wuestenschiff.de

EBOLA VIRUS DISEASE - WEST AFRICA (52): WHO UPDATE, SIERRA LEONE (FREETOWN)
***************************************************************************
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] WHO update 30 May 2014
Date: Fri 30 May 2014
Source: WHO Global Alert and Response, Disease Outbreak News [edited]
http://www.who.int/csr/don/2014_05_30_ebola/en/


Ebola virus disease, West Africa -- update
------------------------------------------
Guinea
------
Cases and deaths attributable to Ebola virus disease (EVD) outbreak continue to be reported from newly infected districts (Telimele and Boffa) and some affected districts that had not reported cases for more than 42 days (Conakry and Macenta). Since the last update of Disease Outbreak News of 28 May 2014, 10 new cases and 7 new deaths have been reported. The current evolving epidemiological situation could be partly explained by persistent community resistance in some communities in Gueckedou, Macenta and Conakry [to isolation of apparently healthy contacts].

As of 18:00 on 28 May 2014, a cumulative total of 291 clinical cases of EVD, including 193 deaths, have been reported. The classification of these cases and deaths are as follows:
- confirmed, 172 cases and 108 deaths;
- probable, 71 cases and 62 deaths; and
- suspected, 48 cases and 23 deaths.

The breakdown of cases and deaths by affected area is as follows: Conakry, 53 cases and 27 deaths; Gueckedou, 179 cases and 133 deaths; Macenta, 40 cases and 23 deaths; Kissidougou, 7 cases and 5 deaths; Dabola, 4 cases and 4 deaths, Djinguiraye, 1 case and 1 death; and Boffa, 4 cases and no deaths. [The case totals add up to 288, not 291. - Mod.JW]

The total number of cases in isolation is 13 (9 in Gueckedou, 3 in Telimele, and 1 in Conakry).

The number of contacts under follow-up is 493 (275 in Gueckedou, 125 in Macenta, and 93 in Telimele).

Sierra Leone
------------
As of 18:00 on 29 May 2014, 34 new cases (7 confirmed, 3 probable, and 24 suspected) and one suspected death were reported from 5 districts. This brings the cumulative total number of clinical cases of EVD to 50 (14 confirmed, 3 probable, and 36 suspected) [correct total here appears to be 53 cases - Mod.JW], including 6 deaths (2 confirmed, 3 probable, and 1 suspected). The geographical distribution of these cases and deaths are as follows: Kailahun (37 cases and 6 deaths), Kenema (1 case and 0 death), Koinadugu (1 case and 0 death), Bo (1 case and 0 death), Moyamba and (1 case and 0 death) [correct total here appears to be 41 cases - Mod.JW].

Liberia
-------
As of 29 May 2014, one new suspected case who died in Foya district was reported. The body was transported to and buried in Sierra Leone. The case is being investigated by both Liberia and Sierra Leone.

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

Community resistance [to hospitalizing apparently healthy contacts to quarantine them - Mod.JW], inadequate treatment facilities and insufficient human resources in certain affected areas are among challenges currently faced by the 3 countries in responding to the EVD outbreak.

WHO response
------------
WHO and its partners have deployed experts to both Sierra Leone and Guinea to support and build capacity of national personnel to mount an effective EVD outbreak response including coordination, disease outbreak investigation, risk assessment, establishment of treatment facilities, case management, infection prevention and control in the newly affected districts, and social mobilization targeting the resistant communities.

In Sierra Leone, WHO and its partners have established a treatment centre in Koindu and are also coordinating the laboratory testing of samples from Kailahun district, Sierra Leone to be tested in Gueckedou, Guinea.

WHO does not recommend that any travel or trade restrictions be applied to Guinea, Liberia, or Sierra Leone 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 Rapporteur Marianne Hopp

******
[2] Sierra Leone: Freetown infected
Date: Fri 30 May 2014
Source: ReliefWeb, AFP report [edited]
http://reliefweb.int/report/sierra-leon ... bola-cases


Sierra Leone confirms 7 Ebola cases, 2 in Freetown
--------------------------------------------------
Sierra Leone on Friday [30 May 2014] said that it had confirmed 7 cases of Ebola and suspects dozens more amid fears the deadly epidemic gripping West Africa is spreading.

"As of 28 May 2014, there were 2 deaths, 7 confirmed cases, 3 probable cases and 26 suspected cases" of Ebola, said government spokesman Abdulai Bayratay. Of the 26 suspected cases, 23 were registered in the eastern region of Kailahun, where Sierra Leone's 1st fatality from Ebola was confirmed on Monday [26 May 2014]. Another case was in the diamond region of Kono, also in the east, and 2 in the capital Freetown, said Bayratay.

Travel restrictions
-------------------
Sierra Leone has restricted travel in some areas, and reaffirmed an earlier ban on trips to funerals in neighbouring Guinea in a bid to stop the spread of the disease. "I call on the population to avoid human contact in order to minimise the risk of transmission," Health Minister Miatta Kargbo told AFP.

Additional logistical support was being sent to the eastern regions of Kailahun and Kenema, where a 2nd patient died on Tuesday [27 May 2014], said Bayratay. Freetown has received aid from the World Health Organization -- which has sent 12 workers, USD 150 000 and more than 5000 medical kits to ensure the safety of their officers [sic.; I doubt that 12 WHO staff need 480 kits each -- these kits must be intended for distribution throughout the country. - Mod.JW] -- as well as aid from Britain and Ireland.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

******
[3] Sierra Leone
Date: Thu 29 May 2014
Source: The Independent [edited]
http://www.independent.co.uk/news/world ... 56917.html


West Africa's deadly Ebola outbreak, which has already killed nearly 200 people in Guinea, has crossed the border and claimed its 1st lives in Sierra Leone, placing health authorities across the region on high alert.

The World Health Organization and Medecins sans Frontieres have dispatched teams to the east of the country, while health authorities in the capital [Freetown] are meeting daily to monitor the disease, amid fears that it could spread quickly among remote rural communities with little access to healthcare.

The current outbreak began in neighbouring Guinea in March [2014]. The 1st confirmed cases were detected in Sierra Leone earlier this week [week of 26 May 2014], and the country has now recorded 16 cases and 5 deaths. [This is out of date -- see [2] above. - Mod.JW]

An Ebola task force has been formed at Sierra Leone's Ministry of Health and Sanitation in the capital Freetown, incorporating government and international volunteer healthcare workers.

Shirley Simbo, head of the Voluntary Service Overseas [VSO] Sierra Leone health programme, told The Independent that the outbreak was already being treated as an emergency. "It is causing major concern," she said. "We are currently working together with the Ministry of Health and Sanitation. Every day we have a task force meeting."

The VSO's team of 14 volunteer [doctors?] and nurses was helping government health workers to alert remote communities to the threat and advise on measures to prevent the virus's spread, she said. "The ministry has dispatched its teams to every district. Right now the prevalence is on the eastern side of Sierra Leone. There are still misconceptions in communities, especially rural communities. Some people are still doubtful that it is Ebola that is manifesting in Sierra Leone. Some still think it is cholera."

At an emergency meeting on Wednesday [28 May 2014], the task force heard that Koindu, a town in the eastern Kailahun district, had become the "epicentre" for the outbreak.

In Kenema, Sierra Leone's 3rd largest city, it was confirmed that one of 3 Ebola patients had died after being admitted to hospital. One woman, the daughter of one of the patients admitted to hospital in Kenema, said she had been told by relatives in Koindu that her mother had died. Her mother was among 8 patients said to have been "forcibly removed" from a health centre in the town. Health authorities are particularly concerned that mistrust of healthcare workers in some communities could prevent effective monitoring and prevention of the disease. A team of health workers, who had entered Koindu, have already been "ambushed" and its ambulance "attacked", minutes from Wednesday's [28 May 2014] meeting revealed.

Earlier this week, 6 suspected Ebola patients were taken out of hospitals in Koindu by their families against doctors' orders. One of the patients has since died and the breach is considered a major infection risk. Dr Amara Jambai, director of disease prevention and control at Sierra Leone's health ministry, told the BBC that staff at the clinic had tried to stop them but the families, who were said to have been afraid their loved ones would die alone, became "aggressive".

The government has prioritised 13 key messages, which it is attempting to disseminate to every Sierra Leonean. People have been told to attend the nearest health clinic immediately if they have symptoms of fever, diarrhoea or vomiting. There have also been warnings over hand-washing, and eating bush meat, especially from monkeys, chimpanzees or bats, or eating fruit that might have been eaten by animals. Fruit bats are believed to be the natural host of the virus.

Ebola treatment has been made available free of charge at all health facilities.

Tarik Jasarevic, spokesperson for the World Health Organisation on Ebola, said the outbreak required a "huge social mobilisation activity" to alert the population to the dangers. "We really have to work with the population," he said. "We need to talk to people to use every means, go to religious leaders, to village chiefs to explain what EVD is. If you come to a village without preparing you can encounter some resistance."

EVD has also been detected in Liberia during the outbreak, but no new cases have been recorded since April [2014]. There is no cure or vaccine for Ebola, but people have a much better chance of survival if the virus is detected early.

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

[The earlier WHO figures for Guinea are also confusing:

"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)."

These figures add up to total 273 cases and 182 deaths (not 281 and 186 as above).

So it is difficult to confirm how many new cases and deaths have occurred in Guinea between 18:00 on 27 May 2014 and 18:00 on 29 May 2014 above.

But in any case, 10 new cases and 7 new deaths in 2 days in Guinea is of great concern, as are 34 new cases including one more suspected death in 2 days in Sierra Leone (38 cases and 2 deaths according to government spokesman Abdulai Bayratay -- see [2] above), and the new suspect case in Liberia, after it was declared EVD free on 22 May.

The Sierra Leone Ministry of Health and Sanitation has issued an Ebola Virus Disease - Situation Report (SitRep) dated 29 May 2014 giving the following information: "A total of 36 suspected cases have been reported with 14 confirmed cases all from Kailahun districts. 7 new EVD laboratory confirmed cases from Kailahun districts. All suspected cases from Bo, Koinadugu and Western area urban are negative." There is no mention of any cases in Freetown.

In-country travel restrictions will not work without police (or military) roadblocks, and it will probably be unacceptable to stop travel to funerals of relatives across the border.

WHO continues to recommend that no travel or trade restrictions be applied to Guinea, Liberia, or Sierra Leone, but may have to reconsider in the light of the reinfection of the capital city of Guinea (Conakry) and the new infection of the capital city of Sierra Leone (Freetown),
- Mod.JW

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

EBOLA VIRUS DISEASE - WEST AFRICA (53): SIERRA LEONE (FREETOWN) NOT
*******************************************************************
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: Freetown, NOT
[2] Viral Hemorrhagic Fever Consortium report

******
[1] Sierra Leone: Freetown, NOT
Date: 31 May 2014
Source: a reliable source well-known to ProMED [edited]


[In Ebola update [52] posted yesterday, 30 May 2014, ReliefWeb quoted government spokesman Abdulai Bayratay "Of the 26 suspected cases, 23 were registered in the eastern region of Kailahun, where Sierra Leone's 1st fatality from Ebola was confirmed on Monday [26 May 2014]. Another case was in the diamond region of Kono, also in the east, and 2 in the capital Freetown, said Bayratay." - ProMED]

The 2 patients from Freetown were from Connaught Hospital and the Emergency Hospital. Samples were received at MOHS/MB Kenema lab earlier this week from the 2 suspected cases. Real time RT-PCR tests were performed on Thursday [29 May 2014], and the results were negative, so there were no Ebola cases in Freetown.

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

******
[2] Viral Hemorrhagic Fever Consortium report
Date: 31 May 2014
From: Pardis Sabeti <pardis@broadinstitute.org> [edited]


I am sending the below update on behalf of Dr. Robert Garry, who is currently in Sierra Leone, and the Viral Hemorrhagic Fever Consortirum. Thank you for your attention and efforts.

The Viral Hemorrhagic Fever Consortium (VHFC) is very concerned about the recent deaths from ebolavirus disease (EVD) in Sierra Leone but is pleased to report on the exemplary response by the Sierra Leone Ministry of Health and Sanitation (MOHS) and its partners.

The new EVD cases occurred in the Koindu, Kailahun District, bordering the current EVD epicenter of Gueckedou, Guinea; 14 samples from that area have since been confirmed to be positive for Zaire ebolavirus at the Lassa Laboratory at Kenema Government Hospital (KGH). All 14 PCR positive cases are females who attended the burial of a traditional medicine practitioner (herbalist), who treated individuals with EVD from neighboring Guinea. Three positive patients have been referred to KGH, with 2 deaths.

The efforts are being led by Physician In-Charge Dr. S. Humarr Khan and the Director of the Lassa Laboratory Mr. Augustine Goba under a mandate and with support from the Sierra Leone MOHS [Ministry of Health & Sanitation] in collaboration with Tulane University, Metabiota, Harvard University, and the Broad Institute. Other partners and international response teams, including those from MSF and WHO, are currently engaging in the response to this outbreak.

In response to these confirmed cases of Ebola in Sierra Leone, the VHFC mobilized a response team for rapid arrival at Kenema Government Hospital (KGH). The team is comprised of Dr. Robert Garry, PhD, Professor of Microbiology and Immunology at the Tulane University School of Medicine, and Principal Investigator of the Consortium, as well as Dr. Lina Moses, PhD, Field Sites Manager. Their goals are to support clinical diagnoses at KGH, provide support for case investigations, as well as to re-supply needed protective equipment for the continued biosafety of all personnel.

Task forces were mobilized and met in less than 12 hours after the 1st diagnosis [on 26 May 2014]. On Thu 29 May 2014, Minister of Health Hon. Miatta Kargbo led a meeting with Paramount Chiefs in Kenema, including Chiefs from Eastern districts in Sierra Leone. The major message was that Sierra Leone is well-prepared for this outbreak and is responding quickly and decisively to a real and serious public health threat. Dr. S. Humarr Khan (Director KGH VHF Program), Dr. Brima Kargbo (Chief Medical Officer), Dr. Mohamed Vandi (KGH District Medical Officer), Bernadette Lahai (Member of Parliament), Dr. Garry (Tulane), and others participated in this informational meeting. (An irresponsible and unfortunate media report about Minister Kargbo's response to the EVD outbreak in Sierra Leone should be ignored and discredited.)

It should be noted that all samples from suspected EVD patients have been referred to the Lassa Laboratory at KGH for diagnosis through Sierra Leone's district health network managed effectively by the MOHS. KGH is a crucial clinical and diagnostic center for VHFs and is one of only 2 permanent sites in West Africa focusing on the diagnosis and treatment of VHFs [the other is Irrua Specialist Teaching Hospital in Nigeria].

Following the Guinean Ebola outbreak of March 2014, the VHFC established a field team comprising Dr. Kristian Andersen (Harvard/Broad), Dr. Lina Moses (Tulane) and Stephen Gire (Harvard/Broad) to provide technical and field support for combating the possible threat of EDV spreading to Sierra Leone. At that time, 2 separate Ebola virus assays were optimized for rapid field deployment. Simultaneously and in close collaboration, a team from Metabiota led by Dr. Nadia Wauquier initiated qPCR assays employing primers developed by the USAMRIID Critical Reagents Program; 6 days ago, these diagnostic tools helped Sierra Leonean researchers and their partners (VHFC and Metabiota) at KGH detect Zaire ebolavirus in a patient for the 1st time in Sierra Leone. Samples have been sent to the Broad Institute (Stephen Gire, Kristian Andersen, Pardis Sabeti) and USAMRIID (Randall Schoepp) for sequencing.

Speculation that the KGH-MOHS outreach team (supported by VHFC (Lansana Kannah and Michael Gbakie) and Metabiota (James Bangura) may have incited the violence at Koindu by attempting to collect samples from contacts without properly engaging community elders has absolutely no basis in fact. The KGH Outreach team is highly experienced in engaging Sierra Leonean communities affected by Lassa fever. Community leaders from Koindu were extensively engaged and cooperative. It was a small faction, principally aggrieved family members of victims, who attacked the outreach team. Sierra Leonean military escorted the outreach team from the site. There were no injuries. As of today [31 May 2014], Koindu has effectively sealed its perimeter on its own initiative. However, the outreach team along with high-level MOHS officials are continuing to engage the community.

Yesterday [31 May 2014] (5 days after the 1st confirmed case), an MOHS team engaged approximately 120 community health workers (CHW) from Kailahun district in a day-long training on EVD. All participants in this "training of trainers" session received instruction on proper use of PPE, VHF case identification, and sample shipping to KGH via the well-established District Medical Officer (DMO) networks. Ms. Simbirie Jalloh (VHFC program manager), Mr. Kannah, Mr. Gbakie, Mr. Bangura, Drs. Khan and Garry, and the KGH Nursing Deputy Matron participated in the training. The outreach was lead by Dr. S. Humarr Khan for the MOHS.

--
Pardis Sabeti
Broad Institute
Cambridge MA, USA
http://www.broadinstitute.org
<pardis@broadinstitute.org>

[Freetown seems to have dodged the bullet once again -- but how long will its luck last?

ProMED would appreciate further information on the 2 suspected cases in Freetown. Were they suspected because they were contacts of cases upcountry who were traced to the capital and hospitalized symptom-free, or patients presenting at those hospitals with suggestive symptoms and travel history? Besides testing negative for ebolavirus, we presume they were also negative for Lassa virus, West Nile virus, and yellow fever. Has there been a final diagnosis? This would be of interest to clinicians looking for a differential diagnosis in suspect cases.

ProMED thanks the Broad Institute for their report. It is good to see such acknowledgement of collaborative efforts in helping the MOHS combat this emergency. - Mod.JW

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

EBOLA VIRUS DISEASE - WEST AFRICA (54): WHO UPDATE, 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 posting:
[1] WHO update 30 May 2014 [revised]
[2] Sierra Leone: Viral Hemorrhagic Fever Consortium report
[3] Contact quarantine

******
[1] WHO update 30 May 2014 [revised]
Date: Mon 2 Jun 2014
Source: WHO Global Alert and Response (GAR), Disease Outbreak News [edited]
http://www.who.int/csr/don/2014_05_30_ebola/en


Ebola virus disease, West Africa -- update
------------------------------------------

Sierra Leone
------------
As of 18:00 on 29 May 2014, 34 new cases (7 confirmed, 3 probable, and 24 suspected) and one suspected death were reported from 5 districts. This brings the cumulative total number of clinical cases of EVD to 50 (14 confirmed, 3 probable, and 33* suspected) including 6 deaths (2 confirmed, 3 probable, and 1 suspected). The geographical distribution of these cases and deaths are as follows: Kailahun (37 cases and 6 deaths), Kenema (1 case and 0 death), Koinadugu (1 case and 0 death), Bo (1 case and 0 death), Moyamba and (1 case and 0 death) [correct total here appears to be 41 cases - Mod.JW]

* On 2 Jun 2014 it was noted that this number was incorrect and it was changed from 36 to 33.

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

[Maps of Sierra Leone can be seen at http://healthmap.org/promed/p/46 and http://salonemicrofinancetrust.org/comm ... 056017.jpg (districts). - Sr.Tech.Ed.MJ]

*******
[2] Sierra Leone: Viral Hemorrhagic Fever Consortium report
Date: Mon 2 Jun 2014
From: Pardis Sabeti <pardis@broadinstitute.org> [edited]


Please accept this report on behalf of Physician In-Charge of the VHF [Viral Hemorrhagic Fever] Program at Kenema Government Hospital, Dr S Humarr Khan, Director of the VHF Laboratory, Mr Augustine Goba, and Professor of Microbiology and Immunology at the Tulane University School of Medicine, Dr Robert Garry for the Sierra Leone Ministry of Health and Sanitation (MOHS), in collaboration with the Viral Hemorrhagic Fever Consortium (VHFC) and Metabiota.

Previously, 14 samples from Koindu in Kailahun District bordering the current Ebola virus disease (EVD) epicenter of Gueckedou, Guinea were confirmed to be positive for ebolavirus at the Lassa Laboratory at Kenema Government Hospital (KGH). All of these 1st 14 PCR positive cases are females who attended the burial of a traditional medicine practitioner (herbalist). The traditional medicine practitioner treated individuals with EVD from neighboring Guinea. Here, we provide an update on an additional 4 PCR positive EVD cases in Sierra Leone, and report on an EVD transmission chain and the ongoing activities of the KGH viral hemorrhagic fever (VHF) Outreach team. The new cases bring the total to 18 PCR positive cases that have been recorded in Sierra Leone (numbers are subject to change); 7 patients, 3 from Koindu and 4 from Daru, have been transported to KGH with 2 deaths.

The 4 new positive patients represent the 1st cases in Sierra Leone of transmission from contacts of the index case, the Koindu traditional medicine practitioner. A sample from healthcare worker B (HCW-B; case 15) sent to KGH through Sierra Leone's district health network tested positive for ebolavirus on Saturday [31 May 2014]. On Sunday [1 Jun 2014] healthcare worker B (HCW-B; case 15) was admitted to the KGH VHF Ward. HCW-A attended one of the 14 confirmed cases from Koindu with exposure to ebolavirus at the funeral of the index case. HCW-A was on her way to self-admit to KGH via Kailahun and Daru when she became too sick to continue. HCW-A died with suspected EVD and major signs of acute kidney failure in Daru without a blood sample being taken. HCW-B attended HCW-A in Daru.

The KGH-MOHS outreach team supported by VHFC (Lansana Kanneh and Michael Gbakie) and Metabiota (James Bangura) collected 7 samples from additional contacts who attended HCW-A and HCW-B in Daru. These samples were transported to KGH by motorbike on Sunday [1 Jun 2014] afternoon. 3/8 are positive for ebolavirus by qPCR employing primers developed and verified by the USAMRIID Critical Reagents Program and performed by Dr Nadia Wauquier (Metabiota) on Sunday [1 Jun 2014] evening. Results were repeated this morning [2 Jun 2014] by RT-PCR by Mr Augustine Goba, Mr Mambu Mamoh and Mohammed Fullah (KGH-MOHS, with support from VHFC) using primers developed and verified in the field by VHFC (Dr Kristian Andersen and Stephen Gire, Harvard/Broad Institute and Dr Lina Moses, Tulane).

Ambulances were sent to Daru for pick-up and transport of the 3 positive cases (cases 16-18) this morning [2 Jun 2014] to the KGH VHF isolation ward. These cases include the 1st male EVD case in Sierra Leone, a community health officer (CHO). The KGH-MOHS VHF isolation ward receives support from VHFC (with funding from the United States National Institutes of Health), Metabiota, other funders and partners. In response to the EVD outbreak in Sierra Leone, Medecins Sans Frontieres (MSF) provided an isolation tent and other supplies to the KGH VHF isolation ward.

The Sierra Leone MOHS under the leadership of Minister of Health, Hon. Miatta Kargbo, along with Dr Brima Kargbo (Chief Medical Officer), Dr Mohamed Vandi (Kenema District Medical Officer), Dr Amara Jambai (Director, Infection Control), Dr Donald Bash-Taqi (Director, Hospitals and Laboratories) are responding quickly and decisively to the public health threat of EVD in Sierra Leone. To date all samples for EVD diagnosis in Sierra Leone have been referred to the VHF Laboratory at KGH through Sierra Leone's district health network managed effectively by the MOHS.

On 30 May 2014 the MOHS team conducted a "training of trainers (ToT)" for approximately 120 HCW from Kailahun district in a day long training on EVD, and the results of this ToT are already evident in the current response. MOHS, VHFC, and Metabiota gratefully acknowledge and commend other partners and international teams, including those from MSF and WHO, currently engaged in the response to this outbreak.

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

*******
[3] Contact quarantine
Date: Mon 2 Jun 2014
From: Daniel Bausch <dbausch@tulane.edu> [edited]

Re- contacts, from WHO:
http://www.afro.who.int/en/clusters-a-p ... fever.html

Note at the end:
"Contacts
---------
As the primary mode of person-to-person transmission is contact with contaminated blood, secretions or body fluids, people who have had close physical contact with patients should be kept under strict surveillance. Their body temperature should be checked twice a day, with immediate hospitalization and strict isolation in case of the onset of fever."

Also, not to sound arrogant, but as someone who has spent a lot of time responding to filovirus outbreaks with both CDC and WHO (including in Guinea recently), I can assure you that isolation of asymptomatic persons is not the protocol. It's frankly difficult enough to isolate even the symptomatic persons.

--
Daniel Bausch
<dbausch@tulane.edu>

[Adherence to WHO procedures would have avoided the unfortunate scenes at Koindu hospital in Sierra Leone -- see ProMED post 20140530.2510209.

To complement the acknowledgements from the VHFC above, ProMED understands that a special secure ambulance was paid for by the US Department of Defense (DoD) and delivered by Metabiota. AFRICOM [United States Africa Command] and many other people were also involved.

Cote d'Ivoire, which shares a border with Guinea, has had a preparedness plan in place since mid-April 2014, but has seen no cases so far. See http://reliefweb.int/map/c-te-divoire/c ... 9-apr-2014.

There is an excellent map showing the EVD-affected areas in all 3 countries at http://reliefweb.int/sites/reliefweb.in ... 202014.pdf. - Mod.JW]

EBOLA VIRUS DISEASE - WEST AFRICA (55): MEDECINS SANS FRONTIERES REPORT, 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] MSF report
[2] Sierra Leone

******
[1] MSF report
Date: 3 Jun 2014
Source: Relief Web [edited]
http://reliefweb.int/report/guinea/resu ... est-africa


While the number of patients appeared to be in decline, new cases of Ebola have been reported in Guinea and Sierra Leone. The virus has already affected more than 300 people in West Africa. Medecins Sans Frontieres/Doctors without Borders (MSF) is continuing its work supporting health authorities in the 2 countries, treating patients and putting measures in place to contain the epidemic.

According to information from the Ministry of Health, there has been one confirmed case and 4 deaths in Koindu, in Kailahun district of Sierra Leone near the Guinean border, since the end of May 2014. On 29 May [2014], the authorities reported 18 suspected cases, of whom 6 died.

In the coming days, MSF will set up a treatment centre in Koindu, the epicentre of the epidemic in Sierra Leone, in collaboration with the Ministry of Health. A team of specialists will join the team already present on the ground. MSF will also send medical and logistical supplies such as protective clothing kits and medicines with a view to protecting health staff and to setting up facilities where patients can be treated.

According to Marie-Christine Ferir, MSF emergency coordinator: "Ebola is a disease that scares people and is perceived as mysterious, but people can overcome it." Since the beginning of the epidemic, about 30 patients treated by MSF in Guinea have survived the disease. "Earning people's trust is essential in efforts to fight the epidemic," says Marie-Christine Ferir.

Despite efforts on the ground, the number of confirmed cases has increased in the last few weeks. As of 30 May 2014, it stands at 178 confirmed cases, while a total of 113 people have died according to the Guinean Ministry of Health. The epidemic has spread to Boffa on Guinea's coast and to Telimele in the Kindia region. New patients have also been registered in Conakry, Gueckedou, and Macenta.

The rise in cases may be due to a reluctance on the part of patients to go to hospital. The movement of infected people and cadavers is also a major issue. Families frequently transport dead bodies themselves in order to organize funerals in other towns. The multiplication of affected areas makes it difficult to treat patients and control the epidemic. "The main challenges we face on the ground are resistance within communities and follow-up with people who have crossed borders and may be infected," says Marie-Christine Ferir.

MSF employs around 300 expatriate and national staff in the region. More than 40 tonnes of equipment and supplies have been sent to fight the epidemic.

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

******
[2] Sierra Leone
Date: 3 Jun 2014
From: Yayah Conteh <contehy@gmail.com> [edited]


Please be advised that The Ministry of Health and Sanitation has set up a Facebook page to keep Sierra Leoneans informed about the Ebola virus.

We encourage you to go to Facebook (https://www.facebook.com/pages/Ministry ... 4805403702, Ministry of Health and Sanitation, Sierra Leone) and click on the raised thumb to "like" the page and to also promote the page on your Facebook wall.

If you have Ebola related information you believe will be helpful to our audience, please send it as a message, and we will review it and then add it to the page.

Thank you for your anticipated cooperation.

--
Tunis Yahya
MoHS
Director of Information, Communication and Technology
<contehy@gmail.com>

[The MSF report of "one confirmed case and 4 deaths in Koindu, in Kailahun district of Sierra Leone near the Guinean border since the end of May 2014" is of serious concern, as is the cross-border movement of infected people and cadavers. MSF says families frequently transport dead bodies themselves in order to organize funerals in other towns or even neighbouring countries, since border residents often have relatives on the other side.

It is quite remarkable that the internet and its social networks are so widespread in Sierra Leone that it is practical for the Ministry to use it for public education. The site says over 500 people are talking about it already, mostly in the 25-34 year age group. Congratulations to the dynamic Minister of Health & Sanitation, Hon. Miatta Kargbo for this initiative! - Mod.JW

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

A number of "non-essential" staff at a British firm in Sierra Leone have left the country following an outbreak of the deadly Ebola virus. London Mining has restricted some travel to the area but said production at its Marampa mine was unaffected. It said it was working with local and international agencies to monitor the situation [...] Iron ore company London Mining said essential staff continued to travel in and out of the country and it was carefully monitoring the health of all of its employees. But non-essential travel of its staff to the region has been restricted. The eight staff who had already left the country departed on regular flights, the firm added.

UK employees leave Sierra Leone over Ebola threat
03.06.2014 - BBC

Gruß
Birgitt

EBOLA VIRUS DISEASE - WEST AFRICA (56): SIERRA LEONE, LIBERIA
*************************************************************
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 posting:
[1] Sierra Leone, official
[2] Sierra Leone
[3] Liberia

******
[1] WHO update 4 Jun 2014
Date: 4 Jun 2014
Source: WHO/DON [edited]
http://who.int/csr/don/2014_06_04_ebola/en


Ebola virus disease, West Africa - update
---------------------
Disease Outbreak News
4 June 2014

Guinea
------
Between 29 May and 1 June 2014, 37 new cases and 21 new deaths were reported from the following 5 districts:
- Conakry, 3 new cases and 0 deaths;
- Gueckedou, 11 new cases and 13 deaths;
- Macenta, 4 new cases and 1 death;
- Telimele, 19 new cases and 5 deaths; and
- Boffa, 0 new cases and 2 deaths.

The cumulative number of cases and deaths attributable to EVD in Guinea is now 328 (laboratory confirmed 193, probable 80, and suspected 55) including 208 deaths.

The geographical distribution of these cases and deaths is as follows: Conakry, 56 cases and 27 deaths; Gueckedou, 190 cases and 140 deaths; Macenta, 44 cases and 24 deaths; Dabola, 4 cases and 4 deaths; Kissidougou, 7 cases and 5 deaths; Dinguiraye, 1 case and 1 death; Telimele, 22 cases and 5 deaths; and Boffa, 4 cases and 2 deaths.

The number of contacts currently being followed countrywide is 604, distributed as follows: Gueckedou, 341 contacts; Macenta, 175 contacts; and Telimele (88 contacts). In terms of isolation, 16 patients are currently being hospitalized in Conakry (1), Gueckedou (12), Telimele (2), and Boffa (1).

Sierra Leone (Freetown)
------------
Between 29 May and 1 June 2014, 13 new cases (3 confirmed and 10 suspected) and no new deaths were reported from Kailahun (12 new cases and 0 death) and Kenema (1 new case and 0 deaths). This brings the cumulative total number of cases to 79 (18 confirmed, 3 probable, and 58 suspected), including 6 deaths [but see update from the Ministry below].
The geographical distribution of these cases and deaths are as follows:

- Kailahun, 41 cases and 6 deaths;
- Kenema, 3 cases and 0 deaths;
- Koinadugu, 2 cases and 0 deaths;
- Bombali, 1 case and 0 deaths;
- Bo, 13 cases and 0 deaths;
- Moyamba, 1 case and 0 deaths; and
- Free Town, 5 cases and 0 deaths.

A total of 4 cases are in isolation at Kenema Hospital.

Liberia
-----
One suspected case from nearby Kailahun, Sierra Leone died in Foya, Liberia. The dead body was taken back to Kailahun for burial; 11 contacts were identified and are being followed up.

The total number of cases is subject to change due to reclassification, retrospective investigation, consolidation of cases and laboratory data and enhanced surveillance.

WHO response
---------------
WHO and partners continue to support the implementation of preventive and control measures in affected countries. In Guinea, an additional 5 experts have been deployed/redeployed in Gueckedou and Macenta to address community resistance and data and case management. In neighbouring counties, WHO continues to provide guidance on preparedness activities in accordance with the EVD preparedness plans developed by each country.

In Sierra Leone, health-care workers from affected districts are being trained to conduct outreach and active search for EVD clinical cases and contacts. Sites have been identified to set up Isolation centres in Kailahun and Koindou and are awaiting MOH approval.

WHO does not recommend any travel or trade restrictions be applied to Guinea, Liberia, or Sierra Leone 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>

*******
[2] Sierra Leone, official
Date: Wed 4 Jun 2014
Source: Sierra Leone Ministry of Health and Sanitation Facebook page [edited]
https://www.facebook.com/pages/Ministry ... 4805403702


Main highlights:
- total number of suspected cases tested is 71 with 24 confirmed [total 95], all from Kailahun District;
- a total of 12 suspected cases were reported from Kailahun 9, Western Area 2, and Kenema 1, on 3 Jun 2014, with 6 laboratory confirmed for ebolavirus;
- The 6 laboratory confirmed Ebola Virus Disease cases are from Jawei Chiefdom, Daru in Kailahun District.
- 6 deaths have been reported with case fatality rate (CFR) based on confirmed cases of 12.5 percent: 24 cases, 3 confirmed deaths;
- laboratory results from the 9 contacts in Daru, Kailahun District, have confirmed 6 positive for ebolavirus, as stated above.

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

[Maps of Sierra Leone can be seen at http://upload.wikimedia.org/wikipedia/c ... tricts.png and http://healthmap.org/promed/p/46. - Sr.Tech.Ed.MJ]

******
[3] Sierra Leone
Date: Tue 3 Jun 2014
Source: Cocorioko Newspaper [edited]
http://www.cocorioko.net/?p=55938


Robin Faley, former Member of Parliament (MP) for Constituency 007, Kailahun District, this past week embarked on an Ebola virus disease (EVD) sensitization drive in the Eastern Region covering various communities.

During the campaign on radio, he educated residents, particularly those in Kailahun and Kenema Districts, on the recent outbreak of EVD in that part of the country. He used his knowledge and experience on the promotion of health to educate them on key issues related to the deadly disease including the signs, symptoms, how it spreads, prevention and what should be done in suspected cases of the disease.

He further admonished residents to be extremely vigilant in reporting suspected cases of EVD to the nearest health facility, assured that the disease would be contained if all adhere to the preventive measures, and he highlighted the role of Government in putting modalities in place since the outbreak of the disease in neighboring Guinea, as well as strengthening various health service providers to contain its spread.

He further appealed to patriotic Sierra Leoneans, particularly opinion and community leaders, to fully participate in ensuring that even the most remote community is aware of the disease, underscoring that EVD has now become a national concern that should not be politicized.

Robin Faley also encouraged residents not to panic as Government is fully committed to handle the disease, and urged media practitioners to be more professional in reporting on EVD to prevent unnecessary fear and panic, guaranteed that people are safe to travel to Kailahun and Kenema Districts and lauded Government and the Ministry of Health and Sanitation for their exceptional and proactive role to respond to the outbreak.

He went on to appeal to Members of Parliament from the regions to visit and sensitize their constituents about the disease and acclaimed Government for providing the required funds to MPs in the affected areas to ensure effective sensitization.

[Byline: Abdul R Bedor]

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

******
[4] Liberia, reminder
Date: Wed 4 Jun 2014
Source: AllAfrica, The New Dawn [edited]
http://allafrica.com/stories/201406041130.html


For weeks now across Liberia either nothing or very little has been heard about the deadly ebolavirus. Apparently, the awareness and sensitization characterizing the battle against the threat of the ebolavirus in Liberia have all disappeared from the airwaves, communities, schools, as well as offices among others, as if we, as nation, have beaten EVD. Despite reports of the threat of the virus in Sierra Leone, which kills between 25 percent and 90 percent of its victims, Liberian health Ministry authorities may still be complacent about the threat to Liberia.

Liberia and neighboring Sierra Leone share a common border just as does neighboring Guinea, where the outbreak was first reported in West Africa in recent times. More than 100 deaths were reported as casualties of the outbreak. Early last week [week of 26 May 2014], the incurable and highly contagious disease was reported in neighboring Sierra Leone with about 50 suspected cases and 5 people have died. [Now 95 (24 lab confirmed) cases and 6 dead, see above. - Mod.JW]

(EVD), which first emerged in Central Africa's Zaire (now Democratic Republic of Congo or DRC) 20 years ago, spreads from one person to another by contact with infected blood, bodily fluids, or organs or through contact with contaminated environments. Given the porous nature of the Liberia-Sierra Leonean border, as well as the cross-border interactions -- either through trade and commerce or farming [and funerals - Mod.JW] between citizens of the 2 countries, the experience from neighboring Guinea is also very possible. We must all remember that Lofa, Gbarpolu, Grand Cape Mount, and maybe Bomi counties are also situated on [Liberia's] border with Sierra Leone.

If nothing at all is being done towards awareness and sensitization in these counties, now is the time for the Ministry of Health and Social Welfare to accelerate its movement so that the threat of the deadly disease can be put under control. And if the necessary precautionary measures are already being executed by the Ministry, we can only appreciate Minister Walter Gwanigale and his Health Ministry team for intervening in time.

If, and only if, this is the case, what is most needed is vigorous public/community awareness and sensitization through the radio, especially those in counties at the border with Sierra Leone -- just a little beyond that which was done with the Guinean Ebola experience. We must not forget so soon -- EVD is still powerful and effective; if it could reach us from Guinea, it is also very possible to reach us from Sierra Leone.

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

[Maps of Liberia can be seen at http://www.mapsofworld.com/liberia/maps ... al-map.jpg and http://healthmap.org/promed/p/46. - Sr.Tech.Ed.MJ

In Guinea, the epidemic is spreading disastrously to new areas. In Sierra Leone, although cases (including some retrospective to the week before the alarm was raised) have doubled in the last few days according to official figures, EVD is killing only 12.5 percent of confirmed cases (see above), not 25-90 percent as quoted in the Liberian media.

Nevertheless, the wake-up call in the Liberian press is an important warning to that country not to think it has dodged the bullet. It is surprising that Liberia has apparently not been reporting the recent upsurge of cases in neighboring Guinea and Sierra Leone.

It would be a good thing if the example of a local MP in Sierra Leone making a health education tour of his former constituency were followed by politicians in the other affected countries. In view of the reported resistance to public health measures being taken in response to EVD, every means should be taken to spread health education messages about EVD to their populations . - Mod.JW]

EBOLA VIRUS DISEASE - WEST AFRICA (57): WHO UPDATE, CHALLENGES
**************************************************************
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 posting:
[1] WHO update 5 Jun 2014
[2] Gaining community trust and confidence

******
[1] WHO update 5 Jun 2014
Date: Thu 5 Jun 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


Ebola virus disease, West Africa - update 5 Jun 2014
----------------------------------------------------
Guinea
------
Between 2 and 3 Jun 2014, 11 new cases (8 confirmed, 1 probable, and 2 suspected) and 3 new deaths were reported from Conakry (7 new cases and 1 death), Gueckedou (2 new cases and 1 death), Telimele (1 new case and 0 death), and Boffa (1 new case and 1 death).

This brings the cumulative total number of cases and deaths attributable to EVD [Ebola virus disease] in Guinea to 344 (laboratory confirmed 207, probable 81, and suspected 56) including 215 deaths.

The geographical distribution of these cases and deaths is as follows: Conakry (65 cases and 27 deaths; Gueckedou, 193 cases and 143 deaths; Macenta, 44 cases and 26 deaths; Dabola, 4 cases and 4 deaths; Kissidougou, 7 cases and 5 deaths; Dinguiraye, 1 case and 1 death; Telimele, 23 cases and 5 deaths; and Boffa, 7 cases and 4 deaths. In terms of isolation, 31 patients are currently hospitalized (6 in Conakry, 9 in Gueckedou, 15 in Telimele, and 1 in Boffa).

The number of contacts currently being followed-up countrywide is 987 distributed as follows: Conakry (329 contacts), Gueckedou (323 contacts), Macenta (176 contacts), Telimele (104 contacts) and Boffa (55 contacts).

Sierra Leone
------------
Between 2 and 5 Jun 2014, 9 new suspected cases were reported bringing the total number of EVD clinical cases to 81 (31 confirmed, 3 probable, and 47 suspected) including 6 deaths. Kailahun district is the epicentre of the outbreak in Sierra Leone. 11 cases are currently in isolation at Kenema Hospital. The number of contacts currently being followed-up is 30. Community resistance is hindering the identification and follow-up of contacts.

Liberia
-------
There have been no new confirmed cases since 6 Apr 2014. 11 contacts (5 health care workers and 6 community relatives) are currently being followed-up. These contacts are of the probable case from nearby Kailahun, Sierra Leone who died in Foya, Liberia. The dead body was taken back to Kailahun for burial.

The total number of cases is subject to change due to reclassification, retrospective investigation, consolidation of cases, and laboratory data and enhanced surveillance.

WHO response
------------
WHO and partners continue to support the implementation of preventive and control measures in affected countries. 6 experts and over 5000 PPEs (personal protective equipment) have been deployed to Sierra Leone to support the response operations. WHO also supported Sierra Leone in developing proposals which were submitted to CERF (UN Central Emergency Response Fund) for USD 238 000, OCHA (Office for the Coordination of Humanitarian Affairs) Emergency Fund (about USD 50 000), and DFID (UK Department for International Development) for GBP 200 000 [about USD 336 000]). A joint WHO/HQ and AFRO mission provided support to Guinea on reviewing the outbreak response operations. The total estimated budget for Sierra Leone EVD outbreak response is about USD 1.8 million.

On 3 Jun 2014, WHO facilitated a cross-border collaboration meeting between Guinea, Sierra Leone, and Liberia. They agreed to re-force cross-border surveillance and harmonise social mobilization communication tools to address community resistance.

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

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

**********
[2] Gaining community trust and confidence
Date: Fri 6 Jun 2014
Source: CIDRAP (Center for Infectious Disease Research & Policy) News [edited]
http://www.cidrap.umn.edu/news-perspect ... un-06-2014


The editorial today [7 Jun 2014] in The Lancet touched on community resistance as one of the factors that continue to fuel the [Ebola virus disease] outbreak. Incidents have included citizens in Guinea and Sierra Leone stoning health workers investigating the outbreak and people in Sierra Leone removing family members from health facilities.

The journal said the biggest challenge for the countries' health ministries and global health partners will be improving public awareness about a disease that is new to West Africa and building trust and confidence in the medical response.

[Reference
---------
Ebola in west Africa: gaining community trust and confidence. The Lancet 2014. 383(9933): 1946. doi:10.1016/S0140-6736(14)60938-7; available at http://www.thelancet.com/journals/lance ... a3=E24A35F.]

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

[The situation appears to be deteriorating, with close to 1000 contacts needing to be followed up in Guinea alone, an almost impossible task. Cross-border traffic and funeral rites are also extremely difficult to control.

The occasional geographically challenged news outlet has headlined the latest update as occurring in New Guinea (Papua New Guinea)! The Ebolavirus-Reston (EBOVR) virus may indeed be present there, since that island nation in the Far East is close to the Philippines, where that strain originated (in spite of its name) -- but EBOVR has never been known to cause clinical disease in humans. - Mod.JW]

EBOLA VIRUS DISEASE - WEST AFRICA (58): SIERRA LEONE, CHALLENGES
****************************************************************
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] Sierra Leone
Date: Fri 6 Jun 2014
Source: Global Post, Xinhua News Agency report [edited]
http://www.globalpost.com/dispatch/news ... erra-leone


Death toll of the Ebola virus disease in Sierra Leone has risen to 6 out of 33 confirmed cases, the Health Ministry said Friday [6 Jun 2014]. "The increase shows that the surveillance as well as the case search is active as for every confirmed case of Ebola," said Idrissu Tunis, Director of Information and Communication in the Ministry of Health, to the press. "We have to do contact tracing, checking all the people that had come in contact with a confirmed case victim to ascertain whether they are positive or negative," said Tunis.

During the case search and contact tracing, the number of suspected cases is expected to increase, he noted. "So far, all these confirmed cases are linked to the index case, i.e. the very 1st confirmed case we received from the Kissi Teng area [Kailahun District, Eastern Province]," he said. "What we are seeing now in the Kissi Teng region is that people still don't believe that the Ebola virus disease exists. We are still finding it difficult to convince them, and they are reluctant to accept health workers. The defiance is making our job difficult, but we met Wednesday [4 Jun 2014] with traditional leaders and the secret society," he added.

According to Tunis, most of the confirmed cases are women, as they demonstrate defiance and refuse to cooperate with the health staff.

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

******
[2] Economic effects
Date: Sat 7 Jun 2014
Source: The American Interest [edited]
http://www.the-american-interest.com/bl ... est-africa


Sierra Leone
------------
West African governments have been trying to bring a killer disease to heel, but sadly with little success. The Ebola virus disease [EVD] outbreak in the region saw an alarming surge at the end of last month [May 2014], with 37 new cases and 21 deaths reported in Guinea between [29 May 2014] and [1 Jun 2014], says the World Health Organization.

Sierra Leone also reported 13 new cases, of which 3 have been confirmed.

The ebolavirus is spread through direct contact with the bodily fluids of an infected person, and the virus can be transmitted even after that person dies. Health workers said families moving bodies for funerals have been a factor in the spread of the disease.

The scourge is troublingly persistent, and a threat not only to locals' health, but also, indirectly, to their livelihood. Bloomberg reports that UK companies with mines in Sierra Leone have seen their stock fall as they put travel restrictions in place for their [expatriate] workers. The mines have not shut down operations as of yet, but are screening [local] workers in order to detect signs of fever.

Guinea
------
Even as Guinea suffers, there has been some welcome news for its economy. The country is slated to be the site of a massive mining project that could double its GDP, and the plan is now proceeding after long delays; see: http://www.miningweekly.com/article/gui ... 2014-05-26.

However, it's not hard to imagine that a future disease outbreak, of EVD or some other epidemic, could cause serious setbacks for this endeavor. It's important to remember that disease control in developing countries smoothes the way for foreign investment, and for changes in economic fortune.

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

[Although the majority of victims of EVD have been women, due to their exposure to the virus as caregivers for the sick in the home and washers of the bodies of their dead relatives, they are reported to be the most defiant of health workers' attempts to hospitalize EVD patients, often far from their home village, and to restrict moving their dead across borders and their performance of traditional burial practices.

Therefore, I suppose that among the many secret societies in Sierra Leone, the one referred to is the women's Bondo Secret Society. For a detailed explanation about it by a local author in August 2013, see: http://www.sierraexpressmedia.com/archives/59854. It includes the following passage:

"The Minister of Social Welfare Gender and Children's Affairs, Moijue Kaikai, recently [2013] said that 'Our traditions must be respected and the government will not interfere in secret societal matters as long as they do not pose a threat to national security or infringe on the rights of anyone without due cause.'"

There is a recent CDC map of the affected areas in the 3 countries (Guinea, Sierra Leone, and Liberia) at: http://blogs.plos.org/thestudentblog/fi ... 060214.jpg. - Mod.JW]

EBOLA VIRUS DISEASE - WEST AFRICA (59): GUINEA, 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 posting:
[1] Guinea: revised figures
[2] Sierra Leone

******
[1] Guinea: revised figures
Date: Sat 7 Jun 2014
Source: Guinee News, La Une (in French, machine trans., edited)
http://guineenews.org/2014/06/fievre-eb ... ur-de-loms


Ebola: the National Management Committee regrets "mistake" by WHO
-----------------------------------------------------------------
The latest figures from the World Health Organization (WHO) on Ebola haemorrhagic fever have been contradicted in a press conference Sat 7 Jun [2014] by the national committee for management of the disease, which speaks of a "mistake" on the part of the UN institution.

According to the national committee, the disease has caused 126 deaths instead of 208 reported by WHO. The minister for development cooperation, Kutub Moustapha Sanoh, member of the committee, said that the figures reported by WHO in Geneva do not come from his representation in Conakry.

Koutoub Moustapha Sanoh and the minister of health, Colonel Remy Lamah, say WHO made a "mistake" in the numbers. They state that there have been 208 cases of Ebola in all. Among them there are 126 dead, [the rest] cured and sick. "The representative of WHO recontacted us to say that this figure was not correct," reported Koutoub Sanoh. "Instead of coming to us to try to understand what the numbers represent, WHO reported directly that there have been 208 deaths from Ebola in Guinea. Initially we saw Doctors Without Borders [MSF] speak of a unprecedented epidemic ... This is not normal. We must try to find out exactly what we are talking about," says Fode Tass Sylla, another member of the national committee.

This is the 2nd time that the national committee has disapproved of the WHO disease [count]. On 19 Apr 2014, the national health crisis committee has had to "groom" the numbers after WHO reported 122 deaths out of 197 confirmed cases. After this correction, the technical coordinator of the WHO Ebola outbreak, Dr J Bosco Ndohokvzwayo had said it is necessary to follow the communications strategy and government figures.

In announcing on Sat 7 Apr 2014, the latest figures on the disease, the health minister reiterated that the spread of the disease is due to the abandoning of the rules of hygiene. Once more he asked the media to continue their support in raising the awareness of the population.

[byline: Topkana Dore]

--
communicated by:
ProMED-mail rapporteur Mary Marshall

******
[2] Sierra Leone
Date: Fri 6 Jun 2014
Source: NBC News [edited]
http://www.nbcnews.com/health/health-ne ... rs-n124961


Ebola in Sierra Leone: outbreak threatens to overwhelm volunteers
-----------------------------------------------------------------
When a team from Tulane University sent a batch of protective clothing and equipment to help workers fighting an outbreak of Ebola virus [disease] in Sierra Leone last month [May 2014], they were fairly confident the 300 or so packs would be enough for a good start. They couldn't have predicted what they would be up against.

The World Health Organization says 22 new cases of Ebola virus [disease] were reported in Sierra Leone between 29 May and 5 Jun 2014. WHO counts 81 cases with 6 deaths but Sierra Leone's health ministry says it has a total of 95 confirmed and suspected cases.

"This is worse than expected. I am fearful that it could get much worse," said Robert Garry, a virologist and specialist in viral hemorrhagic fevers at Tulane University. Garry flew to Kenema Government Hospital last month [May 2014] with as much personal protective equipment (PPE) as he could carry, but he says they are running out fast. "We have to ration them," he said.

Kenema Hospital is treating 11 patients with Ebola, all being kept in isolation; 6 more have died. With each worker needing a complete change of gown, mask, gloves, goggles, and other protective gear with each visit, that means supplies go fast.

At least 35 lab-confirmed Ebola cases have been traced to a traditional healer whose grieving patients apparently handled her body at her funeral and became infected themselves, Garry says. The healer had treated patients just over the border in neighboring Guinea. This cross-border outbreak is worrying health officials because it's spreading in an area where people cross from one country into another casually, passing through large cities on their travels.

Ebola is one of the deadliest viruses known. It kills quickly, taking anywhere between 50 per cent and 90 per cent of victims, depending on the strain. [In the current outbreak in Sierra Leone, the CFR (case fatality rate) is running at 6/95 or just over 6 per cent. - Mod.JW] The good news is it doesn't spread terribly easily -- it requires direct contact with bodily fluids. But caregivers and health care workers can become infected while caring for patients, and funeral rituals such as washing a body can expose more people.

And if people don't know they've been exposed, they can travel sometimes long distances to spreads the virus to others when they themselves become ill. WHO says experts are trying to track down 30 people now.

"Community resistance is hindering the identification and follow-up of contacts," WHO says. "They are just scattering," Garry confirmed. "It's very hard to track them down." Garry's working with local and international experts to identify cases, distribute protective gear, train workers and test samples.

"Unfortunately, these numbers will rise dramatically as cases from the Koindu and Daru regions are tallied. Reports from the field for villages surrounding Koindu and Daru are grim."

The outbreak started in Guinea earlier this year [2014], the 1st time Ebola had been seen in West Africa. WHO says at least 21 people died and 48 new cases of suspected Ebola were recorded in Guinea between 29 May and 3 Jun 2014, taking Guinea's total to 344 [but see [1] above. - Mod.JW]

With more than 215 deaths so far, the West African outbreak is one of the worst on record. The biggest outbreak on record affected 425 people in Uganda in 2000, killing 224 of them.

Education is the key to fighting it. Garry says many people in affected regions don't understand it's a virus and often don't believe advisories about how it's spread. His team is educating health care workers so they can protect themselves and teach others. A poster is being used to educate health care workers in Sierra Leone about symptoms of Ebola virus [see comment below]. "They pay attention once they hear how it's spread," Garry said. "The idea is to train these people here to go back and disseminate the main instructions about the disease."

An Ebola virus disease [EVD] infection often looks like malaria at first, so people may not suspect they have it. It later progresses to the classic symptoms of a hemorrhagic fever, with vomiting, diarrhea, high fever, and both internal and external bleeding. With so many bodily fluids pouring from a patient, it is easy to see how caregivers could become infected.

"Ebola is a disease that scares people and that is perceived as mysterious, but people can overcome it," says Marie-Christine Ferir, emergency coordinator for the group Medecins Sans Frontieres [MSF] Doctors Without Borders. "Earning people's trust is essential in efforts to fight the epidemic."

WHO says 6 experts and 5000 sets of protective equipment have been sent to Sierra Leone by various groups.

Garry says his team is building on years of groundwork. He's been working with the Kenema hospital for a decade to build its capacity to fight another viral hemorrhagic fever, Lassa fever. Protective measures for health care workers treating patients with Lassa fever or Ebola are the same. "We tell them to wear gloves and to protect their eyes," Garry said, speaking by telephone from the hospital. "And we've shown people how to do a traditional burial, [but] wearing gloves. And you can allow the body to be washed briefly. Workers have been attentive to the traditions, allowing the body to be wrapped without exposing people to the virus."

Genetic analysis of the virus causing the current outbreaks show it's distinct from the virus seen in east Africa. This suggests it may be from a local source. No one's sure just where Ebola comes from. It can affect great apes but fruit bats are a prime suspect.

Garry, who was only scheduled to stay for a couple of weeks, now says he is not sure when he can leave. "I don't think it's going to be soon," he said.

[byline: Maggie Fox]

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

[The disagreement over statistics of the outbreak in Guinea is unfortunate, but it is encouraging to hear that the death toll is not as high as previously reported. WHO has repeatedly stated that the statistics are subject to revision.

It is heartening to hear that basic rules of hygiene are now being observed in relation to patients in Sierra Leone.

A poster currently in use in that country is shown at
http://media2.s-nbcnews.com/j/newscms/2 ... 40-360.jpg

A rumour that an EVD case has occurred in the state of Acre, Brazil, illustrated with a photo of a gory patient or corpse, is obviously false. - Mod.JW

A map of the region showing the areas of confirmed and probable cases and areas reporting suspect cases can be seen at http://www.cdc.gov/vhf/ebola/resources/ ... break.html. - Sr.Tech.Ed.MJ

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

EBOLA VIRUS DISEASE - WEST AFRICA (60): GUINEA, SIERRA LEONE, LIBERIA
*********************************************************************
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 update 10 Jun 2014
[2] West Africa
[3] Guinea, Sierra Leone
[4] Guinea: Kankan infected
[5] Sierra Leone: more cases
[6] Sierra Leone: Kambia infected
[7] Liberia

******
[1] WHO update 10 Jun 2014
Date: 10 Jun 2014
Source: WHO Disease Outbreak News [edited]
http://www.who.int/csr/don/2014_06_10_ebola/en


Ebola virus disease, West Africa - update
-----------------------------------------
Guinea
------
On 5 Jun 2014, a new district, Kouroussa, reported one new case and one death. This brings to date a total of 7 new cases nationwide (4 confirmed, 3 suspected), including 6 new cases and 6 new deaths reported from Conakry (2 new cases and 1 death), Gueckedou (1 new case and 1 death), Macenta (1 new case and 1 death), and Telimele (2 new cases and 2 deaths) during this period.

Cumulatively the total number of cases and deaths attributable to EVD in Guinea is 351 (210 laboratory-confirmed, 83 probable, and 58 suspected) including 226 deaths by 5 Jun 2014. [The government contests these numbers, claiming 208 cases and only 126 deaths; see ProMED archive 20140610.2529988. WHO has stated that numbers are subject to revision given the fluid situation. - Mod.JW]

The geographical distribution of these cases and deaths is as follows: Conakry, 67 cases and 29 deaths; Gueckedou, 194 cases and 146 deaths; Macenta, 45 cases and 27 deaths; Dabola, 4 cases and 4 deaths; Kissidougou, 7 cases and 5 deaths; Dinguiraye, 1 case and 1 death; Telimele, 25 cases and 7 deaths; Boffa, 7 cases and 6 deaths; and Kouroussa, 1 case and 1 death.

In terms of isolation, 33 patients are currently hospitalized (8 in Conakry, 9 in Gueckedou, 15 in Telimele, and 1 in Boffa). The number of contacts currently being followed-up countrywide is 1011 distributed as follows: Conakry, 329 contacts; Gueckedou, 317 contacts; Macenta, 176 contacts; Telimele, 111 contacts; and Boffa, 78 contacts.

Liberia
-------
No new cases have been reported from Liberia; however 11 contacts (5 health-care workers and 6 community relatives) are currently being followed-up. These contacts were of the probable case from nearby Kailahun, Sierra Leone who died in Foya, Liberia. The deceased was taken back to Kailahun for burial.

Sierra Leone (Freetown)
-----------------------
As of 18:00 on 6 Jun 2014, 8 new cases (2 confirmed and 6 suspected) and 1 new death were reported from Kailahun (3 cases and 1 death), Kenema (1 case and 0 deaths), Bo (1 case and 0 deaths), Port Loko (1 case and 0 deaths), and Freetown (2 cases and 0 deaths). This brings the total number of EVD clinical cases to 89 (33 confirmed, 3 probable, and 53 suspected) including 7 deaths. All 33 confirmed cases and 7 deaths were reported from Kailahun district. The number of cases among health-care workers is 5 and deaths is 1. There are currently 11 cases in isolation at Kenema Hospital. The number of contacts currently being followed-up is 30.

Community resistance is hindering the identification and follow-up of contacts. Overall, the total number of cases is subject to change due to reclassification, retrospective investigation, consolidation of cases and laboratory data and enhanced surveillance.

WHO response
------------
WHO and partners continue to support the implementation of preventive and control measures in the affected countries. In Sierra Leone, WHO is training health-care workers on case and data management and in reviewing messages for social mobilization. Currently, there is only 1 isolation facility located at Kenema. WHO and partners are establishing 2 isolation sites in Darra and Koindu. Clinicians and infection prevention and control experts will be deployed to manage the new isolation sites. Four proposals which were developed with support from WHO have received funding from CERF (UN Central Emergency Response Fund), OCHA (Office for the Coordination of Humanitarian Affairs) Emergency Fund and DFID (UK Department for International Development) and the African Development Bank (ADB). Guinea and Liberia have also received funding from ADB. In Guinea, the joint WHO/HQ and AFRO mission continues to provide support on reviewing the outbreak response operations.

WHO does not recommend any travel or trade restrictions be applied to Guinea, Liberia, or Sierra Leone 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 rapporteur Mary Marshall

******
[2] West Africa
Date: 9 Jun 2014
Source: European Centre for Disease Prevention and Control (ECDC) [edited]
http://www.ecdc.europa.eu/en/publicatio ... -Leone.pdf


The outbreak of Ebola virus disease (EVD) in West Africa with onset in early December 2013 in Guinea now involves 3 countries: Guinea, Liberia and most recently Sierra Leone. This is the 1st documented EVD outbreak in these countries. By week 14 of 2014, it looked like the control measures would bring the outbreak to a halt, but the situation has now evolved in another direction. In week 22 of 2014, there was an unexpected surge in the number of new cases, and the outbreak spread to previously unaffected areas in Guinea and Sierra Leone. As of 9 Jun 2014, the outbreak situation is the following:

- in Guinea, 344 clinically compatible cases (207 of which were laboratory-confirmed by PCR) including 215 deaths; [now revised to 208 cases and 126 deaths, see the 1st ProMED archive below. - Mod.JW].

- in Sierra Leone, 81 cases (31 confirmed, 3 probable and 47 suspected) including 6 deaths. The surge in cases in weeks 22 and 23 of 2014 and the expanding geographical spread involving previously unaffected areas are reasons for concern. Media reports and personal accounts indicate that the outbreak response operation may have failed to gain the trust and community support required to effectively trace and monitor all contacts of EVD patients and to isolate contacts who develop symptoms. A new wave of human-to-human transmission is currently unfolding, and it is, therefore, likely that additional cases will be identified in the coming weeks.

- in Liberia, one new suspected death clinically compatible with EVD, resulting in 13 cases including 9 deaths reported since March 2014.

For tourists, visitors or residents in affected areas, the risk of infection is still considered very low if elementary precautions are followed: avoiding contact with symptomatic patients or dead bodies and their bodily fluids. In addition, generic precautions for travelling in West African countries also apply for preventing infection with ebolavirus -- for example, avoiding close contacts with live or dead wild animals and consumption of bushmeat, washing and peeling fruit and vegetables before consumption, practising safe sex and following handwashing routines.

Health care workers in the affected area are advised to apply standard precautions and contact point of care risk assessment in the care of all patients. When caring for suspected and confirmed cases of EVD, they should strictly adhere to recommended infection prevention and control measures, including the use of appropriate personal protective equipment [PPE]. The risks associated with seeking medical care in affected countries depend on how well the precautionary measures are implemented in those settings.

--
communicated by:
ProMED-mail rapporteur Mary Marshall

******
[3] Guinea, Sierra Leone
Date: 10 Jun 2014
Source: AP [edited]
http://hosted.ap.org/dynamic/stories/A/ ... TE=DEFAULT

One preacher advocated fasting and prayer to spare people from a virus that usually leads to a horrible death. Some people pray that the EVD outbreaks, which are hitting 3 countries in West Africa, stay away from their home areas. Others seem unruffled and say it will blow over. But more than a month after the president of Guinea, Alpha Conde, told reporters the EVD outbreak that originated in his country was under control, the death toll continues to climb in his country as well as in Sierra Leone and Liberia.

At least [150] people have died since the outbreak of the fearsome disease, which causes bleeding internally and externally and for which there is no known cure. Guinea has recorded just over 200 deaths [officially revised to 126 [see ProMED archive 20140610.2529988 below], along with about a dozen each in Sierra Leone and Liberia.

Experts say the outbreak may have begun as far back as January [2014 - ECDC estimates December 2013 in [1] above] in southeast Guinea. EVD typically begins in remote places, and it can take several infections before the disease is identified, making a precise start date virtually impossible to pin down. It's one of the worst outbreaks since the disease was 1st recorded in 1976 in simultaneous outbreaks in Sudan and Congo, said Dr Armand Sprecher of Medecins sans Frontieres [MSF; doctors without borders].

The West Africa Ebola situation is especially challenging because of the number of "satellite outbreaks" that have cropped up, said Sprecher, who has worked on the emergency responses in Guinea as well as in Uganda in 2000 and in Congo in 2007. There have been at least 6 satellite outbreaks elsewhere in Guinea -- including the sprawling seaside capital of Conakry -- and in Sierra Leone and Liberia, Sprecher said.

In each outbreak, health workers must identify patients, trace and monitor everyone they've been in contact with and teach people how to avoid the disease. "Family members and traditional leaders are strongly advised to work with health teams to avoid dead bodies and their body fluids and prevent spreading EVD and deaths of members of communities. The public is also urged to wash their hands with soap and water or use [alcohol-based] hand sanitizer or ashes, avoid eating bush meat (monkeys, fruit bats), and to chlorinate their water before drinking," Bernice Dahn, deputy minister for health services in Liberia, said in a 7 Jun 2014 news release [The basis for fearing waterborne transmission is not clear. - Mod.JW].

One preacher in Sierra Leone called for divine intervention. "Even though the virus is said to have originated from birds and other animals, I believe the virus could be contained through God's miracle," said Pastor Balogun Macauley, chairman of the Coalition of Religious Youths in Sierra Leone, which has called for a 21-day period of fasting and prayer.

In Sierra Leone, some people take the threat seriously and heed advice put out on radio and TV stations and in newspapers by the Ministry of Health and Sanitation. There is fear that Ebola might get to Freetown, the capital. Some note nervously that while the outbreak has been restricted to eastern Kailahun District next to the border with Liberia, that is the same district where on 23 Mar 1992 war spread to Sierra Leone from Liberia. That war wound up engulfing the whole country of Sierra Leone for more than 10 years.

MSF was forced to suspend activities at one treatment center in Guinea after it came under attack by protesters in April [2014]. The mob accused MSF health workers of bringing EVD to Guinea, where there had never previously been any cases. MSF cycles health workers out after 3-4 weeks because of concerns about fatigue, Sprecher said. "Given that there are [not] many people experienced with EVD in the world, you get stretched thin," he said, noting that some have undertaken multiple tours.

The number of Ebola cases in the 3 countries has risen above 400, according to WHO. The most devastating outbreak on record came in Uganda's Gulu district 14 years ago, with 425 cases and 224 deaths. "By the time this thing is done, it will probably be one of the longer outbreaks, if not the longest," Sprecher said.

[byline: Boubacar Diallo & Clarence Roy-Macaulay]

--
communicated by:
ProMED-mail rapporteur Mary Marshall

******
[4] Guinea: Kankan infected
Date: 9 Jun 2014
Source: Xinhua via Afriquinfos [in French, machine trans. edited]
http://www.afriquinfos.com/articles/201 ... 255219.asp

Kouroussa town, located more than 600 km east of Conakry in the administrative region of Kankan, was on Monday [9 Jun 2014] declared a zone of epidemic hemorrhagic fever, Ebola virus disease (EVD), by the prefectural health department of the locality. The situation is currently 8 dead and several suspected cases currently isolated in the district hospital of Kouroussa.

This prefecture, just like others already affected, has recorded a cascade of deaths in several families who were unaware of the presence of EVD. It is through the analysis of samples taken from patients to the specialized medical laboratory in Conakry that the presence of the epidemic has been confirmed by the health authorities. According to preliminary investigations by the medical profession of the prefecture, the suspect cases came from one of the neighboring prefectures, Mandiana, where there is a gold mine whose operation requires the presence of waves of people from all parts of Guinea, the Ivory Coast, Sierra Leone, Liberia, and Mali.

A medical team was sent to the prefecture Kouroussa to inquire about the progress of the disease and to develop devices to contain the outbreak and prevent its spread to neighboring villages.

Since the emergence of the Ebola outbreak in Guinea in January [2014 - ECDC estimates December 2013, see [1] above], the balance is estimated at 126 deaths out of 206 confirmed cases according to the Guinean government; 7 prefectures and the capital Conakry are already affected by the outbreak of EVD.

--
communicated by:
ProMED-mail rapporteur Mary Marshall

******
[5] Sierra Leone: more cases
Date: Mon 9 Jun 2014
Source: Reuters [edited]
http://www.reuters.com/article/2014/06/ ... HT20140609

The death toll from EVD in Sierra Leone has doubled to at least 12 in a week, local health authorities said on Monday [9 Jun 2014], deepening the spread of a disease that has killed [150] people in Guinea and Liberia. The mounting deaths in Sierra Leone, which had been spared cases for months after EVD was confirmed in the region in March [2014], underscore the challenges weak health systems face tackling one of the deadliest diseases on the planet.

Amara Jambai, Sierra Leone's director of disease prevention and control, said all the confirmed deaths in Sierra Leone were in the east, mainly in the Kailahun district on the border with Guinea. "It is very difficult for us to ascertain community deaths at this moment, but the 12 deaths are the ones the hospital can definitely confirm to have died of EVD," Jambai said. Jambai added that there were now 42 confirmed cases of EVD from 113 people tested and that new cases had been recorded in the northern district of Kambia.

Ebola was confirmed in a remote corner of Guinea in March [2014] and then later spread to Guinea's distant capital, Conakry, and over the border into Liberia. All suspected cases in Sierra Leone tested negative until last month [May 2014], and Jambai said that the disease was spreading as authorities are struggling to control the movement of people.

International medical experts have been dispatched to Sierra Leone, but they face a combination of poor existing health systems and tensions among locals fueled by the lack of understanding over the disease; 2 weeks ago relatives removed an EVD patient from a treatment center in Koindu as they doubted the disease existed.

Iron ore producers London Mining and African Minerals have imposed some restrictions on [expat] staff in Sierra Leone as a result of the outbreak, but the firms say their output has so far not been affected.

[byline: Umaru Fofana]

--
communicated by:
ProMED-mail rapporteur Mary Marshall

******
[6] Sierra Leone: Kambia infected
Date: Mon 9 Jun 2014
Source: Awareness Times Newspaper, Freetown, Sierra Leone [edited]
http://news.sl/drwebsite/publish/articl ... 5533.shtml

[Readers are referred to the source URL for this long story full of human interest. Excerpts follow. - Mod.JW]

The much dreaded Ebola virus disease (EVD) which has been ravaging the people of eastern Kailahun district is now confirmed to have moved up to the northern town of Mambolo in the Kambia district, where there are 2 confirmed Ebola cases and 10 other people having blood samples collected from them as possibly infected with Ebola.

[There is now] widespread infection of residents in the Kissi chiefdoms bordering the neighbouring countries of Liberia and Guinea as well as another major Kailahun locality known as Jawei chiefdom, whose headquarters of Daru town and its surrounding villages have been particularly hit by the illness.

The infection and widespread deaths in Kailahun have left traditional rulers, honourable parliamentarians, and ordinary residents weeping and wailing. The wife and children of the paramount chief of Jawei, PC Musa Ngoumbuklah Kallon II, have been admitted as they are very sick with the ebolavirus. The 2 wives of a key traditional ruler, the section chief of a section located just 6 miles from Daru, have also been infected as have many other residents of the chiefdom. In one village alone, an entire family has been wiped out.

Not knowing his wife was infected with Ebola, Mr SK brought her for treatment to Bombohun in Jawei, and then from Bombohun, on the way to Kenema from Daru, the poor nurse died. Innocently, still not informed it could be EVD, her corpse was washed and prepared for burial by her mother, sisters and other women. All these women have since died from EVD. The mother of the nurse, her sisters, and husband have all died from EVD. Furthermore, Jawei health staff who treated the late nurse have all now died or are said to be in critical condition from EVD.

According to Charles Mambu of the civil society organisation known as the "Health For All Coalition", up to 70 per cent of those who have died from EVD in recent days have been frontline staff of the Ministry of Health & Sanitation. Awareness Times can confirm that despite the fact that EVD was known to be raging in Guinea and also found in neighbouring Liberia, no protective clothing [was received by] our hardworking MCH nurses and paramedics in Kailahun. Furthermore, the Rapid Response Diagnostic Test Kits for Kailahun district, which would have helped in the differential diagnosis to eliminate non-EVD conditions, had expired since March 2014.

--
communicated by:
ProMED-mail rapporteur Mary Marshall

******
[7] Liberia
Date: 9 Jun 2014
Source: Ministry of Health & Social Welfare, Liberia [edited]
http://www.mohsw.gov.lr/content_display ... ss_release

According to our Guinean contact, a 40 year old woman, a close contact of a positive case hospitalized in the EVD Unit in Gueckedou, escaped from the village of Koueldou, Tekoulo district, Gueckedou County, Guinea, and went to Vengbemei village, Foya district, Lofa County. Her symptoms before escape were fever, vomiting, nausea, diarrhea and red eyes. Her reason for escape: "afraid to come to Ebola unit in Gueckedou."

No new cases have been reported. Cumulative numbers of suspected, probable and confirmed cases remain 13 as of the reporting date [6 Jun 2014]. 11 contacts are still on active follow up in Foya (5 health workers and 6 community relatives). There has been 100 per cent follow-up as of the reporting week. None have developed symptoms/signs. There are no cases in isolation/admission.

There are 40 media professionals trained in EVD Response and Prevention (emphasis on the roles and responsibilities of the media and Civil Society in EVD response). UNIMIL (United Nations Mission in Liberia) continues a daily media campaign free of charge, and radio messages in local vernaculars continue at other local radio stations across the country.

Follow-up of 5 close contacts for the Lassa fever positive case in Montserrado County has been established and begun.

Planned activities:
- social mobilization training targeting religious, cultural and traditional leaders;
- sustain information campaign and social mobilization activities in affected and vulnerable counties along the borders (door to door using the general community health volunteers (gCHVs);
- strengthen cross border surveillance and response including information sharing approaches/lessons learnt with bordering countries;
- slan senior MRU level meeting on Ebola response to harmonise strategies and response;
- scale up preparedness and response activities to other counties (training of staff and provide other capabilities and capacities).

Issuing authority: Bernice T Dahn, MD, MPH, chair NTF/chief medical officer/deputy minister health services, MOHSW.

[For the many detailed tables in this report, go to the source URL. - Mod.JW]

--
communicated by:
ProMED-mail rapporteur Mary Marshall

[It is very sad that awareness of EVD is still lacking in some areas, as are supplies of disposable plastic gloves; full personal protective equipment (PPE) is not absolutely necessary to protect carers and burial attendants. It sounds as though health services are losing large numbers of front line workers and are being overwhelmed.

Following up what are currently 1011 contacts in Guinea alone (for the incubation period of 21 days) seems to me a well-nigh impossible task.

The fact that some infected workers came from the Mandiana gold mine in Guinea, where other workers from the Ivory Coast and Mali are employed, means that if the latter flee back to their home countries, there is a risk they may take EVD with them. - Mod.JW

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

EBOLA VIRUS DISEASE - WEST AFRICA (61): GUINEA, SIERRA LEONE, LIBERIA
*********************************************************************
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] CIDRAP News
[2] Sierra Leone: official control measures
[3] Sierra Leone: borders closed
[4] Sierra Leone: VHF Program at KGH
[5] GAC donation to Guinea
[6] Numbers problem
[7] Guinea: revised numbers

******
[1] CIDRAP News
Date: Tue 10 Jun 2014
Source: Source: CIDRAP (Center for Infectious Disease Research & Policy) News [edited]
http://www.cidrap.umn.edu/news-perspect ... est-africa


More Ebola virus disease (EVD) cases and deaths have been reported in 2 countries affected by the ongoing outbreak in West Africa, including a newly affected district in Guinea, the World Health Organization (WHO) reported on 10 Jun 2014. The expansion in numbers and areas affected is worrisome, the European Centre for Disease Prevention and Control (ECDC) said today [10 Jun 2014] in a new risk assessment.

ECDC said in its risk assessment that the resurgence of cases and expanded areas affected in the outbreak that seemed to be winding down a few weeks ago are concerning. It said media and anecdotal reports suggest that public health response operations haven't brokered the trust and community support needed to identify contacts, monitor them, and isolate sick patients. "A new wave of transmission is currently unfolding, and it is, therefore, likely that additional cases will be identified in the coming weeks," the agency wrote.

Transmission chains in Sierra Leone are related to ongoing EVD transmission in Gueckedou, which is in the forested area of Guinea and has been one of the outbreak's hot spots. ECDC added that community and nosocomial infections are still occurring in Gueckedou, Mancenta, and [the capital] Conakry, as well as new areas in Boffa and Telimele.

Outbreaks in other areas, however, including Kissidougou, Dabola, and Dinguiraye, appear to be over, the agency said, because 2 incubation periods [42 days] have passed [without another case].

In Liberia, the new case that was recently reported involves a patient who was discharged against medical advice and died on 25 May 2014. The body was returned to Sierra Leone, and the contacts that are being followed include health workers and family members.

Though rising numbers of cases and affected areas increase the risk for Europeans working and living in affected areas -- especially humanitarian and health workers -- the overall risk of EVD is still low for visitors to the affected West African countries if basic precautions are followed, ECDC advised. Precautions [advised] include avoiding contact with live or dead animals, avoiding consuming bushmeat, washing and peeling vegetables before eating, practicing safe sex, and taking proper hand hygiene steps.

ECDC urged health workers in the area to strictly adhere to infection prevention measures, especially those related to personal protective equipment use. It added that the risk of seeking medical care in the area will depend on how well facilities are implementing precautions.

[byline: Lisa Schnirring]

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

******
[2] Sierra Leone: official control measures
Date: Wed 11 Jun 2014
From: Alfonso Box <alcjbox@gmail.com> [edited]


Ebola update 12: [10 Jun 2014] (evening)
----------------------------------------
A total of 114 cases have been tested with 43 confirmed cases of Ebola and 16 deaths. All deaths are confirmed cases from Kailahun District; 2 of them travelled from Kailahun to Kambia district. There is also a positive case from Port Loco -- linked to one of the positive cases from Kambia. These patients have been isolated and contacts are being traced.

Interventions
-------------
- The outreach medical team is still in the field searching for more cases.
- Sensitization of the communities including the traditional healers is ] ongoing.
- Ebola physician specialist from WHO headquarters is now in Kenema to support case management at the treatment Centre.
- A meeting with SLANGO (Sierra Leone Association of Non-governmental Organizations) which includes faith based organizations and non-health international NGO members was concluded today [10 Jun 2014]. The Minister was able to get commitments from these organizations to support the fight against the spread of the disease.

--

Source: Sierra Leone Government
-------------------------------
Date: Wed 11 Jun 2014
Source: Office of Government spokesman Press release
Ministry of Information and Communications
8th Floor, Youyi Building, Brookfields, Freetown
Freetown


As government and its health development partners continue to fight the outbreak of Ebola virus disease that has so far claimed the lives of 16 people:
The government through the Ministry of Health and Sanitation and other participating ministries, departments, and agencies (MDAs) is therefore putting the following measures in place with immediate effect as part of an overall national strategy in addressing the outbreak of Ebola virus disease:
1. All vehicles and their passengers entering and leaving Kailahun district must subject themselves to screening by authorities at various checkpoints.
2. All schools in Kailahun district are closed with immediate effect, and that the Ministry of Education, Science and Technology is making arrangements with the West African Examinations Council (WAEC) for those students slated to sit to the National Basic Education Examinations (BECE) to take the exams at a later date.
3. To minimise the risk of transmission from person to person, government hereby orders the prohibition of all public gatherings, including but not limited to, cinemas, cultural activities, and night clubs in Kailahun district.
4. That local and cross-border trade fairs (locally known as the "Lumors") are temporarily closed until such a time when the Ebola virus would have been contained.
5. That the general public is mandated to report to health authorities any person (s) or stranger (s) with symptoms of the Ebola disease in their respective communities for appropriate professional health interventions.
6. All deaths across the country must be reported and certified by an authorised health professional before burial.
7. All Ebola or related deaths must be buried at place of occurrence under the supervision of health personnel.

We wish the public to know that government and particularly all participating MDAs are on top of the situation, and therefore call on the general public to cooperate with the above measures as part of the national collective drive to further raise awareness to stop further spread of the disease.

--
communicated by
Fiona McLysaght
Country Director - Concern Sierra Leone
http://www.concern.net

******
[3] Sierra Leone: borders closed
Date: Wed 11 Jun 2014
Source: Reuters [edited]
http://in.reuters.com/article/2014/06/1 ... CG20140611


Sierra Leone shut its borders to trade with Guinea and Liberia on Wednesday [11 Jun 2014] and closed schools, cinemas, and nightclubs in a frontier region in a bid to halt the spread of the ebolavirus; 16 people have died of Ebola in Sierra Leone, a figure that has doubled in the last week, Ministry of Health figures showed.

Authorities will also mount health checkpoints in the eastern Kailahun district and mandated that all deaths there be reported before burial. Anyone who dies of the virus must be buried under the supervision of health personnel, the Information Ministry said.

The decision to close district schools came after a 9 year old whose parents died of Ebola tested positive for the virus, deputy minister of information Theo Nicol told Reuters. "There is more contact between school-going kids than adults, hence the closure of schools in the most affected district," he said. The ban exempted churches and mosques, but religious leaders should urge anyone with a fever to go to a clinic, he said. Local groups welcomed the measures, given public concern over the virus, which can be transmitted by touching victims or their bodily fluids.

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

[A HealthMap/ProMED-mail map can be accessed at http://healthmap.org/promed/p/39270. - Sr.Tech.Ed.MJ]

******
[4] Sierra Leone: VHF Program at KGH
Date: Wed 11 Jun 2014
From: Robert Garry <rfgarry@tulane.edu> [edited]


Here, we provide an update on confirmed, probable, and suspected Ebola virus disease (EVD) cases in Sierra Leone.

As of 10 Jun 2014, 120 suspected cases have been evaluated at the Kenema Government Hospital (KGH) Viral Hemorrhagic Fever (VHF) Laboratory operated under the direction of the Sierra Leone Ministry of Health and Sanitation (MOHS). 74 of the suspected cases were negative by laboratory tests and have been reclassified as non EVD cases. Among 46 laboratory confirmed positive cases that have been recorded in Sierra Leone, outcome data is available on 26 of them. There have been 17 deaths among these 26 confirmed cases, for a case fatality rate [CFR] of 65 per cent. Efforts continue to track 20 confirmed cases, some of whom refused to be admitted to the VHF management unit at KGH. Among 4 probable cases, there have been 3 deaths. The status of the 4th probable case is pending further investigation.

22 of the confirmed EVD cases have been admitted to the KGH VHF management unit; 14 of these patients have died, for a CFR of 64 per cent; 7 cases are currently admitted, and one case was discharged [9 Jun 2014]. 3 additional cases now meet discharge criteria and are being discharged from the KGH VHF management unit today [10 Jun 2014]. It is encouraging that despite late presentations of these cases to the KGH VHF management unit that there are survivors.

All confirmed EVD cases in Sierra Leone are epidemiologically linked to Kailahun district. The index case of the outbreak in Sierra Leone was a traditional medicine practitioner (herbalist) living in Koindu, in Kailahun District bordering the EVD epicenter of Gueckedou, Guinea. She treated individuals with EVD who came from neighboring Guinea and died of probable EVD. The 1st confirmed EVD case in Sierra Leone was a woman identified on the KGH maternity ward who had a late term spontaneous abortion on [25 May 2014]. She had attended the traditional funeral of the index case and was also the 1st case to be discharged from the VHF ward. 6 of the confirmed cases, including the 1st confirmed case, were identified on the general wards of KGH. These individuals were all from Kailahun district and came to KGH seeking medical treatment.

43 confirmed cases are residents of Kailahun district. The 3 confirmed cases that are not Kailahun residents include 2 residents of Kambia district and one resident of Port Loko district. One of these individuals was the driver of a vehicle that included a probable case as a passenger. This passenger was a health care worker (HCW) who attended one or more confirmed cases in Koindu. The entire trip was from Koindu to Daru to Kambia. However, the HCW became too ill to continue and made her way to a health post in Daru before her death from probable EVD. The other case from Kambia and the case from Port Loko are epidemiologically linked to the driver from Kambia. The 3 confirmed cases from Kambia and Port Loko were identified via the MoHS District Health Surveillance system and were subsequently transported to KGH.

Case investigations continue centering principally in and around Daru town. In addition, the MOHS KGH VHF team is transporting confirmed EVD cases to KGH and assisting communities and families in safe burials of probable and confirmed EVD cases. There is active monitoring of case contacts, including KGH staff.

Please note that numbers are subject to change.

--
Dr S Humarr Khan
Physician In-Charge of the VHF Program at KGH

Dr Lina Moses
Director Community and Ecology Based Research
Tulane University
(in collaboration with the Viral Hemorrhagic Fever Consortium (VHFC) and Metabiota)

Robert F Garry
<rfgarry@tulane.edu>

******
[5] GAC donation to Guinea
Date: Wed 11 Jun 2014
Source: AMEinfo.com [edited]
http://www.ameinfo.com/blog/manufacturi ... eak-guinea


Guinea Alumina Corporation SA (GAC), a wholly-owned subsidiary of Emirates Global Aluminium (EGA), has re-affirmed its commitment to investing in the social development of Guinea and the wellbeing of the country's residents by donating a lump sum of USD 250 000 to the United Nations Children's Fund (UNICEF) for use in the latter's efforts (in collaboration with the Guinean Ministry of Health) against the current outbreak of the deadly Ebola fever.

With no effective treatment and no human vaccine against Ebola virus disease (EVD), the World Health Organization has advised that education and hygiene are critical for containing and eliminating EVD. Accordingly, the UNICEF project aims to help limit the spread of the disease through public awareness of the risk factors for infection. "This is an excellent initiative to manage the EVD epidemic, and GAC is pleased to be in a position to make this contribution," said Mamady Youla.

The donation from GAC is in keeping with the company's track record of investing in community-based education and healthcare projects. To date, GAC has built 6 schools, 4 health posts, 3 community centres, and drilled 23 community wells in Guinea. A further 3 schools and 2 health posts are under construction. The company has also engaged in vital community engagement activities such as adult literacy courses, road safety, education programs on HIV and AIDS, and malaria management programmes.

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

*******
[6] Numbers problem
Date: Tue 10 Jun 2014
Source: Crawford Kilian [edited]
http://crofsblogs.typepad.com/h5n1/2014 ... mbers.html


[On 8 Jun 2014], I posted a report from Guinea in which WHO's tally of Ebola cases came in for criticism. Now Dr Jody Lanard offers an explanation:

"I'm sure you already noticed that the Guinea officials are citing confirmed cases only, whereas WHO is citing the total of the probable, suspected, and confirmed cases, which is the normative way of citing Ebola numbers during an Ebola outbreak. The Guinea officials seem to be glossing over this distinction to justify calling the WHO numbers a mistake.

"From WHO's Ebola case definitions during an outbreak, it looks as though suspected and probable cases are thought to have a high likelihood of being true Ebola cases. The definitions can be seen at http://bit.ly/1xEcaiK.

"In the past, WHO and others have routinely and explicitly included "presumptive cases" (suspected plus confirmed) in their totals for Ebola outbreaks, along with the break-outs of suspected vs. confirmed. (Example: Figure 2, graphing the largest Ebola outbreak to date, Uganda 2000, at http://1.usa.gov/SKNtRn).

"The current West Africa outbreak/epidemic now has the 2nd highest number of cases on record (see WHO's "Chronology of previous Ebola virus disease outbreaks" table at http://bit.ly/1ivlbD0)."

I think the Guinea Ministry is ... citing apples to WHO's oranges. ... In any case, their protest makes them look less credible. What a ghastly situation, from so many perspectives.

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

******
[7] Guinea: revised numbers
Date: Wed 11 Jun 2014
From: DB, MD [a reputable source known to ProMED-mail, edited]


If you look at the revised numbers in Guinea, the country has returned to its original approach of only reporting confirmed cases, rather than confirmed, plus probable, plus suspected (which has been the standard for ebolavirus outbreaks). The purpose of this is likely to give a false impression that the outbreak is not as severe as it actually is.

Guinea took this approach initially, and at the strong encouragement of international partners, reluctantly changed their reporting to the standard of confirmed plus probable plus suspected, but it appears that they have reverted back to their original approach. The major consequence of this approach when taken earlier in the outbreak was that contacts of probable and suspect cases were not traced and followed, because they were not officially cases in the eyes of the ministry.

Hopefully, this approach will not be repeated; if it does occur, the situation will continue to deteriorate.

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

[I have to wonder how effective border closure can be in the present circumstances. But the end of cross-border trade will have an economic impact.

The VHF Program at KGH previously reported the number of Lassa fever cases coincidentally diagnosed during the EVD investigations. It would be interesting to know whether there is a concurrent Lassa fever epidemic complicating the picture.

The 1st case of EVD in a child is reported in [3] above. Although children are not involved in the care of sick people, nor in burial rites, they have close contact with their mothers even when their mothers are ill. There is also close contact between children in schools, especially during playground contact.

The problem of the data is complicated further because ProMED-mail has been reliably informed that the experimental Harvard antigen for ebolavirus used in Sierra Leone gives a large number of false negatives. If true, the real case numbers could be much higher, and there may be many unrecognized contacts out there.

Apparently, Dr Nadia Wauquier has been named by MOHS Sierra Leone as responsible for the lab diagnosis; all the samples are tested by her in the MOHS/Metabiota Lab by rtRT-PCR (real-time reverse transcriptase polymerase chain reaction validated by the US Department of Defense), and they are the only confirmatory results taken into account by the MOHS. - Mod.JW]

EBOLA VIRUS DISEASE - WEST AFRICA (62): GUINEA, GAMBIA PREPARES
***************************************************************
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 posting:
[1] Guinea
[2] Gambia preparedness
[3] Gambia: Technical Advisory Committee

******
[1] Guinea
Date: Wed 11 Jun 2014
From: Jean-Paul J Gonzalez <jpgonzalez@metabiota.com> [edited]


From 19 May to 9 Jun 2014, MOHS/Metabiota tested suspected cases of EVD [Ebola virus disease] by RT-PCR (reverse transcriptase polymerase chain reaction) with the following results: 129 negative; 41 positive for ebolavirus, including 4 fatal cases.

--
Jean-Paul J Gonzalez, MD PhD
Metabiota, Senior Scientist, Emerging Diseases & Biosecurity
Washington DC, USA
<jpgonzalez@metabiota.com>

******
[2] Gambia preparedness
Date: Wed 11 Jun 2014
Source: The Point [edited]
http://thepoint.gm/africa/gambia/articl ... -in-gambia


The United Nation System in The Gambia through the World Health Organization (WHO) on Tuesday [10 Jun 2014] presented an assortment of medical items and other supplies to the Ministry of Health and Social Welfare in Banjul in support of national Ebola virus disease [EVD] preparedness and response efforts.

The donation included more than 42 boxes with 400 sets of personal protective equipment, 2000 copies of posters on the prevention and control of EVD, 25 000 copies of leaflets on EVD, 2000 copies of fact sheets on EVD, 2000 copies of EVD guidelines for health workers, and 200 copies of a handbook on EVD and other haemorrhagic fevers. In addition, the United Nations is providing detergents and other sanitary supplies for infection control, as well as strengthening public awareness and social mobilization through the media, and at the community level.

Speaking at the presentation ceremony held at the local WHO office, Dr Chales Sagoe-Moses, the WHO representative in The Gambia, expressed delight on behalf of the UN System in presenting the items to the Minister of Health. He commended The Gambia government for its timely response to the EVD situation in neighbouring countries, as manifested by the number of preparatory measures already put in place. The purpose of Tuesday's [10 Jun 2014] presentation ceremony was to further consolidate the UN's support to the ongoing preparatory measures, he added.

The United Nations believes that an emergency of this nature poses far-reaching health, economic and social implications to individuals, families, the health system and the country at large, and that the country must be adequately prepared for this, Sagoe-Moses continued. This was why the UN deemed it fit to respond as a single entity to these challenges, rather than intervening within individual domains, he further stated, adding that WHO was tasked to coordinate this effort. The United Nations remains firmly committed to supporting The Gambia in all its efforts to prepare for the Ebola virus disease, he declared.

Health and Social Welfare minister Dr Omar Sey described the donation as "very timely". He stressed the importance of close collaboration between the UN System and Health ministry, and thanked UN for their support to the government of The Gambia.

[byline: Abdoulie Nyockeh]

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

******
[3] Gambia: Technical Advisory Committee
Date: Thu 12 Jun 2014
Source: Daily Observer [edited]
http://observer.gm/africa/gambia/articl ... west-coast


Gambian health authorities have been intensifying their sensitisation campaign against Ebola virus, aimed at preventing the highly contagious disease from entering the country.

The latest awareness creation took the officials to the metropolitan town of Brikama, West Coast Region [WCR], where 20 Technical Advisory Committee (TAC) members, health workers, community development officers and security personnel gathered at the conference hall of the governor's office on Wednesday [11 Jun 2014] to discuss the dangers and preventive measures for the deadly ebolavirus.

Since its outbreak in Guinea a few months ago and recently in Sierra Leone, West African countries have been on their toes to prevent the highly contagious killer disease. Countries like The Gambia have strengthened national surveillances and adopted other preventive and response mechanisms with a view to meeting the challenge in case of any eventuality. Thus, this sensitisation is one of the mechanisms or strategies the health authorities are using to prevent the disease from hitting The Gambian borders.

The deputy governor of WCR, Bakary Jaiteh, underscored the importance of the sensitisation, and noted The Gambia government has placed high premium on health. "Ebola virus disease [EVD] is a killer disease and thus the sensitisation of the TAC members is important to raise the awareness level of the people," he noted. The regional public health officer, Sanjally Trawally, explained the existence of a surveillance unit at the Health ministry that monitors EVD. He noted that since the outbreak in the sub-region, the disease has killed many people.

[byline: Amadou Jallow]

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

[I have been informed that some of my comments on the Harvard reagents and those responsible for lab testing have been incorrect in detail, but it is correct that there have been discordant results between 2 different lab tests in use. I am trying to clarify the implications.

The Gambia is to be commended on its advance preparations, and WHO for supporting them. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45, http://healthmap.org/promed/p/481.]

EBOLA VIRUS DISEASE - WEST AFRICA (63): 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

Date: Thu 12 Jun 2014
Source: Awareness Times [edited]
http://news.sl/drwebsite/publish/articl ... 5566.shtml


Ebola survivors on the increase
-------------------------------
Government has confirmed that the driver from Mambolo in Kambia [district, Northern province, Sierra Leone], who tested positive for Ebola virus disease (EVD), has yesterday [11 Jun 2014] been discharged from the Kenema Government Hospital after treatment which saw his viral load reduced to negative tests for many days. Also, it now appears that his wife had never tested positive for Ebola but had merely accompanied her husband to Kenema when his tests initially showed positive.

Health Ministry spokesman Sidie Yahya Tunis confirmed to this paper that the driver has survived. Also, apparently, it was an error on the part of the ministry to have stated in 10 Jun 2014 update that 2 out of the 16 dead Ebola patients were from Kambia. Tunis said no deaths had occurred so far in Kambia. Tunis urged that early reporting of suspected EVD cases increases chances of survival.

According to him, they are now putting robust action in place to contain the disease. He said the United Nations Population Fund (UNFPA) has provided support for them to recruit community volunteers who will be trained to tour various communities and search for contacts.

Meanwhile, reports monitored from Daru in Jawei chiefdom of Kailahun district [Eastern province] are that the husband of the late Nurse MK, has suddenly appeared in the town from apparent hiding. He is reported to be alive but very weak and emaciated from almost 2 weeks in hiding. He confessed that he went into hiding when he was informed that his wife had died from suspected Ebola and he realized that all the medical persons who treated his wife, plus all the women who washed her corpse, had died. The Imam who prayed over her corpse has also died. Mr SK is alleged to have feared he also had EVD and hid to avoid being taken to Kenema hospital. When he was not seen for 2 weeks, it was assumed he had also died and he got recorded as dead. Reports are that on his arrival in Daru yesterday [11 Jun 2014], he received medical care and blood samples have been taken from him for testing.

[According to the Tulane group in Kenema, this is totally wrong -- he had been undergoing treatment in the hospital the whole time and has just been discharged. - Mod.JW]

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

[Dr Robert Garry of the Viral Hemorrhagic Fever Consortium (VHFC) wishes to correct the comment on ProMED-mail from a "reliable" source that the Harvard VHFC is running experimental antigen assays with a high false NEGATIVE rate with the result that case and contacts are being missed. He says this is incorrect. He is having trouble with his internet connection from Sierra Leone, so I expect further details tomorrow. - Mod.JW

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

EBOLA VIRUS DISEASE - WEST AFRICA (64): LIBERIA (MONROVIA), GUINEA, 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] Liberia: EVD in capital, Monrovia
[2] Guinea
[3] & [4] Sierra Leone

******
[1] Liberia: EVD in capital, Monrovia
Date: 13 Jun 2014
Source: UNICEF-Liberia [edited]
http://reliefweb.int/report/liberia/uni ... -june-2014


Monrovia
--------
The Ministry of Health and Social Welfare [MOHSW] will provide official public notice of the outbreak in [the capital] Monrovia on key radio stations today [13 Jun 2014], and over 1000 posters were delivered to the Montserrado CHT today to support the meeting and sensitization.

Five confirmed new cases of EVD were recorded: 2 in Foya, Lofa County and 3 in Monrovia, Montserrado.

On Fri 13 Jun 2014, The Ministry of Health and Social Welfare (MOHSW) convened an emergency meeting to discuss confirmation of EVD cases and deaths in New Kru Town community of Monrovia, Montserrado County. In response to the presence of the disease in Monrovia, the MOHSW has reactivated the ambulance team, a burial team, and are reactivating an alert team.

The total number of suspected, probable, and confirmed EVD cases reported in Liberia since the onset of the EVD outbreak is 28 including: 7 suspected; 5 probable; and 16 confirmed. The total number of EVD related deaths now stands at 16 including: 9 confirmed; 5 probable; and 2 suspected. Results were received yesterday [12 Jun 2014] for 7 tested specimens: 4 are confirmed positive and 3 negative.

Six new contacts have been established from confirmed cases. New admission into treatment units remains now 9 with one in Monrovia, Montserrado County and 8 in Foya, Lofa County.

The MOHSW and partners remain heavily engaged on EVD response activities at the Liberia-Guinea border in Lofa County, with particular focus on Foya District.

UNICEF delivered 3500 posters to MOHSW yesterday [12 Jun 2014], and 14 mobilization teams will increase mobilization in all key towns along the border in Lofa beginning Mon 16 Jun 2014. UNICEF's current estimated funding requirement for EVD-related C4D, Health and WASH interventions remains approximately USD 500 000. As of now, the County Office has received USD 313 000 from various donors. The funding gap as of today [13 Jun 2014] is USD 187 000. The County Office will, however, revise funding requirements based on the recent increase and spread of EVD.

Situation overview
------------------
Based on field investigation to date, a woman from Sierra Leone travelled through Foya, Lofa County to her family in New Kru Town (late May/early June 2014). She was sick on arrival, died and was buried in Liberia. Following this, a sick child relative of the woman also died and was buried in Liberia. On Wed 11 Jun 2014, 4 persons (caretakers of the woman and child) in the New Kru Town household were sick. One was carried to a church for care (St. Moses) and died. The body was transported by taxi and wheelbarrow. Another died at the house in New Kru Town.

The field investigation team met the family and was able to collect a specimen from the recently deceased for lab testing.

Two caregivers of the deceased have since reported sick, one male and one female. The male died in transport to ELWA Hospital. The female is currently under treatment at ELWA Hospital. Specimens were collected from both. Three specimens collected from the 2 deceased and the one patient at ELWA hospital were found positive for ebolavirus. 12 contacts have been traced so far.

A cook shop is operated from the house in New Kru Town where people have died, and the need for intensified contact tracing is noted as critical.

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

******
[2] Guinea
Date: 14 Jun 2014
Source: Aujourdhui en Guinee online [in French, machine trans. edited]
http://www.aujourdhui-en-guinee.com/fic ... 648674c215


The death toll from ebolavirus disease on 13 Jun 2014 is 236 confirmed cases, including 144 deaths, said the Guinean minister of health, Remy Lamah, on Saturday [14 Jun 2014].

To date, 34 patients remain hospitalized in different treatment centers in the country, including 15 in Guekedou (epicenter of the disease in the south), 8 in Telmele, 2 in Boffa and 9 in Conakry, the capital. Personnel and logistics have been sent to the main centers of the epidemic to break the chain of transmission, said Dr Lamah.

Through follow up of patients by medical teams of Guinean doctors and experts from the World Health Organization (WHO) and Medecins Sans Frontieres (MSF), 64 people have been found to be completely healed.

The Guinean minister reiterated the ban on transport of corpses of people who have died from EVD from one prefecture to another or one place to another. At present, the rate of follow up of contacts identified in the country is 98 per cent for the Guekedou prefecture, 100 per cent for Macenta, and about 68 per cent for Conakry, said the minister of health.

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

******
[3] Sierra Leone
Date: 14 Jun 2014
Source: AFP via News, New Zealand [edited]
http://news.msn.co.nz/worldnews/8859723 ... d-of-ebola


Sierra Leone raised its death toll from ebolavirus disease (EVD) on Thursday [12 Jun 2014] to 17, announcing 5 new deaths over the previous 48 hours [now 19 deaths, see [4] below].

A pregnant women identified as the 1st person to be cured of the deadly ebolavirus in Sierra Leone has spoken of her joy at her "miracle" recovery. She was discharged from hospital in the eastern city of Kenema on Sunday [8 Jun 2014] after hovering for weeks between life and death battling the tropical disease, which has killed more than 200 people since an outbreak in neighbouring Guinea. "I am thankful to God to have survived the ordeal. I can hardly say more, I am overjoyed," she told the Sierra Leone Broadcasting Corporation on Friday [13 Jun 2014].

Health officials in Kenema, 320 km from the west African nation's capital, Freetown, say no other Sierra Leonean had been given the all-clear before her recovery, although 3 more unnamed survivors have since been announced. "[She] was among 46 people tested and confirmed as having EVD. She tested positive 3 times, 3 weeks ago," district medical officer Mohamed Vandi told the [broadcasting] station. Crowds gathered outside the broadcaster's headquarters in Kenema as she was interviewed, with well-wishers chanting that she was the "miracle woman of the year". "We are thankful that we didn't lose her. The family is grateful to God and to all others that fought to save her life," her husband said.

Ebolaviruses can fell victims within days, causing severe fever, muscle pain, weakness, vomiting and diarrhoea, and in some cases shutting down organs and causing unstoppable bleeding. No medicine or vaccine exists for the disease, [but] medical aid organisation Medecins sans Frontieres [MSF; doctors without borders] says the chances of surviving are greatly improved if patients are kept hydrated and receive treatment for secondary infections. The woman has not revealed her age or the date her baby is due, but she is thought to be in her 30s. A doctor at the hospital who asked not to be named said her survival was down to a combination of a strong immune system and excellent care.

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

*******
[4] Sierra Leone
Date: 14 Jun 2014
Source: Business Week.com [edited]
http://www.businessweek.com/news/2014-0 ... ises-to-52


Sierra Leone confirms number of EVD cases rises to 52
-----------------------------------------------------
Sierra Leone laboratory confirms 19 deaths from EVD, according to statement emailed by Health Ministry in capital, Freetown.

* Number of suspected EVD cases: 138
* Sierra Leone Food and Nutrition Directorate and World Food Program discussed need for supplementary feeding in Kailahun district, an affected area.
* Medical team in Kailahun searching for more suspected cases
* NOTE: 12 Jun 2014, Sierra Leone has not closed Liberia, Guinea borders over EVD.

[byline: Silas Gbandia]

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

[The virus is spreading through unrecognized cases travelling between countries. This is the risk for intercontinental spread if an ebolavirus case should arrive at a hospital where the treating physician has not heard of the EVD epidemic in West Africa. This is what actually happened when a doctor in Gabon, who had not heard of an EVD epidemic in his own country, unsuspectingly treated 2 cases arriving from the epidemic area and became sick himself. He flew to South Africa for treatment (none of his co-travellers on the flight became infected), but the nurse who treated him died, and he survived to go home.

A travel history should always be taken for any patient admitted with a high fever. There is always an increased risk when a case reaches a capital city with an international airport, as is now the case for Monrovia, Freetown in Sierra Leone, and Conakry in Guinea. - Mod.JW

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

EBOLA VIRUS DISEASE - WEST AFRICA (65): SIERRA LEONE (FREETOWN), NOT
********************************************************************
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: 16 Jun 2014
Source: Daily Independent Nigeria online [edited]
http://dailyindependentnig.com/2014/06/ ... rra-leone/?


Sierra Leone Ministry of Health and Sanitation confirmed on Monday [16 Jun 2014] that it had so far recorded 19 deaths and 53 ebolavirus infections. According to a press statement, 138 cases of the Ebola disease have so far been tested.

Community sensitisation in the Kailahun district in the east and its environs including other areas in the West African state has been intensified.

The release made it clear that rumours about a confirmed case of an Ebola patient at the main referral hospital in the capital Freetown, the Connaught Hospital, were not true [see comment below].

The release states: "The Ministry of Health is not restricting the movement of people, but the purpose of the screenings at checkpoints or border crossing areas are to avert the risk of contracting the disease." The statement also mentioned the strengthening of surveillance at checkpoints within Kailahun where the disease 1st manifested itself.

Meanwhile, the ministry said it was happy to disclose that 4 people, who earlier tested positive, had proved to [have converted to] negative and had been discharged.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Below is the latest revision of EVD numbers from Sierra Leone. When a patient who initially tested PCR positive for a virus has a negative PCR test result after treatment, it means that person has cleared the virus from the bloodstream and may be considered cured. News of cured EVD patients in Sierra Leone is very welcome:

WHO reported in its update of 10 Jun 2104 http://www.who.int/csr/don/2014_06_10_ebola/en regarding Sierra Leone:

"As of 18:00 on 6 Jun 2014, 8 new cases (2 confirmed and 6 suspected) and one new death were reported from Kailahun (3 cases and 1 death), Kenema (1 case and 0 deaths), Bo (1 case and 0 deaths), Port Loko (1 case and 0 deaths), and *Freetown* (2 cases and 0 deaths)." But WHO also stated in the same update that: "Overall, the total number of cases is subject to change due to reclassification, retrospective investigation, consolidation of cases and laboratory data, and enhanced surveillance," (asterisks added). - Mod.JW

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