no new cases being reported. [But there is now a confirmed case in Sierra Leone -- see ProMED archive (45) below. - Mod.JW] Social mobilization and surveillance activities are ongoing.

WHO response
------------
In response to the new cluster of cases and deaths in Guinea, WHO has redeployed experts to the affected areas to support the EVD investigation; active case search and contact follow-up; establishment of isolation facilities in Telimele; case management and infection prevention and control. A team of social mobilization experts trained by WHO has also been redeployed to support public health awareness with an emphasis on approaches to addressing community resistance from some villages.

WHO does not recommend that any travel or trade restrictions be applied to Guinea or Liberia based on the current information available for this event.

This update has also been posted on the regional website of the WHO African Regional Office.

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

[It is disappointing that new cases continue to appear in Gueckedou and that Macenta has reappeared on the infected list. The source of infection was not reported -- whether it was a contact of a known or suspect case, or a participant in preparing a body for burial. Epidemiological information such as that is essential for prevention and control. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45.]

EBOLA VIRUS DISEASE - WEST AFRICA (47): SIERRA LEONE, MORE CASES
****************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

[1] New cases
Date: 26 May 2014
Source: NBC News.com [edited]
http://www.nbcnews.com/health/health-ne ... ak-n114611


5 Dead in Sierra Leone's First Ebola Outbreak
-------------------------------
5 people have died in Sierra Leone's 1st confirmed outbreak of ebolavirus, the World Health Organization (WHO) said on Monday [26 May
2014].

Ebola virus disease (EVD), a haemorrhagic fever with a fatality rate of up to 90 percent, has killed more than 100 people in neighbouring
Guinea and Liberia since March [2014] in the first deadly appearance of the disease in West Africa. In a statement posted on its website,
the WHO said the outbreak in Sierra Leone was located in an area along the country's border with Guinea's Gueckedou prefecture, where some of the earliest cases of the disease were recorded. "Preliminary information received from the field indicates that one
laboratory-confirmed case and 5 community deaths have been reported from Koindu chiefdom," it said.

The WHO said it was immediately deploying 6 experts to the area along with essential supplies. Previously, several suspected cases of Ebola were recorded in Sierra Leone early on in the West African outbreak, but they later tested negative for the disease. Ebola has been more commonly found in Central Africa including Democratic Republic of Congo and Gabon, and in Uganda and South Sudan.

By Reuters, Cellou Binani/AFP

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

*******
[2] New cases
Date: 26 May 2014
Source: News24 [edited]
http://www.news24.com/Africa/News/4-die ... 20140526-2


4 die from Ebola virus in Sierra Leone
---------------------------------
Freetown - 4 people in eastern Sierra Leone have died after contracting the Ebola virus, a health ministry official announced on
Monday.

"I can categorically confirm that the Ebola sickness has materialised," said Amara Jambai. "We have on record 4 deaths".

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

*******
[3] External aid
Date: 26 May 2014
From: Robert F. Garry <rfgarry@tulane.edu> [edited]


We would like to inform ProMED readers that in point of fact our teams from Harvard and Tulane who have worked at the KGH [Kenema Government Hospital] site on Lassa fever for a decade http://www.plosntds.org/article/info%3A ... td.0002748
and were instrumental in setting up ebolavirus diagnostics at KGH.

I myself am heading to KGH tomorrow to bring PPE [personal protective equipment, e.g. masks, face shields, gowns, gloves - Mod.JW] and more diagnostic reagents.

--
Robert F. Garry, PhD
Professor, Department of Microbiology and Immunology
Assistant Dean, Graduate Program in Biomedical Sciences
Tulane University School of Medicine, SL-38
1430 Tulane Avenue, JBJ568
New Orleans, LA 70118
<rfgarry@tulane.edu>

[This contradicts earlier reports that the cases were not EVD.

But it is not clear if the 4 (later 5) "community deaths" were lab confirmed, given that all VHF cases in Serra Leone tested up to this one Ebola
positive turned out to have been cases of Lassa fever.

The scale of external medical aid to Sierra Leone in the past and again now is impressive.

A map showing the outbreak locations is at https://goo.gl/maps/uOLlY. - Mod.JW]

EBOLA VIRUS DISEASE - WEST AFRICA (48): SIERRA LEONE, MORE CASES, PREPAREDNESS
******************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Mon 26 May 2014
Source: Sierra Leone Ministry of Health and Sanitation [edited]
<info@health.gov.sl>


Ebola fever disease [EVD] emergency preparedness and response
-------------------------------------------------------------
A few days ago health officials in Guinea reported an increase of ebolavirus activity in particular in the Kissidougou aera (centered by the Gueckedou or Gueckedougou prefecture) close to the borders of Sierra Leone and Liberia: 11 suspected cases (2 were then confirmed), and 41 contacts were reported last week.

Since 18 May 2014, the MOHS [Ministry of Health and Sanitation] surveillance team in Kailahun, Sierra Leone, observed an increase in the number of patients presenting with diarrhea and vomiting symptoms in the communities around Koindu town; 3 patients died including a nurse, a student and a housewife on 23 May 2014. These cases are under investigation.

On 24 May 2014 one sample was collected from a patient, suspected EVD case, at Koindu health post, Kailahun District (bordering Guinea) and sent 25 May 2014 to the Lassa Fever Laboratory LFL (supported by Metabiota Inc. and Tulane/Harvard Universities). The sample was immediately tested by MOHS and showed positive for ebolavirus Zaire by conventional RT-PCR (MOHS -- Harvard University reagents) and by real time RT-PCR (Metabiota Inc., USAMRIID and Critical Reagents Program reagents). Further tests including antigen detection and IgM ELISA are currently being run (Metabiota Inc. -- USAMRIID reagents).

The Lassa Fever Laboratory is receiving more samples from suspected cases and potential contacts of this confirmed case; 8 more samples from viral hemorrhagic fever (VHF) suspected cases were received on 26 May 2014. The same tests were run (conventional RT-PCR and real time RT-PCR) and the LFL confirms 6 more cases originating from Kailahun District.

The Lassa fever outreach team is currently on site in Kailahun investigating, searching for suspected cases and contacts; 300 kits of personnel protective equipment have been distributed to health officials in Kailahun, the Lassa Ward and the Lassa Fever Laboratory in Kenema (USAMRIID, Metabiota) and more are to be delivered shortly (Tulane, USAMRIID, Metabiota Inc.).

The World Health Organization was notified on 25 May 2014 of an Ebola virus disease [EVD] outbreak in Sierra Leone including one laboratory confirmed case and 5 community deaths reported from Koindu area bordering the current Ebola fever epidemic epicenter of Gueckedou, Guinea.

Global results
--------------
From the Ebola Surveillance & VHF Preparedness - Metabiota Inc. Laboratory team at KGH in partnership with the MOHS Lassa fever Laboratory of Kenema Government Hospital (supported by Tulane University): from 19 Mar to 20 May 2014 a total of 140 EVD suspected cases sampled in Sierra Leone tested negative for ebolavirus.

Suspected cases of Lassa fever and other potential VHF were also tested for ebolavirus when required, 14 samples tested positive for Lassa virus and one for West Nile virus.

Training
--------
385 health workers at the national level have been trained in 3 weeks for emergency preparedness and response to EVD(MOHS/Metabiota Inc.).

Intensified health communications and a weekly task force chaired by the Minister were implemented. Since then, upon request of the MOHS, a "Metabiota Daily report" has been produced since the beginning of the Ebola alert in Sierra Leone reporting on laboratory diagnostics, training progress and other issues related to EVD preparedness and response. 30 reports have been produced for the MOHS and WHO to monitor the EVD outbreak response.

Background
----------
- 23 Mar 2014: samples from 2 patients from Guinea, collected by the Guinean authorities were handed to the MOHS (Sierra Leone) investigation field team and subsequently referred to the Lassa laboratory and the Metabiota Viral Hemorrhagic Fever (VHF) team at the Kenema Government Hospital. All were found to be negative for Ebola, Lassa fever, Marburg and Yellow fever by real time RT-PCR on the following day.

- 24 Mar 2014: Sierra Leone outbreak response is decided, after MOHS (Ministry of Health and Sanitation) official request. Partners (Metabiota Inc. USAMRIID, NIH) are contacted to support the response

- 25 Mar 2014: an MOHS multidisciplinary field team carried out epidemiological investigations to examine reports on the death of a suspected case; 15 probable contacts were identified, sampled and tested negative by RT-PCR for all existing 5 known ebolavirus species.

- 28 Mar 2014: 2 Metabiota Inc. experts leave Washington for Freetown with approx. 800 pounds (363 kg) of equipment, reagents and other supplies (such as, personal protective equipment (PPE) from USAID). The aim was to develop an efficient health survey of the border adjacent to the Guinean epidemic region, where confirmed and suspected EVD cases have been reported. The immediate objectives included: all necessary means for an early and specific diagnosis of EVD and providing a reporting system (forms) for a precise follow up and early response on suspected EVD cases: intensive and emergency training for all Health Officers of the most threatened districts bordering Guinea and Liberia and the Western district sheltering air and sea transportation facilities for commercial exchanges with Guinea and Liberia; assess risk, identify means (reporting forms, practical material for case management, disinfection, safe environment) and develop strategy for prevention of viral hemorrhagic fever emergence and/or spread in country.

Partners
--------
National including the Ministry of Health and Sanitation: HE the Minister of Health, Chief Medical Officer (CMO), Director of Infectious Disease Control; MOHS Kenema Government Hospital (KGH), KGH including the Lassa Fever Laboratory, and the Metabiota VHF team: Biological diagnostic of VHF; WHO office in Freetown: Regional reporting on Ebola outbreak and training; MSF: awareness and reporting on Ebola suspected cases; US Embassy: in country facilitator (airport, MOHS). International: WHO Geneva: Communicable Disease Programs; USAMRIID: expertise (RS), equipment and reagents; NIH: providing expertise (LH), equipment and reagents; Tulane University (laboratory support from Harvard University); USAID: providing supplies (PPE, protective masks, etc.)

Training
--------
After the 1st Task Force meeting on EVD emergency preparedness and response, chaired by the Minister, attended by the 2 Metabiota experts as requested by the MOHS, it was decided to train in less than 10 days all key health officers involved in the response of medical support/clinics (case management), survey (case definition) and field investigation (contacts) on EVD. A total of 75 Hospital Medical Officers, 35 Surveillance Medical Officers and, 25 Port Health Officers have been trained in 8 days. Also 50 Primary Heath care workers from 5 districts (250 trainees) were trained by the previous trainees (Health Officers): total of 385 health workers from Sierra Leone have been trained and supported by complementary equipment (PPE, rubber boots, concentrated bleach, WHO VHF manual, thermometers, etc.), and other reporting forms. Ultimately post training and active surveillance (by the former trainees) has been conducted in the 5 districts bordering the Guinea EVD epidemic area.

Laboratory diagnostics
----------------------
Metabiota Inc., working with the MOHS, had previously installed Zaire Ebola-specific real time RT-PCR (2012), which was used to screen the 1st cases reported to ProMED-mail. Since that time and under MOHS and WHO guidance, Metabiota Inc., with support from international partners from the US (USAMRIID, DTRA, NIH, and others), the Democratic Republic of Congo (INRB) and Gabon (CIRMF), have installed and are currently running a full suite of Ebola specific and differential diagnostics, including: Zaire Ebola-specific antigen and IgM capture ELISAs, Zaire Ebola-specific and pan-filovirus RT-PCR, as well as published PCR assays for the detection of Lassa fever, yellow fever and other confounding, locally endemic pathogens, as well as laboratory reagents and equipment, and personal protective equipment (PPE) for health workers exposed to suspected cases.

Also the Lassa fever laboratory, supported by Tulane University has developed an ebolavirus test (conventional RT-PCR) provided by Harvard University. All Ebola suspected cases are tested by both collaborating teams as a permanent and efficient control.

Providing supplies
------------------
PPE: masks, gloves, lab coats and full suits, shoe covers, respirators -- as well as general laboratory supplies (from international partners at USAMRIID, NIH, and Metabiota Inc. Cameroon)

Material & methods
------------------
Reagents and supplies given by USAMRIID and NIH, including 2 thermal cyclers (USAMRIID/Metabiota), one MagPix(R) (multiplex platform for qualitative and quantitative analysis of proteins and nucleic acids); real time RT-PCR for Ebola, Marburg, Lassa viruses, yellow fever, West Nile and chikungunya viruses; IgM and IgG ELISA assays for Ebola serology; Ebola antigen capture ELISA.

Capacity building
-----------------
A MOHS-KGH laboratory technician has been trained to perform real time RT-PCR against all pathogens presently tested. Training continues on other assays.

Providing expertise
-------------------
The head of the laboratory, present full time on site, joined by 2 scientists from the Applied Diagnostics Branch, Diagnostic Systems Division, USAMRIID. Senior scientist coordinated and supervised Metabiota support (scientific & academic) to MOHS and under the guidelines of WHO Metabiota Inc. Provided Public Health comprehensive forms (public health sectors recording data from clinic, laboratory, epidemiology and surveillance).

Upgraded the security level & data management system (recording, analysis, transfer) of the sample collection for EVD/VHF in partnership with KGH Lassa Ward (HK); security level of the Lassa laboratory was upgraded by all partners; protocols reviewed for safe handling and disposal of Ebola samples and waste; laboratory workers and visiting scientists protection enhanced.

Safety
------
A specialized infectious disease ambulance provided by Metabiota Inc. is being used to transport all suspected cases and every precaution is made to protect both health care workers and local populations from the risk of spread of the diseases.

The MOHS National Task Force, working with Metabiota Inc. and other partners, is continuing to actively conduct surveillance for EVD, as well as for Lassa fever; the Kenema Government Hospital has been designated as the central treatment facility for anyone suspected of contracting either Ebola or Lassa fever in the country.

--
Communicated by
Ministry of Health & Sanitation
Freetown
Sierra Leone

[ProMED-mail thanks the Sierra Leone Ministry of Health and Sanitation for this update. The collaboration with external partners is exemplary.

We would be interested to know why so many different types of tests are necessary to confirm an EVD case, but suppose these are experimental reagents being field tested for research as well as public health purposes.

There is an excellent map by CDC of the affected areas at
http://www.cdc.gov/vhf/ebola/images/out ... 041414.jpg
Kailahun should now be coloured red. - Mod.JW]

EBOLA VIRUS DISEASE - WEST AFRICA (49): SIERRA LEONE, NIGERIA, CALL FOR ACTION
******************************************************************************
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: dangerous misinformation
[2] Sierra Leone: 2nd death confirmed
[3] ECDC summary
[4] Nigeria, call for action

******
[1] Sierra Leone: dangerous misinformation
Date: 28 May 2014
Source: Cocorioko Newspaper [edited]


Dr. Gbakima says Abdul Fonti's report is very misleading and unfortunate. As the Government fights to stop the Ebola outbreak in Sierra Leone, Editor-In-Chief of the opposition SLPP online newspaper, The New People, wrote on Facebook and in his newspaper that the Minister of Health, Hon. Miatta Kargbo, had ordered all patients who have tested positive for the Ebola virus to be kidnapped, killed and buried.

In an exclusive interview with Cocorioko last night [27 May 2014], the minister condemned the story without naming the editor. She said that certain journalists wanted to incite the people of Sierra Leone by spreading dangerous and misleading reports in the social media to create chaos that has the potential to engulf the whole country. The minister doubted the sanity of any journalist who would sit down and fabricate such a wicked story.

"This sort of message does not help," remarked Dr Aiah A. Gbakima, a biologist and country director at Global Viral Testing. ... He called the editor's story "misleading" [a huge understatement. - Mod.JW]. There has been vigorous preparation to stop this virus from entering Sierra Leone by the Ministry of Health and Sanitation, development partners, non-governmental organizations, and many others, Gbakima asserted. On learning about the crisis Monday [26 May 2014] night from the team in Kenema, Gbakima said the health minister was kept informed as were a group of people from the Ministry of Health who stayed up in meetings until 2:00 am.

"Bear in mind, Gbakima explained, Kenema is the only hospital in the country with a special isolation unit to handle all viral hemorrhagic fevers. The ambulance was to bring the confirmed case for hospitalization. Meanwhile, the contacts of this patient (7-8 people) were identified and were also put in health centers pending their samples being tested. When the ambulance and the health surveillance team got to Kissi Teng, the chief apparently refused to cooperate with the team and refused to allow the ambulance to take the patient to Kenema for admission and to be given supportive treatment and possibly save her life. They [the chief and associates] did not stop at this but forcibly removed all the contacts who were beginning to show signs of Ebola (vomiting, diarrhea, high fever, and body pains) and took them away and hid them."

"Before this confirmed case, a lot of training had been done for most health workers, and they were all given personal protective equipment, gloves, masks, etc. The border post health workers were trained and these "Train the Trainers" were also supported to train others in their areas. There was a lot of sensitization about Ebola. These programs were all presented and discussed at the National Task Force meetings every week that was chaired by the Minister of Health and Sanitation herself. I am a member of this Task Force. I do not see any reason for the writer to say that there was lack of preparedness."

"On Mon 26 May 2014, there was an emergency Task Force meeting to announce that we have a confirmed case and that there were patients admitted with diarrhea and vomiting; 4 others were admitted later on. There were 4 deaths. The minister did not hide anything from the Task Force, and we all discussed the approach to this outbreak."

"The index case was a lady, and all those who attended the funeral and the 40th day ceremony were requested to be seen by trained surveillance officers and to possibly take a blood sample from each if there was a need to do so. The idea was to eliminate those who were positive from those who were not at that point in time."

"When the Minister was told of the removal of the patients from the Hospital/clinic in Kissi Teng chiefdom, she alerted the stakeholders and summoned another Task Force meeting today, Tue 27 May 2014. Before that meeting, she met with all Members of Parliament from Kailahun District and other stakeholders from that district to solicit their assistance in identifying these patients and to stop the spread of this deadly virus. The teams from Kailahun, Kenema and Kono depart on Wed 28 May 2014 to have meetings with their chiefs and people in these border districts."

"As far as I know, and I was at both Task Force meetings on Monday and Tuesday [26-27 May 2014], at no time did the Minister of Health say or even suggest that these patients should be kidnapped and brought to Kenema to die. In fact, it was decided by the Task Force that we should set up an isolation unit in Koindu to stop people from being transported to Kenema for the distance."

"In addition, all samples will be sent to the mobile lab in Gbakedu on the [Guinea] border to be tested instead of Kenema due to distance. Tents have been donated by MSF (Medecins Sans Frontieres, or Doctors without Borders) to set up the isolation unit in Koindu and to expand the ward in Kenema in case we are overwhelmed. The health workers in all the border districts were trained on how to set up an isolation unit during the 3 weeks of training preparedness response."

"Let me tell you why these patients were taken away by their relatives. They live very close to Guinea, and most use the Guinean currency; they buy from and sell in Guinea and have relatives in Guinea. During the outbreak in Guinea, the news going around was that when they take one's relatives to take blood, they never come back. This created fear that if they take their relatives to either take samples or take them to Kenema for treatment, they will not come back. But 3 of those who disappeared from Kissi Teng came by themselves to the Kenema Government Hospital for treatment for diarrhea and vomiting. Because of the alertness of staff there, they were immediately referred to the isolation ward, and we now have 3 patients confirmed for Ebola admitted, and they are all alive. The World Health Organization is sending expert physicians and anthropologists to help educate these people on Ebola virus disease (EVD). The posting by the editor is really false and very unfortunate. The minister and her team have been working very hard to contain this outbreak. I am sure you will hear from them," Gbakima said.

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

******
[2] Sierra Leone: 2nd death confirmed
Date: 28 May 2014
Source: ReliefWeb [edited]
http://reliefweb.int/report/sierra-leon ... erra-leone


Sierra Leone Wednesday [28 May 2014] confirmed a 2nd death from the ebolavirus, as the WHO warned of possible further contagion as others sick with the haemorrhagic fever had been moved out of isolation and back to their village.

"One of the 7 ebolavirus disease (EVD) patients, a woman admitted at the Isolation Centre in the Government Hospital in Kenema, died on Tuesday [27 May 2014]," Dr Brima Kargbo, the chief medical officer, told AFP in a telephone interview. The 6 other patients affected were "undergoing treatment," added Dr Kargbo. The announcement of the death comes 2 days after Sierra Leone confirmed its 1st fatality from Ebola.

The WHO meanwhile warned of likely further contagion as 4 of the sick patients had been taken back to their home village. They were removed from an isolation facility in the east of the country by family members who were unwilling to see them remain in a hospital far from home, WHO scientist Pierre Formenty told reporters in Geneva. "Of course by doing that, they exposed themselves, and they exposed the villages," he said, adding that the EVD patients were still in Kuindu village, near the border with Guinea, the epicentre of the West African outbreak.

In response to the epidemic, Sierra Leone has restricted travel in some areas and reaffirmed an earlier ban on trips to attend funerals in Guinea.

Lack of cooperation allows epidemic to spread
-------------------------------
Authorities have designated the eastern regions of Kailahun, where the 1st case was confirmed, and Kenema as "high risk." Officials are trying to encourage residents to cooperate with health workers, but Formenty said getting populations in both Sierra Leone and Guinea on board with efforts to rein in the epidemic remained a major challenge. "The lack of collaboration with some affected families has allowed this epidemic to continue to spread invisibly between family members," he said, insisting on the need to work harder to explain the benefit of isolating the sick. West African authorities have also been scrambling to stop mourners from touching bodies during traditional funeral rituals.

However, Formenty pointed to the fluid borders between Liberia, Guinea, and Sierra Leone and said: "We're on high alert in Liberia."

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

******
[3] ECDC summary
Date: 28 May 2014
Source: European Centre for Disease Prevention and Control [excerpted, edited]
http://ecdc.europa.eu/en/press/news/_la ... 68&ID=1012


On 26 May 2014 ProMED-mail, quoting MoH, reported 6 confirmed new cases from Kailahun district, Sierra Leone.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

******
[4] Nigeria, call for action
Date: 28 May 23014
From: Shamsudeen Fagbo (Cross-posted from Nigerian Biomedical and Life Scientists, a Yahoo group) <oloungbo@yahoo.com> [edited]


ProMED post "Ebola virus disease - West Africa (48): Sierra Leone, more cases, preparedness 20140527.2501116" reminds us that the threat of Ebola to other parts of West Africa, including the Giant of Africa [Nigeria], is far from being over.

We ask again: What levels of preparedness do we have in place at the federal and state levels? Will the symptoms mentioned below -- diarrhoea and vomiting -- lead our clinicians to suspect ebolavirus disease (EVD) or even any other hemorrhagic fever?

Though Nigeria should be donating to Sierra Leone (surely we should able to afford the concentrated bleach given to them by the Americans) as a form of health diplomacy, we can benefit in several ways from the events being led by the Americans as described in the post. We can make hay while the sun shines.

--
Shamsudeen Fagbo
<oloungbo@yahoo.com>

[There is active social and commercial cross-border traffic in the region where Guinea, Sierra Leone and Liberia meet, with people moving in all directions. Allegations such as those reported above just help to keep the outbreak going by frightening people into not cooperating with prevention and control measures.

ProMED is happy to have been quoted by ECDC News. Shamsudeen's comment on Nigeria is well timed. - Mod.JW

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

EBOLA VIRUS DISEASE - WEST AFRICA (50): GUINEA (CONAKRY), WHO 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] Guinea: Conakry again
[2] WHO/AFRO update

******
[1] Guinea: Conakry again
Date: 28 May 3014
Source: Mail & Guardian, South Africa/Reuters [edited]
http://mg.co.za/article/2014-05-28-ebol ... est-africa


Ebola is still spreading in West Africa, and the World Health Organization declared the situation "serious" when new cases surfaced after officials thought they had contained the virus.

Guinea's capital city of Conakry has recorded its 1st new Ebola cases in more than a month, while other previously unaffected areas have reported infections in the past week, according to the World Health Organization (WHO).

The spread of the 2-month-old outbreak, which Guinean authorities said had been contained, risks further complicating the fight against the virus in a region already struggling with weak healthcare systems and porous borders.

"The situation is serious; you can't say it is under control, as cases are continuing, and it is spreading geographically," Dr Pierre Formenty, a WHO expert who recently returned from Guinea, told a news briefing in Geneva on Wednesday [28 May 2014]. "There was no decline. In fact, it is because we are not able to capture all of the outbreak that we were under the impression there was a decline," he said.

The WHO reported 2 new cases, including one death, between 25-27 May 2014 in Conakry. They were the 1st to be detected since 26 Apr 2014. An outbreak in the capital could pose the biggest threat of an epidemic because the city is Guinea's international travel hub.

Telimele and Boffa -- 2 districts north of Conakry that were previously untouched by the disease -- confirmed outbreaks through laboratory testing, the WHO said; 12 cases, including 4 deaths, were reported there between 23-26 May 2014, while suspected ebolavirus disease (EVD) infections were documented in the adjacent districts of Boke and Dubreka.

Aboubacar Sidiki Diakite, who heads the Guinean government's efforts to halt the virus's spread, said the origins of all the new outbreaks had been traced back to cases in Conakry. The problem is that there are families that refuse to give information to health workers. They hide their sick to try to treat them through traditional methods," he said.

The outbreak -- the 1st deadly appearance of the haemorrhagic fever in West Africa -- spread from a remote corner of Guinea to the capital and into Liberia. Sierra Leone reported its 1st confirmed outbreak of the disease earlier this week. The WHO has documented 281 clinical cases of Ebola, including 185 deaths, in Guinea since the virus was 1st identified as an ebolavirus in March [2014]. The disease is thought to have killed 11 people in Liberia, though there have been no new cases there since 9 Apr 2014.

16 cases -- 7 of them confirmed through laboratory testing and another 9 suspected -- have been reported in Sierra Leone's Kailahun district, where 4 people were said to have died of the disease. Researchers say a new strain of the virus caused the West African outbreak.

[Byline: Stephanie Nebehay, Saliou Samb, Joe Bavier]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>
& ProMED Rapporteur Marianne Hopp

******
[2] WHO/AFRO update
Date: 27 May 2014
Source: WHO/AFRO [edited]
http://www.afro.who.int/en/clusters-a-p ... -2014.html


Ebola virus disease, West Africa (Situation as of 27 May 2014)
---------------------------------------
Guinea
-------
From 23 May 2014 to 27 May 2014, 4 new districts reported 14 new EVD clinical cases and 5 deaths as follows: Boffa (5 cases and 1 death), Telimele (7 cases and 4 deaths), Boke (1 case and 0 deaths), and Dubreka (1 case and 1 death). Community and nosocomial transmission are still occurring in Gueckedou, Macenta and Conakry.

As of 18:00, 27 May 2014, the total cumulative number of cases due to EVD is 281 and 186 deaths. The classification of these cases and deaths are as follows:

confirmed (163 cases and 103 deaths);
probable (66 cases and 56 deaths) and
suspected (44 cases and 23 deaths).

The geographical distribution of the cases is as follows:

Conakry (48 cases, and 26 deaths),
Gueckedou (176 cases and 126 deaths),
Macenta (31 cases and 19 deaths),
Kissidougou (7 cases and 5 deaths),
Dabola (4 cases and 4 deaths),
Djinguiraye (1 case and 1 death)
in addition to the cases and deaths in the newly affected areas.

The total number of cases in isolation is 16 (10 in Gueckedou, 3 in Telimele and 3 in Boffa).

The number of contacts under follow-up is 427 (250 in Conakry, 213 in Gueckedou, 126 in Macenta, and 88 in Telimele) [My calculator makes the total 677, but subtracting the 250 in Conakry leaves, in fact, 427. - Mod.JW].

In Guinea, Ministry of Health and partners have mounted a response including outbreak investigation, risks assessment, case management, infection control in the newly affected districts, and social mobilization targeting the resistant communities in Gueckedou and Conakry.

Sierra Leone
---------
In Sierra Leone, 16 cases, (7 laboratory-confirmed, 9 suspected) and 5 community deaths have been reported from Kailahun district. The district is located in the eastern region of Sierra Leone sharing borders with Gueckedou in Guinea and also with Liberia.

Liberia
-------
In Liberia, there have been no new cases since 9 Apr 2014. Social mobilization and surveillance have been enhanced in border districts. The number of cases remains subject to change due to reclassification, retrospective investigation, consolidation of cases and laboratory data, and enhanced surveillance.

WHO response
----------
In response to the confirmation of the EVD outbreak in Sierra Leone, WHO held multi-level teleconferences to review the situation and propose key actions to be taken. These include establishment of an Emergency Response Team at the WHO Country Office, deployment of experts, logistics and supplies, and provision of catalytic funds.

WHO is facilitating the active participation of national authorities and community leaders to address community resistance and hiding of cases in some communities in both Guinea and Sierra Leone.

WHO does not recommend that any travel or trade restrictions be applied to Guinea or Sierra Leone based on the current information available for this event.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[The reappearance of EVD in Conakry is a serious setback for the control program in Guinea. The capital is now apparently re-exporting cases back to the provinces. Conakry has a population of 2 million, and with families not taking their sick to hospitals, the outbreak could go on indefinitely.

It is also serious that nosocomial transmission is still occurring in Gueckedou, Macenta, and Conakry. Do even Conakry hospitals still lack proper isolation facilities and infection control procedures?

There is an excellent map by CDC of the affected areas at http://www.cdc.gov/vhf/ebola/images/out ... 041414.jpg. Kailahun should now be coloured red. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45.]

EBOLA VIRUS DISEASE - WEST AFRICA (51): SIERRA LEONE 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] Case update
[2] WHO experts arrive

******
[1] Case update
Date: Thu 29 May 2014
Source: a reliable source in Sierra Leone [edited]


ProMED-mail has learned that since 23 May 2014 there have been 14 cases in Kailahun [district, Eastern Province of Sierra Leone] confirmed by molecular test methods, 2 of them fatal. Investigation of the index case has revealed that in April 2014 she attended the funeral of a traditional healer who had been treating patients coming from Guinea. A major challenge is that community members are really ignorant of the risk and do not want to send an apparently healthy contact person to the hospital. There are more than 20 major sites of active surveillance and investigation for Ebola fever preparedness and response around the borders of Sierra Leone with Guinea and Liberia.

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

******
[2] WHO experts arrive
Date: Thu 29 May 2014
Source: GlobalPost, Xinhua News Agency report [edited]
http://www.globalpost.com/dispatch/news ... ight-ebola


The World Health Organization (WHO)'s country representative, Jacob Mufunda, has confirmed the arrival [in Sierra Leone] of 12 experts from the WHO inter-country team on Ebola to assist the Ministry of Health and Sanitation in the fight against the disease.

The representative told Xinhua that WHO has provided the country with 5144 personal protective equipment and distributed them to health facilities. What's more, additional gear has been sent to the Kailahun and Kenema districts. He reiterated WHO's commitment to boost health promotion as well as human resource development.

Meanwhile, Health Minister Miatta Kargbo left the capital, Freetown, for Koindu [the outbreak centre] to sensitize the township and the environs. She confirmed 7 positive cases [14 in the report above] as of the early hours of Wednesday [28 May 2014] and encouraged all health staff at the front line to intensify efforts. Madam Kargbo said the ministry and the government would continue to be vigilant in addressing the situation, and called on all Sierra Leoneans to take the necessary precautionary measures and report to the nearest health facilities when signs and symptoms are noticed.

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

[There is clearly a problem in trying to convince uneducated rural people, who believe that disease is caused by spirits, that they may be carrying an invisible virus that will make them ill in a few days time, and that they can pass it to their relatives and friends unless they stay in quarantine.

The WHO team includes logistics, data manipulation, and other auxiliary staff.

There is an excellent map by ReliefWeb of the affected areas at
http://reliefweb.int/sites/reliefweb.in ... 202014.pdf. - Mod.JW]