Ebola Situation Report - 13 May 2015

Total confirmed cases (by week, 2015)

 

 
 
 

SUMMARY

  • A total of 9 confirmed cases of Ebola virus disease (EVD) was reported in the week to 10 May: the lowest weekly total this year. Guinea reported a total of 7 cases, Sierra Leone reported 2. For the first time since the beginning of the outbreak in Sierra Leone, the country reported zero confirmed cases for more than 2 consecutive days in the week to 10 May. As at 12 May, Sierra Leone has reported 8 consecutive days without a confirmed case. The EVD outbreak in Liberia was declared over on 9 May, after 42 complete days elapsed since the burial of the last confirmed case. The country has now entered a 3-month period of heightened vigilance. WHO will maintain an enhanced presence in the country until the end of 2015, with a particular focus on areas that border Guinea and Sierra Leone.
  • Of 55 districts in Guinea, Liberia, and Sierra Leone that have reported one or more confirmed cases of EVD since the outbreak began, 43 have not reported a case for over 6 weeks.
  • Of the 7 confirmed cases reported from Guinea, 6 were reported from the prefecture of Forecariah, which has been the focus of transmission for several weeks. Of those 6 cases, 4 were reported from the central sub-prefecture of Moussayah, which borders the Sierra Leonean district of Kambia. Kaliah and Sikhourou, the sub-prefectures to the west and north-east of Moussayah, respectively, each reported 1 confirmed case. The remaining case in Guinea was reported from Dubreka prefecture. The case was identified post mortem in a community setting. Investigations have as yet been unable to establish a link with a previously reported case.
  • In total, 4 of the 7 cases reported from Guinea in the week to 10 May were identified after post-mortem testing. One of the 7 cases was a registered contact of a previously reported case. A total of 529 laboratory samples were tested in the week to 10 May, although this total includes both initial and repeat testing. The number of reported unsafe burials declined for a third consecutive week, to 23 out of 368 reported community deaths. These indicators suggest that tracking transmission chains is still challenging, and there remains a possibility of an increase in case incidence and/or geographical spread in coming weeks. The absence of an established epidemiological link between the case in Dubreka and a known chain of transmission is of particular concern. Preliminary reports from the prefecture since 10 May indicate that the case has resulted in at least 3 additional confirmed cases.
  • Both cases reported from Sierra Leone occurred in the Moa Wharf area of the East 1 Chiefdom of the capital, Freetown. The cases are a mother and her 10-year old daughter, both of whom are known contacts of a previous case in the Moa Wharf area, and were under quarantine at the time of symptom onset. After treatment at the Ebola Treatment Centre in Hastings, the mother has now tested negative for EVD for a second time. The daughter is still EVD-positive and remains in treatment.
  • For the fourth consecutive week, no health worker infections were reported in the week to 10 May. There have been a total of 868 confirmed health worker infections reported from Guinea, Liberia, and Sierra Leone since the start of the outbreak, with 507 reported deaths. However, on 12 May WHO received notification of a laboratory-confirmed EVD case in Italy. The case is a volunteer health worker who returned to Italy from Sierra Leone on 7 May. The patient developed symptoms on 10 May, and was transported on 11 May to the infectious diseases ward of the Hospital of Sassari, Sardinia. Clinical samples were confirmed as EVD positive on 12 May, and the patient was securely transferred to the National Institute for Infectious Diseases in Rome. Because onset of symptoms occurred 72 hours after the case’s last flight, contact tracing of passengers who shared flights with the case is not considered necessary.

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION

  • There have been a total of 26 724 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (figure 1, table 1), with 11 065 reported deaths (this total includes reported deaths among probable and suspected cases, although outcomes for many cases are unknown). A total of 7 new confirmed cases were reported in Guinea and 2 in Sierra Leone in the 7 days to 10 May. The outbreak in Liberia was declared over on 9 May.
  • The total number of confirmed cases is similar in males and females (table 2). Compared with children (people aged 14 years and under), people aged 15 to 44 are approximately 3 to 4 times more likely to be affected. People aged 45 and over are 4 to 5 times more likely to be affected than children.
  • A total of 868 confirmed health worker infections have been reported in Guinea, Liberia, and Sierra Leone; there have been 507 reported deaths (table 5).

Figure 1: Confirmed, probable, and suspected EVD cases worldwide

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Table 1: Confirmed, probable, and suspected EVD cases in Guinea, Liberia, and Sierra Leone

Country Case definition Cumulative cases Cases in past 21 days Cumulative deaths
Guinea Confirmed 3174 38 1977
Probable 415 * 415
Suspected 8 *
Total 3597 38 2392
Liberia§ Confirmed 3151 0
Probable 1879 *
Suspected 5574 *
Total 10 604 0 4769
Sierra Leone Confirmed 8597 22 3538
Probable 287 * 208
Suspected 3639 * 158
Total 12 523 22 3904
Total Confirmed 14 922 60
Probable 2581 *
Suspected 9221 *
Total 26 724 60 11 065

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Table 2: Cumulative number of confirmed cases by sex and age group in Guinea, Liberia, and Sierra Leone

Country Cumulative cases
By sex*
(per 100 000 population)
By age group
(per 100 000 population)
Male Female 0-14 years 15-44 years 45+ years
Guinea 1527
(28)
1635
(30)
493
(11)
1809
(39)
817
(52)
Liberia§ 1911
(96)
1835
(93)
561
(33)
2056
(120)
704
(132)
Sierra Leone 4654
(163)
4953
(171)
1911
(79)
5454
(211)
2065
(279)

View data »

Figure 2: Geographical distribution of confirmed cases reported in the week to 10 May 2015

Geographical distribution of new and total confirmed cases

 

Table 3: Location and epidemiological status of confirmed cases reported in the week to 10 May 2015

  Prefecture/district Sub-prefecture/Chiefdom    Cases Contact list Epi-Link* Unknown source of infection Community death§
Guinea  Forecariah Kaliah 1 1 0 0 0
Moussayah 4 0 4 0 2
Sikhourou      1 0 1 0 1
Dubreka      Dubreka-centre 1 0 0 1 1

Sub-Total

7 1 5 1 4
Sierra Leone  Western Area Urban Moa Wharf 2 2 0 0 0

Sub-Total

2 2 0 0 0
Total     9 3 5 1 4

 

Figure 3: Geographical distribution of new and total confirmed cases

Geographical distribution of new and total confirmed cases

View interactive map »

GUINEA

  • Key performance indicators for the EVD response in Guinea are shown in table 4.
  • A total of 7 confirmed cases were reported in the 7 days to 10 May (table 3, figure 3), compared with 9 cases the previous week (figure 4).
  • Of 26 prefectures that have reported at least one confirmed case of EVD since the beginning of the outbreak, 19 have not reported a confirmed case for over 6 weeks (figure 6).
  • Of the 7 confirmed cases reported from Guinea, 6 were reported from the western prefecture of Forecariah, which has been the focus of transmission for several weeks and accounted for all cases reported in the previous week. Of the 6 cases reported from Forecariah, 4 were reported from the central sub-prefecture of Moussayah, which borders the Sierra Leonean district of Kambia (figure 2, table 3). Kaliah and Sikhourou, the sub-prefectures to the west and north-east of Moussayah, respectively, each reported 1 confirmed case. The previous week, 6 of Forecariah’s 10 sub-prefectures reported a confirmed case.
  • The remaining case in Guinea was reported from Dubreka prefecture, which lies to the immediate north of the capital, Conakry (figure 2, figure 3). The case was identified post mortem in a community setting in the sub-prefecture of Khorira, and epidemiological investigations have as yet been unable to establish a link with a previously reported case. Dubreka had not reported a confirmed case for 2 weeks. Preliminary reports from the prefecture since 10 May indicate that the case has resulted in at least 3 additional confirmed cases.
  • In total, 4 of the 7 cases reported from Guinea in the week to 10 May were identified after post-mortem testing of deaths in community settings (table 3). One of the 7 cases was a registered contact.
  • The number of reported unsafe burials declined for a third consecutive week, to 23 out of 368 reported community deaths.
  • A total of 529 laboratory samples were tested in the week to 10 May, although this total includes both initial and repeat testing. A total of 6% of samples tested positive for EVD.
  • Taken together, key performance indicators suggest that tracking transmission chains is still challenging, and there remains a possibility of an increase in case incidence and/or geographical spread in coming weeks. The absence of an established epidemiological link between the case in Dubreka and a known chain of transmission is of particular concern.
  • Locations of 8 operational Ebola treatment centres (ETCs) are shown in figure 7. For the fourth consecutive week, no health worker infections were reported in the week to 10 May.
  • Locations of the 10 operational laboratories in Guinea are shown in figure 8.

Table 4: Key performance indicators for Guinea for Phase 2 of the Ebola Response

Figure 4: Confirmed weekly Ebola virus disease cases reported nationally and by district from Guinea

Guinea_facet_plot.png

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Table 5: Ebola virus disease infections in health workers in Guinea, Liberia and Sierra Leone

Country Cases Deaths
Guinea 187 94
Liberia* 378 192
Sierra Leone 303 221
Total 868 507

SIERRA LEONE

  • Key performance indicators for the EVD response in Sierra Leone are shown in table 6.
  • A total of 2 confirmed cases were reported in the week to 10 May, compared with 9 the previous week (figure 5).
  • One district reported at least one confirmed case in the week to 10 May, compared with 2 districts the previous week and 3 districts the week before that (figure 3, figure 6). Of 14 districts in Sierra Leone that have ever reported a confirmed case since the beginning of the outbreak, 9 have not reported a confirmed case for over 6 weeks (figure 6).
  • For the first time since the beginning of the outbreak in Sierra Leone, the country reported zero confirmed cases for more than 2 consecutive days in the week to 10 May. As at 12 May, Sierra Leone had reported zero cases for 8 consecutive days.
  • Both cases reported from Sierra Leone occurred in the Moa Wharf area of the East 1 Chiefdom of the capital, Freetown (table 3, figure 2). The cases are a mother and her 10-year old daughter, both of whom are known contacts of a previous case in the Moa Wharf area, and were under quarantine at the time of symptom onset. After treatment at the Ebola Treatment Centre in Hastings, the mother has now tested negative for EVD for a second time. The daughter is still EVD-positive and remains in treatment.
  • The Sierra Leonean district of Kambia, which has been the country’s main focus of transmission for over a month, reported zero cases in the week to 10 May (figure 3).
  • Laboratory indicators continue to reflect a heightened degree of vigilance, with 1756 new samples tested in the week to 10 May, compared with 1635 samples the previous week. Less than 1% of samples tested positive.
  • Locations of the 13 operational Ebola treatment centres (ETCs) in Sierra Leone are shown in figure 7. One ETC in the district of Tonkolili closed in the week to 10 May. No new health worker infections were reported for the fifth consecutive week.
  • Locations of the 11 operational laboratories in Sierra Leone are shown in figure 8. One laboratory in the district of Tonkolili closed in the week to 10 May.

Table 6: Key performance indicators for Sierra Leone for Phase 2 of the Ebola Response

 

Figure 5: Confirmed weekly Ebola virus disease cases reported nationally and by district from Sierra Leone

SL_facet_plot.png

View data »

 

Figure 6: Days since last confirmed case by district in Guinea, Liberia, and Sierra Leone

Days since last reported confirmed case by district in Guinea, Liberia, and Sierra Leone

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PREVIOUSLY AFFECTED COUNTRIES

  • Six countries (Mali, Nigeria, Senegal, Spain, the United Kingdom and the United States of America) have previously reported a case or cases imported from a country with widespread and intense transmission.
  • The EVD outbreak in Liberia was declared over on 9 May. The country, which had previously experienced widespread and intense transmission, completed 42 days since the burial of the last confirmed case without any new confirmed cases. The country has now entered a 3-month period of heightened vigilance. 

Figure 7: Location of Ebola treatment centres in Guinea, Liberia, and Sierra Leone

Location of Ebola treatment centres in Guinea, Liberia and Sierra Leone

  • The introduction of an EVD case into unaffected countries remains a risk for as long as cases are reported in any country. With sufficient levels of preparation, however, such introductions of the disease can be contained with a rapid and adequate response.
  • WHO’s preparedness activities aim to ensure all countries are ready to effectively and safely detect, investigate and report potential EVD cases, and to mount an effective response. WHO provides this support through country visits by preparedness-strengthening teams (PSTs), direct technical assistance to countries, and the provision of technical guidance and tools.

Figure 8: Location of laboratories in Guinea, Liberia, and Sierra Leone

Location of laboratories in Guinea, Liberia, and Sierra Leone

View interactive map »

Priority countries in Africa

  • The initial focus of support by WHO and partners is on highest priority countries – Côte d’Ivoire, Guinea Bissau, Mali and Senegal – followed by high priority countries – Burkina Faso, Benin, Cameroon, Central African Republic, Democratic Republic of the Congo, Ethiopia, Gambia, Ghana, Mauritania, Nigeria, South Sudan, Niger and Togo. The criteria used to prioritize countries include geographical proximity to affected countries, trade and migration patterns, and strength of health systems.
  • Since 20 October 2014, preparedness-strengthening teams (PSTs) have provided technical support in 14 countries: Benin, Burkina Faso, Cameroon, Central African Republic, Côte d'Ivoire, Ethiopia, Gambia, Ghana, Guinea Bissau, Mali, Mauritania, Niger, Senegal, South Sudan, and Togo. Technical working group meetings, field visits, high-level exercises and field simulations have helped to identify key areas for improvement. Each country has a tailored plan to strengthen operational readiness. WHO and partners are deploying staff to the 14 countries to assist with the implementation of national plans.
  • Follow-up missions in the four highest priority countries (Côte d’Ivoire, Senegal, Mali, and Guinea Bissau) were able to strengthen cross-border surveillance and the sharing of outbreak data under the framework of the International Health Regulations (IHR: 2005), as well as support other technical areas.
  • A programme to roll-out longer term support to countries is ongoing, with staff levels being increased in WHO country offices to coordinate preparedness activities. EVD preparedness officers have been recruited to WHO Country Offices in Benin, Côte d’Ivoire, Guinea Bissau, Ghana, The Gambia, Ethiopia, Mali, and Senegal. Deployments to all other priority countries are being finalized, and two subject-matter experts are providing dedicated support to countries in the areas of outbreak logistics and coordination.
  • Standard viral haemorrhagic fever modules have been delivered to Mali, Guinea-Bissau, Côte d'Ivoire, Senegal, Mauritania, Burkina Faso, Benin, Chad, Gambia, Niger, Nigeria, Togo, Egypt, and Ghana. The personal protective equipment (PPE) modules contain minimum stocks to cover staff protection and other equipment needs to support 10 beds for 10 days for all staff with essential functions.
  • Further modules are being dispatched to all other unaffected countries in the African Region and seven countries on the African continent in WHO Eastern Mediterranean Region.
  • Contingency stockpiles of PPE are in place in Accra and in Dubai, and will be made available to any country in the event that they experience a shortage.

Follow-up support to priority countries

  • Following the initial PST assessment missions to the 14 priority countries undertaken in 2014, a second phase of preparedness strengthening has been initiated to achieve the following goals:
    • Provide tailored, targeted technical support to strengthen EVD capacities in human resources; operationalize plans; test and improve procedures through field exercises and drills; and support the implementation of preparedness plans with financial and logistics support;
    • Provide leadership and coordinate partners to fully support one national plan;
    • Contribute to the International Health Regulations (2005) strengthening of national core capacities and the resilience of health systems.
  • WHO has deployed an epidemiologist to Mauritania to strengthen surveillance and information management for viral haemorrhagic fevers over a period of four weeks.
  • WHO has deployed two experts to Senegal to strengthen the logistical capacity, support the roll-out of the national training plan and preparations for a functional outbreak exercise. WHO is also deploying three epidemiologists to Senegal’s border regions with Guinea.
  • In Benin, WHO is currently providing support to training trainers on safe and dignified burials, and on the Ebola Treatment Centre in Cotonou.

Training

  • A clinical management training of trainers is ongoing in Senegal this week. Participants from Cameroon, Mauritania, Benin, Togo, Niger, Côte D’Ivoire, and Burkina Faso will attend. The preparedness strengthening team will continue to support the roll-out of training at country level following the training of trainers.
  • In The Gambia, training courses for EVD Preparedness and Response will be held at the central and regional level on 18 May.
  • A follow-up visit to Ghana is planned for early June, focusing on rapid response teams, ETCs, infection prevention and control, and logistic support.

Surveillance and preparedness indicators

  • Indicators based on surveillance data, case-management capacity, laboratory testing and equipment stocks continue to be collected on a weekly basis from the four countries neighbouring affected countries: Côte d’Ivoire, Guinea-Bissau, Mali, and Senegal.
  • An interactive preparedness dashboard based on the WHO EVD checklist is now available online.

 

ANNEX 1: COORDINATION OF THE EBOLA RESPONSE ALONG 4 LINES OF ACTION

WHO continues to work with many partners in response to the EVD outbreak, including the African Union, the Economic Community of West African States, the Mano River Union, national governments, non-governmental organizations and UN agencies. Agencies responsible for coordinating four key lines of action in the response are given below.

Lines of action Lead agency
Case management WHO
Case finding, laboratory services and contact tracing WHO
Safe and dignified burials International Federation of Red Cross and Red Crescent Societies (IFRC)
Community engagement and social mobilization UNICEF

 

ANNEX 2: DEFINITIONS OF PHASE 2 KEY PERFORMANCE INDICATORS

Indicator Numerator Numerator source Denominator Denominator source
Cases and deaths
Number of confirmed cases # of confirmed cases

Guinea: Daily WHO situation reports

Sierra Leone: Daily Ministry of Health Ebola situation reports

N/A N/A
Number of confirmed deaths # of confirmed deaths

Guinea: Daily WHO situation reports

Sierra Leone: Daily Ministry of Health Ebola situation reports

N/A N/A
Number of confirmed deaths that occurred in the community # of deaths in the community with positive EVD swab results

Guinea: Weekly WHO situation reports

Sierra Leone: Daily Ministry of Health situation reports

N/A N/A
Diagnostic services
Number of samples tested and percentage with positive EVD results

# of new samples tested

# of new samples tested with a positive EVD result

Guinea: Laboratory database

Sierra Leone: Daily Ministry of Health Ebola situation reports

N/A

# of new samples tested

Guinea: Laboratory database

Sierra Leone: Daily Ministry of Health Ebola situation reports

Contact tracing
Percent of new confirmed cases from registered contacts # of new confirmed cases registered as a contact

Guinea: Weekly WHO situation reports

Sierra Leone: Weekly Ministry of Health Surveillance Report

of new confirmed cases

Guinea: Daily WHO situation reports

Sierra Leone: Daily Ministry of Health Ebola situation reports

Hospitalization
Time between symptom onset and case hospitalization (days) Time between symptom onset and hospitalization of confirmed, probable or suspected case (geometric mean # of days) Clinical investigation records N/A N/A
Outcome of treatment
Case fatality rate (among hospitalized cases) # of deaths among hospitalized cases (confirmed) Clinical investigation records # of hospitalized cases (confirmed) with a definitive survival outcome recorded Clinical investigation records
Infection Prevention and Control (IPC) and Safety
Number of newly infected health workers # of newly infected health workers

Guinea / Sierra Leone: Daily WHO situation reports

N/A N/A
Safe and dignified burials
Number of unsafe burials reported # of reports/alerts of burials that were not known to be safe

Guinea: Weekly WHO situation reports

N/A N/A
Social mobilization
Number of districts with at least one security incident or other form of refusal to cooperate # of districts with at least one security incident or other form of refusal to cooperate in the past week

Guinea: Daily WHO situation reports

Sierra Leone: UNICEF

N/A N/A