Ebola Situation Report - 27 May 2015

Total confirmed cases (by week, 2015)

 

 
 
 

SUMMARY

  • There were 12 confirmed cases of Ebola virus disease (EVD) reported in the week to 24 May: 9 from Guinea and 3 from Sierra Leone. A total of 5 districts (3 in Guinea, 2 in Sierra Leone) reported at least one confirmed case, compared with 6 districts the previous week. The west-Guinean prefecture of Forecariah reported the most cases of any one district, and continues to present the greatest challenge in terms of response, with multiple chains of transmission over a wide geographical area (4 sub-prefectures), and the continued occurrence of cases from unknown sources of infection.
  • Cases from Guinea were reported from the western prefectures of Dubreka (3 cases) and Forecariah (5 cases), with a single case reported from the north-western prefecture of Boke, which borders Guinea-Bissau. In line with the previous week, cases in Boke and Dubreka were concentrated in the sub-prefectures of Kamsar and Tanene, respectively. The 5 cases reported from Forecariah were reported from 4 different sub-prefectures. A 4-day targeted case-finding and sensitisation campaign concluded in Forecariah on 19 May. During the course of the campaign multidisciplinary teams trained in case detection and social mobilisation visited 8023 homes, and contacted 38 557 people.
  • Of the 9 cases reported from Guinea, 7 were known contacts of a previous case, 1 (in Forecariah) arose from an unknown source of infection, and one case was not a registered contact of a previous case but, on further investigation, does have an epidemiological link to a known chain of transmission in Forecariah. The case that arose from an unknown source of infection was 1 of 3 cases in Guinea identified after post-mortem testing of community deaths. A total of 13 unsafe burials were reported in the week to 24 May, representing 4% of 335 reported burials: a decrease compared with 25 (6%) of 386 reported burials the previous week, and a marked decrease compared with 163 (43%) of 375 reported burials during the week ending 19 April 2015.
  • Because of the proximity to Guinea-Bissau of the recent cluster of cases in the Guinean prefecture of Boke, a response team from Guinea-Bissau has been deployed to the border to assess points of entry. Investigations are ongoing to trace a contact who attended the funeral of a case in Boke, and who is thought to have returned to a fishing community in Guinea-Bissau.
  • In Sierra Leone, 3 confirmed cases were reported from Freetown (2 cases), and Port Loko (1 case). In Freetown, cases were reported from two densely populated neighbourhoods, Kroo Town and ward 350, in the north and east of the city, respectively. Both cases are known contacts of recent cases, and are linked to the chain of transmission originating in Moa Wharf. One of the cases was in voluntary quarantine at the time of symptom onset, and was transferred to a nearby Ebola Treatment Centre. The second case was a high-risk contact of a previous case from Moa Wharf. After being lost to follow-up, the case developed symptoms on 15 May and was subsequently relocated to a community care centre in ward 350, and treated for malaria on 19 May. Intensive efforts are under way to identify all contacts associated with this case, and many high-risk contacts are currently in voluntary quarantine. The single case in Port Loko was reported from the chiefdom of Kaffu Bullom, and is thought to be linked to a chain of transmission from the northern district of Kambia. Having been a focus of transmission several weeks ago, Kambia has not reported a confirmed case for 10 consecutive days as at 24 May.
  • The last health worker infection in Guinea was reported on 6 April, and 14 May in Sierra Leone. There have been a total of 869 confirmed health worker infections reported from Guinea, Liberia, and Sierra Leone since the start of the outbreak, with 507 reported deaths.

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION

  • There have been a total of 27 013 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (figure 1, table 1), with 11 134 reported deaths (this total includes reported deaths among probable and suspected cases, although outcomes for many cases are unknown). A total of 9 new confirmed cases were reported in Guinea and 3 in Sierra Leone in the 7 days to 24 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 869 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 3210 43 2001
Probable 419 * 419
Suspected 12 *
Total 3641 43 2420
Liberia§ Confirmed 3151 0
Probable 1879 *
Suspected 5636 *
Total 10 666 0 4806
Sierra Leone Confirmed 8608 13 3542
Probable 287 * 208
Suspected 3811 * 158
Total 12 706 13 3908
Total Confirmed 14 969 56
Probable 2585 *
Suspected 9459 *
Total 27 013 56 11 134

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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 1546
(28)
1657
(31)
497
(11)
1833
(39)
828
(53)
Liberia§ 1911
(96)
1838
(93)
561
(33)
2060
(121)
703
(132)
Sierra Leone 4641
(163)
4948
(171)
1904
(79)
5454
(211)
2062
(279)

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Figure 2: Geographical distribution of confirmed cases reported in the week to 24 May 2015

Geographical distribution of new and total confirmed cases

 

Table 3: Cases and contacts by district/prefecture over the past 4 weeks

cases_contacts.PNG

Table 4: Location and epidemiological status of confirmed cases reported in the week to 24 May 2015

cases_admin3.PNG
 

Figure 3: Geographical distribution of new and total confirmed cases

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 187 94
Liberia* 378 192
Sierra Leone 304 221
Total 869 507

GUINEA

  • Key performance indicators for the EVD response in Guinea are shown in table 6.
  • A total of 9 confirmed cases were reported in the 7 days to 24 May (table 3, table 4, figure 2, figure 3), compared with 27 cases the previous week (table 3, figure 4). The same 3 prefectures that reported cases during the previous week, Boke, Dubreka, and Forecariah, also reported cases in the week to 24 May (figure 3).
  • Of 26 prefectures that have reported at least one confirmed case of EVD since the beginning of the outbreak, 18 have not reported a confirmed case for at least 6 weeks (figure 6). The majority of cases reported in the week to 24 May came from the western prefectures of Dubreka (3 cases) and Forecariah (5 cases; table 4, figure 4), with the remaining case reported from the north-western prefecture of Boke, which borders Guinea-Bissau (figure 2).
  • The single case from Boke was reported from the coastal sub-prefecture of Kamsar (table 3, table 4, figure 2), which reported 5 cases the previous week (table 3). The most recent case belongs to the same chain of transmission as the 5 cases reported during the previous week. As at 24 May there were 233 contacts under follow-up in the prefecture (table 3).
  • All 3 cases reported from Dubreka in the week to 24 May came from the sub-prefecture of Tanene (figure 2). All were known contacts of a previous case, although 1 was identified only after post-mortem testing. As at 24 May there were 382 contacts under follow-up in the prefecture (table 3).
  • The 5 cases reported from Forecariah were reported from 4 different sub-prefectures (table 3, table 4, figure 2). Forecariah continues to present the greatest challenge in terms of response, with multiple chains of transmission over a wide geographical area, and the continued occurrence of cases from unknown sources of infection. The single case that arose from an unknown source of infection in the week to 24 May came from Forecariah, as did 2 of 3 cases that were identified after post-mortem testing of corpses in the community. 2 cases were known contacts of a previous case. A 4-day targeted case-finding and sensitisation campaign concluded in Forecariah on 19 May. During the course of the campaign multidisciplinary teams trained in case detection and social mobilisation visited 8023 homes, and contacted 38 557 people. Only 3 instances of a refusal to cooperate with the teams were reported. As at 24 May there were 758 contacts under follow-up in the prefecture (table 3).
  • Given the proximity to Guinea-Bissau of the recent cluster of cases in the north-west Guinean prefecture of Boke (figure 2, figure 3), a response team from Guinea-Bissau has been deployed to the border with Guinea to assess points of entry. Investigations are ongoing to trace a contact who attended the funeral of a case in Boke, and who is thought to have returned to a fishing community in Guinea-Bissau.
  • A total of 594 laboratory samples were tested in the week to 24 May, including both initial and repeat testing. Including repeat positive samples taken from patients undergoing treatment, 6% of samples tested positive for EVD compared with 10% the previous week.
  • The number of reported unsafe burials decreased compared with the previous week, from 25 (6%) of 386 reported burials to 13 (4%) of 348 reported burials. This represents a marked decrease compared with 163 (43%) of 375 reported burials during the week ending 19 April 2015.
  • Locations of 8 operational Ebola treatment centres (ETCs) are shown in figure 7. No health worker infections were reported in Guinea the week to 24 May.
  • Locations of the 10 operational laboratories in Guinea are shown in figure 8.

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

Guinea_KPI_v2.PNG

Figure 4: Confirmed weekly Ebola virus disease cases reported nationally and by district 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.
  • A total of 3 confirmed cases were reported in the week to 24 May, compared with 8 the previous week (table 3, figure 5).
  • Two districts, Port Loko and Western Area Urban (Freetown), reported confirmed cases in the week to 24 May, compared with 3 districts the previous week (table 3, figure 2, 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).
  • In Freetown, cases were reported from two densely populated neighbourhoods, Kroo Town and ward 350, in the north and east of the city (figure 2), respectively. Both cases are known contacts of recent cases, and are linked to the transmission chain that originated in Moa Wharf several weeks ago. One of the cases was in voluntary quarantine at the time of symptom onset, and was transferred to a nearby Ebola Treatment Centre. The second case was a high-risk contact of a previous case from Moa Wharf. After being lost to follow-up the case developed symptoms on 15 May, and was subsequently relocated to a community care centre in ward 350 and treated for malaria on 19 May. Intensive efforts are under way to identify all contacts associated with this case, and many high-risk contacts are currently in voluntary quarantine. As at 24 May there were 298 contacts under follow-up in Freetown (table 3). The remaining case, reported from the Kaffu Bollom chiefdom of Port Loko, has an epidemiological link to a case from the northern district of Kambia. As at 24 May there were 129 contacts under follow-up in Port Loko, and 5 in Kambia (table 3).
  • The district of Kambia, which borders the Guinean prefecture of Forecariah to the north and Port Loko to the south, has not reported a case for 10 consecutive days as at 24 May (figure 6).
  • No health worker infections were reported in the week to 24 May.
  • Laboratory indicators continue to reflect a heightened degree of vigilance, with 1736 new samples tested in the week to 24 May. Less than 1% of samples tested positive.
  • Locations of the 12 operational Ebola treatment centres (ETCs) in Sierra Leone are shown in figure 7.
  • Locations of the 11 operational laboratories in Sierra Leone are shown in figure 8. 

Table 7: Key performance indicators for Sierra Leone for Phase 2 of the Ebola Response

SierraLeone_KPI_v2.PNG

 

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

View interactive map »

 

OTHER AFFECTED AND 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.
  • On 12 May, WHO received notification of a laboratory-confirmed EVD case in Italy (table 7). 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 was not considered necessary. A total of 19 contacts associated with the case are currently being monitored. None of the contacts are considered to have been at a high risk of exposure.
  • The EVD outbreak in Liberia was declared over on 9 May. The country, which had previously experienced widespread and intense transmission, completed 42 days without any new confirmed cases since the burial of the last confirmed case on 28 March. The country has now entered a 3-month period of heightened vigilance. In the week to 24 May, an average of 25 laboratory samples were tested per day.

Table 8: Ebola virus disease cases in Italy

Country Cumulative cases Contact tracing
Confirmed Probable Suspect Deaths Health-care workers Contacts under follow-up Contacts who have completed 21-day follow-up Date last patient tested negative Number of days since last patient tested negative
Italy 1 0 0 0 100% 19 - - -

 

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 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 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 – 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 includes 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 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 priority 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, Ethiopia, Guinea Bissau, Ghana, The Gambia, Mali, Senegal, and Togo. Deployments to all other priority countries are being finalized, and three subject-matter experts are providing dedicated support to countries in the areas of infection prevention and control, outbreak logistics, and coordination.
  • WHO 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. PPE modules have been delivered and forwarded to strategic locations in Senegal, Mauritania, Mali, Guinea Bissau, Cote d’Ivoire, Ghana, Togo, Niger, and Cameroon. PPE modules are currently in country and awaiting delivery to strategic locations in Benin, Gambia, and Burkina Faso. PPE modules have been dispatched to both Central African Republic and Ethiopia.
  • Further modules are being dispatched to all other unaffected countries in the WHO African Region and seven countries on the African continent in the 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 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.
  • In Guinea Bissau, WHO has deployed a logistician to assess PPE stocks and to implement a basic stock-management system. 1500 sets of PPE have arrived in Guinea Bissau to replace stocks that were damaged in a warehouse fire. In addition, WHO is deploying two epidemiologists in collaboration with Portugal, and two community engagement experts to the regions of Tombali and Gabu to strengthen surveillance and early warning systems in the country.
  • In Mali, WHO has deployed an expert on field coordination from 24 May to prepare national simulation exercises and review the national training plan.
  • In Côte d’Ivoire, WHO has deployed an expert to provide logistic support for holding centres, patient transport procedures, communications, and outbreak stock management.
  • In Mauritania, WHO continues to provide epidemiological support to the Ministry of Health for surveillance through the training of surveillance focal points, on case definitions, surveillance protocols, and data management. 

Training

  • In The Gambia, training courses for EVD Preparedness and Response were held at the central and regional level from 18 to 24 May.
  • The WHO Eastern Mediterranean Regional Office has developed a rapid-response field-training course, which was implemented in Morocco (18 to 22 May), and Jordan (24 to 29 May).
  • Priority countries that have achieved a minimum of 50% implementation of preparedness checklist activities will be encouraged to undertake an outbreak-response exercise. This exercise will involve a series of drills on elements of an EVD response, and a functional exercise to test the coordination of the Ebola operations centre. Outbreak-response exercises are planned for 8 to 18 June in Ghana and Senegal, with dates to be confirmed for Burkina Faso, Cote d’Ivoire, Gambia, Guinea Bissau, and Mali.

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
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