EBOLA VIRUS DISEASE - WEST AFRICA (09)
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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] West Africa situation
[2] Guinea attack
[3] Guinea, economic impacts
[4] Liberia
[5] Liberia, economic impacts
[6] Sierra Leone official response
[7] Ghana, suspected
[8] Senegal
[9] Questions of virus origin
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[1] West Africa situation
Date: Fri 5 Apr 2014
Source: WHO [edited]
http://www.afro.who.int/en/clusters-a-p ... -2014.html
As at 4 Apr 2014, the Ministry of Health of Guinea has reported a cumulative total of 143 clinically compatible cases of Ebola virus disease (EVD), of which 54 are laboratory confirmed by PCR. The total number includes 86 deaths (CFR 60 per cent). New cases have been reported from Conakry, Guekedou and Macenta; 23 patients are currently in isolation units. The date of onset of the most recent laboratory confirmed case is 3 Apr [2014].
The current number of clinical and confirmed cases and deaths by place of report is Conakry (18 cases, including 5 deaths), Guekedou (85 cases/59 deaths), Macenta (27 cases/14 deaths), Kissidougou (9 cases/5 deaths), and Dabola and Djingaraye combined (4 cases/3 deaths). Of the 18 clinical cases in Conakry 6 have been laboratory confirmed for EVD. There has been no increase in the number of affected health care workers (HCW) from the 14 reported previously, including 8 deaths; 11 of the affected HCWs are laboratory confirmed cases. Of the 86 deaths overall 16 are laboratory confirmed, 65 are classified as probable cases and 5 as suspected cases.
Case investigation and contact tracing are continuing, with 623 contacts requiring medical follow-up; this includes 74 new contacts identified on 3 Apr [2014] while 49 have been released from observation as they have remained well after the maximum incubation period for EVD of 21 days following the last exposure to a case.
Laboratory support for the investigation is being provided by Institut Pasteur Dakar, Senegal, and the mobile laboratory in Guekedou. Reference laboratory functions have been provided by Institut Pasteur Lyon, France, the Bernhard-Nocht Institute of Tropical Medicine Hamburg, Germany, and the Centre International de Recherche en Infectiologie (CIRI) laboratory in Lyon, France.
WHO, in collaboration with technical partners in the Global Outbreak Alert and Response Network (GOARN) has deployed field laboratory support, and experts in anthropology, epidemiology, logistics, clinical case management and infection prevention and control and outbreak coordination to support the response in Guinea.
The Ministry of Health and Social Welfare (MOHSW) of Liberia has reported 18 suspected and 2 confirmed cases of EBV, including 7 deaths, since 24 Mar [2014] (CFR 31 per cent); 7 patients are currently in an isolation unit while 2 suspected cases have been discharged. On 4 Apr [2014], 4 new clinically compatible cases were reported. One of the suspected cases is in a health care worker. Both of the laboratory confirmed cases, sisters from Lofa County, have died. The suspected cases include a hunter treated at a hospital in Tapita, Nimba County, who died shortly after presenting to the health facility and a 3 year old boy with a clinically compatible illness who had travelled from Guinea. The deceased hunter gave no history of contact with known cases in Liberia or Guinea and his exposure is being investigated to exclude transmission from an animal source (bush meat). The laboratory results for both of these suspected cases are pending. The MOHSW has placed 46 contacts under medical observation, including those of the 2nd confirmed case who travelled from Foyah, Lofa Country, to Monrovia, Montserrado Country, and then to Firestone in Margibi County. A total of 21 clinical samples have been sent to Conakry, Guinea, for laboratory testing. Counties of concern for EVD in Liberia include Lofa, Bong, Nimba, Margibi and Montserrado.
In response, Liberia has been scaling up activities to prevent the further spread of EVD. The National Task Force is conducting daily coordination meetings with response partners. WHO continues to provide technical expertise to the MOHSW, including public communications, providing a high level briefing on EVD prevention and control to the joint session of both houses of parliament and mobilising experts in epidemiology and infection prevention and control. The WHO Country Office in Liberia is working closely with the MOHSW to carry out needs assessments in areas such as procurement and the supply chain for critical materials and equipment need in the response to the outbreak. WHO is also working with the health information systems team at the MOHSW to further develop templates for case-based data collection and to track technical assistance. Additional deployments of regional experts, and partners in GOARN, are planned to support coordination activities, infection prevention and control, risk communications and social mobilisation. At the request of the MOHSW and WHO, the Metabiota Laboratory in Kenema, Sierra Leone, will install Real-Time Zaire ebolavirus-specific PCR, a pan-filo PCR, Lassa virus PCR, yellow fever and Marburg virus PCRs among other assays. This technology is being transferred from its laboratory in Kenema, Sierra Leone. Metabiota will also provide training to laboratory staff in Liberia.
Medical supplies and equipment have been provided by WHO, UNHCR, MSF, Save the Children and other partners, including personal protective equipment for health care facilities. In 5 countries, 7 isolation units have been established. Medecins Sans Frontières (MSF) is conducting training for health care workers in the affected counties on case management, including on setting up isolation facilities. An additional 60 HCWs have been trained in Margibi County. Community education and social mobilisation activities have been strongly supported by the media and telecommunications sectors in Liberia. Local government officials, community and religious leaders and traditional healers have been approached to support the MOHSW in prevention and control activities; however, additional resources are needed to expand surveillance and health promotion and social mobilisation activities to schools, religious gatherings, market places and work places. Plans are also underway to mobilise the public through house-to-house visits.
The Ministry of Health of Mali has notified WHO of 4 patients suspected to have a viral haemorrhagic fever who presented for health care in Sibiribougou, Koulikoro Region of Mali; 2 of the suspected cases had travelled from Guinea. The patients were placed in isolation pending epidemiological investigations and laboratory testing. Contact tracing is underway. Clinical samples have been sent to the Centers for Disease Control and Prevention (CDC), Atlanta, United States, for testing. Epidemiological surveillance is being enhanced on the ground and Rapid Response Teams are being mobilised to identify and treat suspected cases should others present. An isolation unit has been prepared in Bamako and units are also being installed in other locations. Information hotlines are being made available to the public.
There has been no change in the situation in Sierra Leone following the deaths of 2 probable cases of EVD in one family who died in Guinea and their bodies repatriated to Sierra Leone. The office of the Chief Medical Officer (CMO) is coordinating all operations involving suspected cases of Ebola as well as the follow-up investigations. [All cases were negative by laboratory test. See the report below. Mod TY]. Enhanced surveillance and public education activities are continuing. Senior officials from the Ministry of Health and Sanitation (MOHS) have visited border crossings between Sierra Leone and Guinea to sensitise border authorities about current prevention and response plans and public health medical officers are visiting border communities to support social mobilisation activities. Metabiota Laboratory in Kenema working under the MOHS and with the WHO Country Office in Sierra Leone, has established a full suite of ebolavirus-specific assays and differential diagnostics for other important viral haemorrhagic fevers that are locally endemic. The full range of assays is described in the section of this report for Metabiota activities in Liberia.
As this is a rapidly changing situation, the number of reported cases and deaths, contacts under medical observation and the number of laboratory results are subject to daily changes due to consolidation of case, contact and laboratory data, enhanced surveillance and contact tracing activities and ongoing laboratory investigations.
WHO does not recommend that any travel or trade restrictions be applied to Guinea, Liberia, Sierra Leone or Mali based on the current information available for this event.
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Communicated by:
ProMED-mail Rapporteur Mary Marshall
[The outbreak is having social repercussions in Guinea. A 6 Apr 2014 report from 10 News (
http://www.wtsp.com/story/news/health/2 ... a/7379153/) indicates that "people are so afraid, one man said, they've stopped shaking hands. An Air France flight from Guinea to Paris was quarantined on Friday after a passenger was sick in the bathroom. No one was infected with Ebola [virus]". - Mod. TY]
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[2] Guinea attack
Date: Sun 4 Apr 2014
Source: Reuters [summ. & edited]
http://mobile.reuters.com/article/idUSL ... 4?irpc=932
A crowd angry about an Ebola outbreak that has killed 86 people across Guinea attacked a center where victims were being held in isolation, prompting an international aid group to temporarily evacuate its team, officials said Saturday [5 Apr 2014].
The violence took place in the southern town of Macenta, where at least 14 people have died since the outbreak emerged last month. The mob, who descended upon the clinic, accused Doctors Without Borders health workers of bringing Ebola to Guinea, where there had never previously been any cases.
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Communicated by:
ProMED-mail from Google Alerts
<
promed@promedmail.org>
[This situation underscores the need for timely public education in order to avoid panic by an uninformed public. It also illustrates the need for public trust in their health care system.
A HealthMap/ProMED-mail map showing the location of Guinea can be accessed at
http://healthmap.org/promed/p/45. - Mod. TY]
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[3] Guinea, economic impacts
Date: Sat 4 Apr 2014
Source: Reuters [summ. & edited]
http://mobile.reuters.com/article/idUSL ... 4?irpc=932>
Foreign mining companies have locked down operations and pulled out some international staff in mineral-rich Guinea. French health authorities have also put doctors and hospitals on alert in case people travelling to and from countries in the region pick up the disease.
Conakry's luxury five-star Palm Camayenne Hotel, popular among businessmen and politicians, is running at less than a third of occupancy, according to a receptionist.
Flight data told a similar story. A return Brussels Airlines flight between the Belgian capital and Conakry on Thursday had just 55 people arriving and 200 leaving, an airline employee said.
Regional airline Gambia Bird delayed the start of a route to Conakry due to begin last weekend while Senegal has closed its border with Guinea because of the outbreak.
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Communicated by:
Ryan McGinnis
<
ryan@bigstormpicture.com>
[ProMED thanks Ryan McGinnis for sending in this report. - Mod. TY]
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[4] Liberia
Date: 4 Apr 2014
Source: Business Standard [edited]
http://www.business-standard.com/articl ... 202_1.html
The deadly Ebola virus has claimed 2 more lives in Liberia, Minister of Health and Social Welfare Walter Gwenigale said Thursday [4 Apr 2014], taking the death toll to 7 in the West African nation.
Gwenigale told a regular press conference in Morovia, the country's capital city, that the 2 people included a woman who got infected as a result of taking care of her sister who contracted the virus in Lofa county. The woman died Wednesday night [3 Apr 2014], Xinhua reported.
The minister told reporters that after contracting the virus, the woman travelled from Lofa to Chicken-soup Factory in Gardnersville and was later taken to Firestone by the taxi driver where she later died and that her child who is currently sick is being quarantined.
Gwenigale said the other one of the 2 newly deceased is a 25-year-old man who died at the Tapita Hospital in Nimba county few minutes after he was taken there for treatment.
He said though his death is not proven to be Ebola [EVD] from standard laboratory test, the ministry concluded that he died of the deadly virus having considered the different signs and symptoms that go along with the virus and observed that they were exactly the same that affected him before he died.
He said Ebola [EVD] is real and is present in Liberia and that no one Liberian should take it as a joking matter.
Ebola virus is considered one of the most aggressive viruses known to date in part because of its rapidity to kill, which can be within one week from exposure or 3-4 days from the 1st symptoms become apparent. This leaves very little time for any treatment to act and save a sick individual.
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Communicated by:
ProMED-mail from HealthMap Alerts
<
promed@ppromedmail.org>
[In a separate 6 Apr 2014 statement cited in Sky News (
http://www.skynews.com.au/world/article.aspx?id=964879), Liberian President Ellen Johnson Sirleaf appealed to her countrymen not to panic over the Ebola outbreak. She said "We do not believe that one needs to do anything more than take precaution, follow the instructions and advice of the Ministry of Health team. She dismissed the recent recommendation by the senate to close the border with neighboring Guinea, the origin of the Ebola outbreak that has spread to several countries in the region. "This is not a thing for politicians," the president said.
Although response to an outbreak is not the responsibility of politicians, support for a public health system that can deal with outbreaks depends on political support.
A HealthMap/ProMED-mail map showing the location of Liberia can be accessed at
http://healthmap.org/promed/p/54. - Mod. TY]
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[5] Liberia, economic impacts
Date: Sun 6 Apr 2014
Source: AFK Insider [edited]
http://afkinsider.com/50296/ebola-epide ... y-liberia/
The deadly Ebola epidemic reported to have entered the Liberian territory after the outbreak in Guinea that has killed more than 80 persons in that neighboring country is causing panic among many Liberians with market women dealing in Bush meat otherwise known as dry meat, complaining that they are losing customers because of a government announcement warning people to stay off the local cuisine for a while.
Scientists say Ebola [virus] is transmitted to humans through several means with monkeys, gorillas, chimpanzees and other animals serving as carriers of the deadly virus and Liberia's Health Minister, Dr. Walter Gwenigale, on Monday [31 Mar 2014] issued a warning to Liberians to desist from eating bush meat for now, cautioning County Superintendents to take the lead in working in their respective counties to advise the citizens from consuming bush meat.
The bush meat business is a big market in Liberia and serves as a major source of income for a whole group of people ranging from hunters to marketers who purchase directly from the hunters to sellers on the local market, onward to restaurants and other food centers before reaching a vast consuming public.
Liberia is one of the countries in the West African sub region with vast natural rain forest which has been used for hunting for centuries. In the southeastern Grand Gedeh, River Gee, Grand Kru and other counties hunting is an occupation for many. Monkey, one of the animals listed as a carrier of Ebola is a favorite bush meat for many Liberians, an age-old food, and convincing people to stay away from a food they have been consuming for years is proving difficult.
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Communicated by:
ProMED-mail from Google Alerts
<
promed@promedmail.org>
[The sale of bush meat in Africa is controversial in conservation circles because of the adverse impacts it can have on wildlife populations, especially the great apes that are also susceptible to Ebola virus infection and suffer mortality. Now, a public health dimension has been added to that debate. - Mod. TY]
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[6] Sierra Leone official response
Date: 4 Apr 2014
From: Metabiota Inc., on Behalf of the Ministry of Health and Sanitation <
jpgonzalez@metabiota.com> [edited]
As of today, 4 Apr 2014, there are NO laboratory confirmed cases of Ebola virus in Sierra Leone. The Ministry of Health & Sanitation [MOHS] is closely collaborating with the World Health Organization and Metabiota to provide rapid diagnostics and case investigations by MOHS personnel.
In order to effectively manage this emergency The MOHS has established National Outbreak Response task force and the following actions have been taken in response to the potential for spread of the epidemic:
- The office of the Chief Medical Officer (CMO) is coordinating all operations involving suspected cases of Ebola as well as the follow-up investigation.
- Active surveillance of suspected cases meeting the WHO case definition for either Ebola or Lassa fever is ongoing and on an as-needed basis.
- National Taskforce biweekly meetings are being held, bringing together all senior officials of national and international health institutions to provide them with relevant information in real time.
- The MOHS, the UN, foreign governments, NGOs and other National and International stakeholders are currently positioning support funds and other resources to aid in sensitization, distribution of PPE and care guidelines, educational campaigns by radio and television, and other support.
- The MOHS has established a central reporting "hotline" for the reporting of suspected VHF cases.
- Radio and television "jingles" have been developed in local languages to sensitize the community to this disease.
- Daily press conferences are being held by the MOHS to inform the public and prevent panic initiated by the spread of rumors.
Metabiota Inc., working under the MOHS and with the WHO Country Office, had previously installed Zaire Ebola-specific PCR, which was used to screen the 1st cases reported to PROMED. The laboratory team has installed and are currently running a full suite of Ebola specific and differential diagnostics, including: WHO recommended Zaire Ebola-specific RT-PCR, Zaire Ebola-specific antigen and IgM capture ELISAs, pan-filovirus RT-PCR, as well as published PCR assays for the detection of Lassa fever, yellow fever and other confounding, locally endemic pathogens. WHO, Metabiota, and other partners are providing the recommended full personal protection equipment (PPE) for health workers exposed to suspected cases.
On 30 Mar 2014, the MOHS of Sierra Leone has carried out 4 epidemiological investigations with multidisciplinary field teams to investigate suspected cases reported by local health centers. Over 15 suspected cases (contact with confirmed from a suspected infected patient from Guinea) have been investigated by the field team, at which time blood samples were collected, tested negative by RT-PCR for all existing known 5 Ebola virus species. Samples from 2 patients from Guinea, collected by the Guinean authorities (border proximity of the investigation field teams) were also referenced to the Kenema laboratory and were found to negative for Ebola, Marburg, Yellow Fever and Lassa fever by RT-PCR.
Since that time, 2 additional suspected cases from Sierra Leone were tested and found to be Negative.
The MOHS National Task Force, working with Metabiota and other partners, is continuing to actively conduct surveillance for Ebola virus, as well as Lassa fever, and the Kenema Government Hospital has been designated as the central treatment facility for anyone suspected of contracting Ebola fever. This facility of KGH specializes in the treatment and management of viral hemorrhagic fever. A specialized infectious disease ambulance previously provided by Metabiota for the transport of acutely ill Lassa fever patients is being used to transport suspected cases and every precaution made to protect both health care workers and local populations from the risk of spread of the diseases.
Just-in-time, hands-on clinical management training for district healthcare workers, including how to set up local isolation wards will be conducted in the next week. Additional training and VHF sensitization will also be provided to National level and District level surveillance officers, as well as border checkpoint health surveillance workers. Each training event will be used as a distribution opportunity for up to date materials, as well as the recommended PPE and instructions on its use. The training of trainers for clinical personnel is being managed by Dr. Sheik Humarr Khan, Chief Physician of the Lassa fever ward at the Kenema Government Hospital, and Dr. Jean-Paul Gonzalez, Metabiota Senior Scientist and physician, according to the WHO manual on the control of viral hemorrhagic fevers.
Communicated by
Metabiota Inc., on Behalf of the Ministry of Health and Sanitation
Sierra Leone
<
jpgonzalez@metabiota.com>
[It is good to learn that the suspected cases are negative for Ebola virus infection. Sierra Leone with its Metabiota and WHO collaborators is very well prepared should cases appear in that country. This outstanding organization and preparedness for response could serve as a good model for the rest of West Africa. ProMED thanks Metabiota and the Sierra Leone MOHS for this communication. Receipt of this kind of 1st hand information from the field is extremely valuable.
A HealthMap/ProMED-mail map showing the location of Sierra Leone can be accessed at
http://healthmap.org/promed/p/46. - Mod. TY]
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[7] Ghana, suspected
Date: Sun 6 Apr 2014
Source: Radio XYZ [edited]
http://edition.radioxyzonline.com/pages ... /18998.stm
XYZ News can report that blood sample from a 12-year-old girl has been sent to the Noguchi Memorial Institute for tests to confirm if Ghana has recorded its 1st case of Ebola [virus infection].
The 12-year-old girl was first admitted at the paediatric unit of the Komfo Anokye Teaching Hospital in Kumasi with symptoms of fever and bleeding.
Doctors have met over the patient and taken emergency steps to ensure she is quarantined.
The results of the test will be known in a couple of days.
The deadly haemorrhagic disease has already killed dozens of people in neighbouring Guinea. Cases have also been reported in Liberia and lately Mali.
Over 70 people have died so far in Guinea alone since the outbreak begun a little over a month ago.
There is no known cure or vaccine for the haemorrhagic fever.
It is spread by close personal contact with people who are infected and kills between 25 per cent and 90 per cent of victims.
Symptoms include internal and external bleeding, diarrhoea and vomiting.
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Communicated by:
ProMED-mail from Google Alerts
<
promed@promedmail.org>
[One hopes that the tests results are negative. ProMED will appreciate receiving followup news about this case.
A HealthMap/ProMED-mail map showing the location of Ghana can be accessed at
http://healthmap.org/promed/p/53. - Mod. TY]
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[8] Senegal, reaction
Date: Thu 3 Apr 2014
Source: Xinhua News [edited]
On Wednesday [2 Apr 2014], the chief of Kolda region closed the weekly Diaobe market that is attended by people from countries such as Gambia, Guinea, Guinea Bissau and Senegal.
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Communicated by:
ProMED-mail from Google Alerts
<
promed@promedmail.org">
http://news.xinhuanet.com/english/afric ... 227868.htm
Senegal's government over the weekend decided to close its border with Guinea to prevent the spread of Ebola virus prevalent in the latter, Senegal's interior ministry said.
As part of the preventive measures, the statement added, the border posts in Senegal's southern region of Kolda and Kedougou in the southeast will be closed until further notice. "Governors in the concerned areas have taken appropriate measures to ensure full execution of the decision," the statement concluded.
On Wednesday [2 Apr 2014], the chief of Kolda region closed the weekly Diaobe market that is attended by people from countries such as Gambia, Guinea, Guinea Bissau and Senegal.
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Communicated by:
ProMED-mail from Google Alerts
<
promed@promedmail.org
[Closure of the border seems to be a drastic measure, given that the WHO does not recommend any travel restrictions due to the outbreak. Intensification of surveillance at the border for febrile individuals, coupled with education of the public and issuance of alerts for the medical community does seem prudent at this time.
A HealthMap/ProMED-mail map showing the location of Senegal can be accessed at
http://healthmap.org/promed/p/48. - Mod. TY]
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[9] Question of virus origin
Date: Thu 4 Apr 2014
Source: Relief Web [in French, trans. Corr. SB, edited]
http://reliefweb.int/report/guinea/l-pi ... -cialistes>
The ongoing epidemic in West Africa, of haemorrhagic fever, in part due to Ebola virus is, causing concern to experts interviewed by AFP.[Agence France Press]
This epidemic "is serious because it is still, a priori , not controlled and because there the patients are dispersed, said the French physician, Sylvain Baize , who heads the National Reference Centre (CNR) for viral hemorrhagic fevers based in Lyon.[France]
"I am very concerned because no-one has any idea how the virus came to the region and the size of the of the infected area is unclear, said Thomas Geisbert , specialist in hemorrhagic fevers at the Medical Branch of the University of Texas ( UTMB ) .
Several countries in West Africa were mobilized Friday [April 4th] against the outbreak of hemorraghic fever that has killed more than 80 people in Guinea , a little more than half due to Ebola [virus infections], while suspected cases were reported in neighboring countries , Liberia, Sierra Leone [Proven negative] and more recently in Mali .
The suspected case of a deceased hunter in Liberia who had no contact with other cases of this haemorrhagic fever "poses questions ," said Dr Baize, on Friday [4 Apr 2014]. If this case is confirmed and if it turns out that this man had no prior contact with other patients , this could be a sign that Ebola virus has "massive circulation in forest through the bats and there may be an ongoing epidemic in progress", said Dr Baize.
As with many other viruses, bats are " very probably" the natural reservoir of Ebola virus : the animals " are not affected by the virus , but are able to transmit it. The most likely hypothesis is that the epidemic (in West Africa ) is related to virus introduction via bats but that remains to be seen "commented Dr. Baize , adding , however, that other assumptions are "possible".
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Communicated by:
ProMED-mail Rapporteur Mary Marshall
[Only prospective field studies will establish which species of wildlife are the reservoirs of Ebola virus in nature. Mod. TY]
