Ebola Situation Report - 26 August 2015

Total confirmed cases (by week, 2015)

 

 
 
 
 

SUMMARY

  • There were 3 confirmed cases of Ebola virus disease (EVD) reported in the week to 23 August, all of which were reported from Guinea. No new confirmed cases were reported from Sierra Leone for the second consecutive week. Overall case incidence has held at 3 confirmed cases per week for 4 consecutive weeks. In addition, the number of contacts under observation continues to fall, from over 800 on 16 August to approximately 600 on 23 August throughout 4 prefectures in Guinea and 2 districts in Sierra Leone. All contacts associated with the recent cluster of cases in Tonkolili, Sierra Leone, have now completed the 21-day follow-up period. However, there remains a significant risk of further transmission. All 3 cases in Guinea this week were reported from the capital, Conakry, and have generated a substantial number of high-risk contacts. One of the cases, who was detected after post-mortem testing of a community death, was one of 35 contacts to have been lost to follow-up in Conakry in the past 6 weeks.
  • All of the 3 confirmed cases reported from Guinea in the week to 23 August were identified in the Ratoma area of the capital, Conakry. The first case, a male taxi driver in his early 40s, was not a registered contact, and is thought to have worked for a short time in Conakry whilst symptomatic. Efforts are ongoing to trace any passengers who may be contacts. A male health worker who was registered as a contact after treating the taxi driver at a private clinic subsequently also tested positive for EVD. Over 40 contacts from the private clinic and household have been identified so far. The remaining case, a woman in her early 40s, was a registered contact of a previous case in Conakry but was lost to follow-up. Investigations suggest she travelled outside Conakry to consult a traditional healer in the prefecture of Dubreka before her death. She was subsequently identified as an EVD-positive community death after post-mortem testing. 600 contacts were under follow-up on 23 August in 4 western prefectures (Conakry, Coyah, Dubreka, and Forecariah), compared with approximately 800 contacts in 3 prefectures the previous week.
  • No new cases were reported from Liberia in the week to 23 August. All contacts in Liberia have now completed their 21-day follow-up period. The last 2 patients with EVD in Liberia were discharged after completing treatment and testing negative for EVD for a second time on 23 July. Surveillance continues to be strengthened, with approximately 800 samples tested for EVD in the week to 23 August.  
  • No cases were reported from Sierra Leone in the week to 23 August: the second consecutive week without a confirmed case. The last case to be diagnosed with EVD completed treatment and was discharged from an Ebola treatment centre on 24 August after testing negative twice for EVD. The number of contacts under follow-up has declined from 72 contacts across 3 districts (Tonkolili, Western Area Urban, and Western Area Rural) on 19 August to 29 contacts in Western Area Urban (Freetown) and Western Area Rural on 23 August, after all contacts associated with the Tonkolili cluster of cases completed follow-up.
  • For the first time in 4 weeks a new health worker infection was reported in the week to 23 August. The case was reported from Conakry, Guinea. There have been a total of 881 confirmed health worker infections reported from Guinea, Liberia, and Sierra Leone since the start of the outbreak, with 512 reported deaths.

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION

  • There have been a total of 28 005 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia, and Sierra Leone (figure 1, table 1) up to 23 August, with 11 287 reported deaths (this total includes reported deaths among probable and suspected cases, although outcomes for many cases are unknown). Three new confirmed cases were reported in Guinea in the week to 23 August.
  • The total number of confirmed cases is similar in males and females (table 2). Compared with children (people aged 14 years and under), adults aged 15 to 44 are approximately four times more likely to be affected in Guinea and Liberia, and three times more likely to be affected in Sierra Leone.
  • One new health worker infection was reported from Guinea in the week to 23 August. Since the start of the outbreak a total of 881 confirmed health worker infections have been reported in Guinea, Liberia, and Sierra Leone; there have been 512 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 3335 8 2075
Probable 452 * 452
Suspected 5 *
Total 3792 8 2527
Liberia§ Confirmed 3151 -
Probable 1879 -
Suspected 5636 -
Total 10 666 - 4806
Liberia** Confirmed 6 0 2
Probable 0 *
Suspected *
Total 6 0 2
Sierra Leone Confirmed 8697 1 3586
Probable 287 * 208
Suspected 4557 * 158
Total 13 541 1 3952
Total Confirmed 15 189 9
Probable 2618 *
Suspected 10 198 *
Total 28 005 9 11 287

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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 1592
(29)
1737
(32)
529
(11)
1898
(41)
858
(55)
Liberia§ 1911
(96)
1838
(93)
561
(33)
2060
(121)
703
(132)
Sierra Leone 4792
(168)
5081
(175)
1978
(82)
5592
(216)
2129
(288)

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Figure 2: Geographical distribution of confirmed cases reported in the week to 23 August 2015

Geographical distribution of new and total confirmed cases

Table 3: Cases and contacts by district/prefecture/county over the past 3 weeks

district_table.png

Data are based on official information reported by ministries of health. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results. *Data as of 23 August 2015 for Guinea and Sierra Leone and 20 August 2015 for Liberia. Includes Freetown.

 

Table 4: Location and epidemiological status of confirmed cases reported in the 3 weeks to 23 August 2015

chiefdom_table.png

Sub-prefectures/chiefdoms/districts that reported one or more confirmed cases in the 7 days to 23 August are highlighted. *Epi-link refers to cases who were not registered as contacts of a previous case (possibly because they refused to cooperate or were untraceable), but who, after further epidemiological investigation, were found to have had contact with a previous case, OR refers to cases who are resident or are from a community with active transmission in the past 21 days. Includes cases under epidemiological investigation. §A case that is identified as a community death can also be registered as a contact, or subsequently be found to have had contact with a known case (epi-link), or have no known link to a previous case. **Includes Freetown. *** One of the cases was a registered contact that was lost to follow-up.

 

Figure 3: Geographical distribution of new and total confirmed cases in Guinea, Liberia and Sierra Leone

Geographical distribution of new and total confirmed cases

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

Country Cases Deaths
Guinea 196 99
Liberia* 378 192
Sierra Leone 307 221
Total 881 512

GUINEA

  • Key performance indicators for the EVD response in Guinea are shown in table 6.
  • Three confirmed cases were reported from Conakry in the week to 23 August (table 3, table 4, figure 2, figure 3).
  • All 3 cases in Conakry were reported from the Ratoma area of the city. The first case, a male taxi driver in his early 40s, was not a registered contact, and is thought to have worked for a short time in Conakry whilst symptomatic. Efforts are ongoing to trace any passengers who may be contacts. A male health worker who was registered as a contact after treating the taxi driver at a private clinic subsequently also tested positive for EVD. Over 40 contacts from the private clinic and household have been identified so far. The remaining case, a woman in her early 40s, was a registered contact of a previous case in Conakry but was lost to follow-up. Investigations suggest she travelled outside Conakry to consult a traditional healer in the prefecture of Dubreka before her death. She was subsequently identified as an EVD-positive community death after post-mortem testing.  
  • An interim analysis of the Ebola ça suffit! ring vaccination trial in Guinea suggests that the investigational rVSV-ZEBOV Ebola vaccine protects people exposed to EVD. The trial will continue in Guinea, with all rings around confirmed cases now receiving immediate vaccination. Previously, rings were randomly allocated to receive either immediate vaccination or vaccination 21 days after the confirmation of a case.
  • 600 contacts remain under follow-up in 4 western prefectures in Guinea (Conakry, Coyah, Dubreka, and Forecariah), compared with 796 in 3 prefectures the previous week (table 3). 371 contacts are located in Conakry, 220 in Forecariah, 8 in Dubreka, and 1 in Coyah.
  • There was 1 (0.2%) unsafe burial reported in Guinea out of 573 recorded community deaths in the week to 23 August, compared with 3 (0.5%) unsafe burials out of 577 recorded community deaths in the previous week.
  • Including both initial and repeat testing, a total of 803 laboratory samples were tested in the week to 23 August. Most tests (87% in the week to 23 August) are of post-mortem swabs taken to rule out EVD as the cause of death.
  • Locations of the 8 operational Ebola treatment centres (ETCs) are shown in figure 7. One health worker infection was reported from Guinea in the week to 23 August.
  • Locations of the 10 operational laboratories in Guinea are shown in figure 8. 

Table 6: Key performance indicators for Guinea

sierraleone_v2.png

For definitions of key performance indicators see Annex 2. Data are given for 7-day periods. *Includes repeat samples. Data missing for 0–3% of cases. #Outcome data missing for 0–5% of hospitalized confirmed cases. 

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

guinea_facet_plot.png

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SIERRA LEONE

  • Key performance indicators for the EVD response in Sierra Leone are shown in table 7.
  • For the second consecutive week, no cases were reported from Sierra Leone in the week to 23 August.
  • The last case to be treated for EVD in an Ebola treatment centre was discharged on 24 August after testing negative twice for EVD.
  • The total number of contacts under follow-up has declined from 72 contacts across 3 districts (Tonkolili, Western Area Urban, and Western Area Rural) on 19 August to 29 contacts in Western Area Urban (Freetown) and Western Area Rural on 23 August, after all contacts associated with the Tonkolili cluster of cases completed follow-up. All remaining contacts are due to complete follow-up on 29 August.
  • Locations of the 10 operational Ebola treatment centres (ETCs) in Sierra Leone are shown in figure 7. No health worker infections were reported in the week to 23 August.
  • Laboratory indicators continue to reflect a heightened degree of vigilance, with 1805 new samples tested in the 7 days to 23 August. No new samples tested positive for EVD. Most tests (78% in the week to 23 August) are of post-mortem swabs taken to rule out EVD as the cause of death.
  • Locations of the 9 operational laboratories in Sierra Leone are shown in figure 8. 

Table 7: Key performance indicators for Sierra Leone

sierraleone_v2.png

For definitions of key performance indicators see Annex 2. Data are for 7-day periods. §Laboratory data missing for 14 July. Data missing for 4–12% of cases. #Outcome data missing for 25–75% of hospitalized confirmed cases. An outcome is known for only 6 hospitalized, confirmed cases in each April and May. 

 

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

sl_facet_plot.png

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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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OTHER AFFECTED AND PREVIOUSLY AFFECTED COUNTRIES

  • Liberia was declared free of Ebola transmission on 9 May 2015, after reporting no new cases for 42 consecutive days. The country subsequently entered a 3-month period of heightened surveillance. On 29 June, this heightened surveillance detected an EVD-positive community death in Margibi County, Liberia—the first new confirmed case reported from the country since 20 March. The case was a 17-year-old male who first became ill on 21 June, died on 28 June, and subsequently tested positive for EVD. As at 12 July, 5 contacts associated with the first-detected case have since been confirmed as EVD-positive. Of the 6 confirmed cases reported since 29 June, 2 have died, and the remaining 4 have now all been discharged after treatment. The last case was discharged after testing negative for EVD for a second time on 23 July. All contacts have now completed follow-up.
  • Seven countries (Italy, 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.

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

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

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PREPAREDNESS OF COUNTRIES TO RAPIDLY DETECT AND RESPOND TO AN EBOLA EXPOSURE

  • The introduction of an EVD case into unaffected countries remains a risk as long as cases exist in any country. With adequate preparation, however, such an introduction can be contained through a timely and effective 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 support visits by preparedness-strengthening teams (PSTs) to help identify and prioritize gaps and needs, direct technical assistance, and provide technical guidance and tools.

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

Location of Ebola treatment centres 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—Benin, Burkina Faso, Cameroon, Central African Republic, Democratic Republic of the Congo, Ethiopia, Gambia, Ghana, Mauritania, Niger, Nigeria, South Sudan, and Togo. The criteria used to prioritize countries include the geographical proximity to affected countries, the magnitude of trade and migration links, and the relative strength of their health systems.
  • Since 20 October 2014, PSTs have provided technical support in 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 table-top exercises, and field simulations have helped to identify key areas for improvement. Each country has a tailored plan to strengthen operational readiness.
  • From October 2014 to August 2015 WHO has undertaken over 267 field deployments to priority countries to assist with the implementation of national plans.
  • WHO provides personal protective equipment (PPE) modules containing minimum stocks to cover staff protection and other equipment needs to support 10 beds for 10 days for all staff with essential functions. PPE modules have been delivered or are in the process of being delivered to all countries on the African continent. In addition, all countries have received 1 PPE training module.
  • Contingency stockpiles of PPE are in place in the United Nations Humanitarian Response Depots (UNHRD) in Accra and Dubai, and are 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 activities have provided support on a country-by-country basis. Activities in the last week are highlighted below.
  • In Benin, training in infection prevention and control (IPC) was carried out by the ministry of health with support from WHO. Further IPC training is being planned.
  • In Cameroon, a WHO logistician supported the ministry of health to assess storage capacities, preparedness stock levels, and plan new EVD treatment centres and warehouses.
  • In Guinea Bissau, preparedness support continues to be provided at the central level, and in two priority regions (Tombali and Gabu) through WHO sub-offices. Weekly progress updates are undertaken to identify and address any issues. Activities implemented by WHO and partners during the reporting period with national authorities include: regional meetings in Tombali and Gabu held by the EVD preparedness officer; border post visits and assessments in Gabu region by the WHO Representative and sub-regional teams; a simulation exercise to test capacity for case isolation, safe sample collection, and shipment; and continued provision of technical support and equipment to health centres.

EVD preparedness officers

  • Dedicated EVD preparedness officers have been deployed to support the implementation of country preparedness plans, coordinate partners, provide a focal point for inter-agency collaboration, offer specific technical support in their respective areas of expertise, and develop capacity of national WHO staff. Preparedness officers are currently deployed to Benin, Cameroon, Central African Republic, Côte d’Ivoire, Ethiopia, Gambia, Ghana, Guinea-Bissau, Mali, Mauritania, Niger, Senegal, and Togo. 

Training, exercises, and simulations

  • Priority countries that have achieved a minimum of 50% implementation of preparedness checklist activities are encouraged to undertake a series of drills on elements of an EVD response and a functional exercise to test the coordination of the Ebola operations centre.
  • From 17 to 21 August a planning visit to Gambia took place to plan a series of simulation exercises in the country. Further simulations are also being scheduled in Benin, Burkina Faso, Ethiopia, Ghana, and Mauritania.
  • Rapid-response team trainings are currently taking place in Banjul, Gambia, and are being planned for points-of-entry in Mauritania and for clinical management and IPC in Côte d’Ivoire.

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 that share a border with 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, and technical institutions and networks in the Global Outbreak Alert and Response Network (GOARN). Agencies responsible for coordinating 4 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
Proportion of EVD- positive reported community deaths

# of community deaths for which a sample was taken 

# of community deaths 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