EBOLA VIRUS DISEASE - WEST AFRICA (70): SIERRA LEONE, LIBERIA, TRAVEL ADVICE
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A ProMED-mail post
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International Society for Infectious Diseases
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In this update:
[1] Region
[2] Sierra Leone: hospital closure
[3] Liberia: one more death
[4] Liberia: child case negative
[5] Travel advice
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[1] Region
Date: Sat 21 Jun 2014
Source: Rappler.com, Agence France-Presse (AFP) report [edited]
http://www.rappler.com/world/regions/eu ... on-efforts
The recent rapid spread of Ebola in 3 countries in West Africa has come in part because efforts to contain the deadly virus have been relaxed, Pierre Formenty, a World Health Organization specialist, told Agence France-Presse (AFP) on Saturday, [21 Jun 2014].
Question: We have around 530 cases of hemorrhagic fever, mostly from the Ebola virus, in the region, compared to 225 at the end of April [2014]. How do you explain this leap?
Answer: We have had since [21 Mar 2014], when the epidemic was declared in Guinea, a 1st wave that has started to diminish. Since the start of May [2014] we have had a sort of resurgence with an increase in the number of cases and notably also with an epidemic which has spread to Sierra Leone and Liberia. We are seeing a 2nd wave of cases for West Africa.
Q: How do you explain this new peak?
A: When the epidemic started, it was a little under-estimated, so that the states took a while to really prepare themselves. At the end of April [2014], we started to see a decrease in the number of cases and we maybe saw a relaxation by the teams in the 3 countries, and this relaxation allowed things to restart. In addition, there were some problems with the affected populations which were sometimes not fully listened to.
Q: Were the right measures implemented?
A: The most important things are monitoring and communication. States are getting better and better, but the problems of communication continue. The medical corps on their own cannot stop this epidemic. It is only with the help of the population that we can fight this epidemic and stop it.
Q: What are the specific features of this epidemic?
A: The epidemic is pretty much identical in the 3 countries. What's really important in this epidemic is that the majority of cases are cases of human-to-human transmission, by contact, especially during care, but also during funerals because it is particularly when victims are deceased that Ebola is present around the body.
Q: How did the epidemic spread?
A: The epicentre of this epidemic is in the forested border zone around the town of Gueckedou (in the south of Guinea), and now it has spread to the district of Kailahun in Sierra Leone and the district of Lofa in Liberia. It has been spread most of all by people who travel to Conakry or Monrovia for healthcare. These people travel a great deal. As soon as they are sick with the symptoms, even if they know that it might be Ebola, they will go see friends in one town or another and that's how the disease spreads.
Q: Why is it important for the authorities and humanitarian agencies to communicate with the populations?
A: One case can restart an entire epidemic. So these dramatic measures, which are not put in place for other diseases like meningitis or measles, are hard for the populations to understand. In an area where the quality of health services are not optimal, the populations have struggled to understand why we were asking them to make such an effort and probably we have not been able to explain both the disease and the means of control to the populations.
Q: What is the latest assessment of the WHO?
A: As of 17 Jun 2014, we had 528 cases of Ebola, including confirmed, probable and suspected cases. Included in these 528 cases are 337 dead. All the deaths are confirmed, probable or suspected cases of Ebola. At the level of the international community, Doctors Without Borders [MSF], WHO and other international partners have mobilised 100 to 160 international experts who are on the ground and who are working hard. In Conakry, for patients admitted (to hospital) we have been able to reduce the mortality rate to 40 percent.
[Let's say, rather, that this epidemic was expected to be controlled quickly, just as previous outbreaks in Africa have always been. But because of the hiding of cases, funeral practices and extensive cross-border travel, this time it has been different. However, the mortality rate in Conakry is less than half the frequently quoted 90 percent. - Mod.JW]
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[2] Sierra Leone: hospital closure
Date: Fri 20 Jun 2014
Source: All Africa, The News (Monrovia) report [edited]
http://allafrica.com/stories/201406200896.html
Investigation conducted by this paper has revealed that workers at the Redemption Hospital in New Kru Town have abandoned the hospital for fear of more deaths from the deadly Ebola virus. The decision of workers to stay away from work has led to the closure of the Hospital.
Authorities at the Ministry of Health told journalists at the Ministry of Information regular press briefing that the hospital was temporarily shut down after nurses decided to stay away, but has since been reopened and was carrying on normal medical operations.
Assistant Health Minister for Preventive Services, Tolbert Nyenswah, blamed the brief closure of the hospital on the trauma suffered by nurses and other health workers following the death of their colleague, E.K.
Nyenswah said the situation is under control. He said nurses and workers are going about their normal duties at the hospital.
But contrary to the Minister's assertion, our investigation established that nurses and other health workers at the hospital have decided to stay away from the hospital until the government and the hospital's administration ensure that the entire hospital's environment is sprayed and they (nurses) are supplied the necessary protective gears before returning to work.
A nurse who chose anonymity (for fear of losing her job) said since the death of their colleague, E.K., of the deadly Ebola virus, they unconditionally discharged all of the patients that were admitted at the hospital and have refused to accept new patients.
She said their non-corporative action will continue until the government provides them with the needed materials to work with, especially during the 'Ebola crisis' period.
Nurses at the Redemption Hospital told reporters Tuesday [17 Jun 2014] that their lives were at risk in the performance of their daily duties after the death of their colleague. The nurses said they work in a risky environment especially in the wake of the reported outbreak of the deadly Ebola virus in the New Kru Town community. The assertions and stay-away action of the Redemption nurses and other workers also contradict comments by the Hospital's Interim General Administrator who claimed that the nurses were provided with the necessary protective gear to carry on their work.
[Byline: Sam Zota, Jr.]
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[3] Liberia: one more death
Date: Fri 20 Jun 2014
Source: Vice News [edited]
https://news.vice.com/article/eight-now ... as-capital
The spread of the Ebola virus into the Liberian capital of Monrovia has claimed another life, according to a statement from the country's Ministry of Health and Social Welfare (MOHSW) today [20 Jun 2014]. The news comes as public health officials ramp up efforts and struggle to maintain enough manpower to combat the outbreak that began in Guinea this spring [2014].
Earlier this week, Liberia's health minister said 7 people had died from Ebola in Monrovia since [8 Jun 2014]. Friday's [20 Jun 2014] MOHSW statement confirmed an 8th death. Today's news brings Liberia's total lab confirmed death count up to 17, with at least another 7 suspected. The country had gone nearly 2 months without any new reported cases.
[Byline: Kayla Ruble]
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[4] Liberia: child case negative
Date: Fri 20 Jun 2014
Source: All Africa, The New Dawn (Monrovia) report [edited]
http://allafrica.com/stories/201406200126.html
President Ellen Johnson-Sirleaf has called on Liberians to see the deadly Ebola virus disease (EVD) in the country as a national emergency and stop politicizing the issue, stressing that a united front will complement the efforts of government and its partners to successfully fight the virus.
According to the Executive Mansion, President Sirleaf paid a visit to the Redemption Hospital in the Borough of New Kru Town on Tuesday, 17 Jun 2014, to show solidarity for staff and nurses there after the death of a staff member, who contacted the ebolavirus.
In the wake of a renewed outbreak of the virus in Liberia, the President has expressed government's commitment to fighting the pandemic. During the visit to the hospital, the President sympathized with the administration, nurses and staff, who are mourning the loss of a colleague, E.K. The Liberian leader also ascertained the state of affairs of the Redemption Hospital relative to its preparedness to cope with an influx of patients if the need arises. She paid tribute to the administration, nurses and staff for their courage and sacrifices to the nation and promised government's fullest support. [But there seems to have been a breakdown in the provision of PPE (personal protective equipment) to hospital staff -- see [1] above. - Mod.JW]
The Ministry of Health and Social Welfare recently announced a renewed outbreak of EVD in the New Kru Town vicinity that has claimed the lives of at least 7 persons, including a health worker at the Redemption Hospital, who was infected by the virus while attending to a patient.
Speaking earlier, the Assistant Minister of Health for Curative Services, Tolbert Nyenswah, informed President Sirleaf of the challenges faced by health workers in the fight against the outbreak, including fear and denial. He explained that nurses at the Redemption Hospital are seriously shocked by the death of their colleague, which has also affected their passion to work in the wake of fear of being infected by the virus while attending to suspected cases. Mr. Nyenswah disclosed that based on the demand of health workers since the death of their colleague, the administration has fumigated all the strategic areas at the hospital which has helped to alleviate their fear.
He however highlighted that family members of Ebola victims are posing a serious hindrance to the instant burial of these fatalities which is one of the surest ways of prevention. Minister Nyenswah said family members were demanding the remains of dead relatives for burial in keeping with normal traditions -- he warned that if not curtailed, the practice could hinder prevention efforts.
The World Health Organization Representative to Liberia, Dr. Nestor Ndayimirije, who provided updates to President Sirleaf on the recent outbreak, agreed with Assistant Minister Nyenswah that government and its partners were not only fighting the ebolavirus but also trying to allay the fear that has caused health workers to sometimes desert patients. He indicated that the Liberian leader's visit to the hospital was a great motivation to the health workers in dealing with the fear.
Child with suspected EVD tested negative
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Meanwhile, authorities at the James N. Davies Memorial Hospital in Nezoe Community, Paynesville [Montserrado county], have clarified that the death of 11-year-old T.J., at the hospital recently was not related to the ebolavirus. Little T.J. was a resident of Rehab Community. He was taken to the James N. Davies Memorial Hospital with blood oozing from his body, but was pronounced dead 2 days later. A laboratory technician at the hospital David Mulbah, told The New Dawn that the remains of the deceased was held for 2 days for necessary tests to establish whether the death was EVD related, but they proved negative. Mulbah said blood oozing from the body is one symptom of the Ebola virus, but all tests performed on the victim showed that he was negative. The laboratory technician however, did not disclose what killed little T.J. He said family of the deceased has been granted permission to pick up the body for burial. "If he had died from EVD then the Government would have kept the body for the safety of the family", he added.
[Byline: Ethel A. Tweh]
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[The 1st child fatality of the epidemic was reported in ProMED archive (68) -- see below. It is paradoxical that all confirmed cases so far have been in adults. Certainly infants and toddlers, if not older children, would be in close enough contact with their mothers to be at risk of contagion. - Mod.JW]
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[5] Travel advice
Date: Wed 28 May 2014
Source: Public Health Agency of Canada [edited]
http://www.phac-aspc.gc.ca/tmp-pmv/noti ... php?id=125
[Although 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, people who unavoidably have to travel to those countries might appreciate the advice from Public Health Canada below. - ProMED]
Ebola Outbreak in West Africa: Travel Health Notice Updated: 28 May 2014
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The Ministry of Health of Guinea continues to report on the evolving outbreak of Ebola virus disease (EVD, formerly known as Ebola haemorrhagic fever). Confirmed cases have been reported in several districts in Guinea. Confirmed cases in the neighbouring countries of Liberia and Sierra Leone have also been reported and additional cases can be expected.
The Ministries of Health of Guinea, Liberia and Sierra Leone are working with the World Health Organization (WHO) and other partners to implement measures to control the outbreak and prevent further spread. The WHO does not recommend that any travel or trade restrictions be applied to Guinea, Liberia or Sierra Leone in relation to this outbreak.
For the latest updates on Ebola virus disease, including the total number of cases and deaths, please visit the World Health Organization's Global Alert and Response website (
http://www.who.int/csr/don/en).
Ebola virus disease is a rare and severe viral disease. The virus can infect both humans and non-human primates (monkeys, gorillas, etc.). When infected, people can get very sick, with fever, intense weakness, headache, sore throat and pains, and may bleed from different parts of the body (i.e., haemorrhage).
The risk of infection is low for most travellers, although the risk may increase for those who are working in a health care setting since most human infections result from direct contact with the bodily fluids of infected patients. The Public Health Agency of Canada recommends travellers avoid all direct contact with a person or corpse infected with the Ebola virus. Also, avoid contact with or handling an animal suspected of having Ebola. Travellers should immediately seek medical attention at the 1st sign of illness.
Recommendations
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- Consult a health care provider or visit a travel health clinic at least 6 weeks before you travel.
- Avoid direct contact with blood and other bodily fluids of people with Ebola virus disease or unknown illnesses.
- Avoid direct contact with bodies of people who died of Ebola virus disease or unknown illnesses.
- Avoid unprotected sexual intercourse with an infected person or a person recovering from Ebola virus disease.
- Avoid contact with any objects, such as needles, that have been contaminated with blood or bodily fluids.
- Health care workers should practise strict infection control measures including the use of personal protective equipment (i.e., gowns, masks, goggles and gloves).
- Avoid close contact with or handling of wild animals.
- Avoid live or dead animals, as both can spread the virus. Animals such as chimpanzees, gorillas, monkeys, forest antelope, pigs, porcupines, duikers and fruit bats may be carriers.
- Avoid handling of raw or undercooked wild meat.
- Know the symptoms of Ebola virus disease and see a health care provider if they develop during travel or within 3 weeks after your return.
- If you have symptoms upon arrival into Canada, tell a flight attendant or a border services officer when you arrive. They will determine whether you need further medical assessment.
- Seek medical attention immediately, if a fever and any other symptoms arise during or after travel.
- Be sure to tell your healthcare provider that you have travelled to a region where Ebola virus disease was present.
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