Ebola Situation Report - 6 May 2015

Total confirmed cases (by week, 2015)

 

 
 
 
 

SUMMARY

  • A total of 18 confirmed cases of Ebola virus disease (EVD) was reported in the week to 3 May: Guinea and Sierra Leone each reported 9 cases. This is the lowest weekly total this year, and comes after a month-long period during which case incidence fluctuated between 30 and 37 confirmed cases per week. That both countries have each reported fewer than 10 cases is encouraging, but it is important to guard against complacency. Liberia has reported fewer than 10 cases per week since the start of January this year, but the outbreak will be declared to have ended only if no new cases are reported up to 9 May, which marks 42 complete days since the burial of the last confirmed case.
  • A total of 9 cases were reported from Forecariah prefecture in Guinea, with the remaining 9 cases reported from the two Sierra Leonean districts of Kambia (which borders Forecariah) and Western Area Urban, which includes the capital, Freetown. This is the lowest total number of districts to report a confirmed case in the 3 most-affected countries since May 2014. Of 55 districts in Guinea, Liberia, and Sierra Leone that have reported one or more confirmed cases of EVD since the outbreak began, 41 have not reported a case for over 6 weeks.
  • Forecariah was the only prefecture in Guinea to report confirmed cases in the week to 3 May, compared with 5 prefectures that reported at least one case the previous week. However, it is a large prefecture, and the 9 reported cases were widely dispersed throughout 6 separate sub-prefectures. Additionally, 5 of the 9 reported cases were identified post mortem after the investigation of deaths in community settings, although 1 of those 5 was a registered contact of a previous case. In total, 4 of the 9 cases were registered contacts of a previous case. There were also 36 unsafe burials reported from 7 prefectures in the week to 3 May. This represents 10% of a total of 368 recorded deaths in the 7 prefectures. A total of 374 laboratory samples were tested in the week to 3 May, although data are missing from 1 laboratory. 4% tested positive for EVD (this includes repeat testing). Taken together, 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 9 cases reported from Sierra Leone were divided between 2 distinct geographical clusters. Most (5) of the cases were reported from the district of Kambia, which also reported 8 cases in the previous week. Within the district, cases were concentrated in the Chiefdoms of Magbema (4 cases) and Gbinle Dixing (1 case), the latter of which directly borders the Guinean prefecture of Forecariah. All of the remaining 4 cases were reported from the Moa Wharf area of the East 1 Chiefdom of Freetown. Of the 9 reported cases, 3 were identified after post-mortem investigation of deaths that occurred in a community setting: 1 in Moa Wharf and 2 in Magbema. In addition, only 2 of the 9 cases were identified registered contacts of a previous case. However, after further investigation, an additional 5 of the 9 cases were found to have an epidemiological link to a known chain of transmission. Laboratory indicators continue to reflect a heightened degree of vigilance, with 1654 new samples tested in the week to 3 May. Less than 1% tested positive.
  • The last confirmed case in Liberia died on 27 March and was buried on 28 March. Heightened vigilance is being maintained throughout the country. In the week to 3 May, 319 new laboratory samples were tested for EVD, with no confirmed cases.
  • For the third consecutive week, no new health worker infections were reported in the week to 3 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.

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION

  • There have been a total of 26 593 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (figure 1, table 1), with 11 005 reported deaths (outcomes for many cases are unknown). A total of 9 new confirmed cases were reported in Guinea, 0 in Liberia, and 9 in Sierra Leone in the 7 days to 3 May.
  • The total number of confirmed and probable 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 three times more likely to be affected. People aged 45 and over are three to five 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 6). An additional 3 cases of health worker infection were added to the cumulative total for Liberia this week after an investigation led to the reclassification of historical cases.

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 3167 50 1971
Probable 415 * 415
Suspected 7 *
Total 3589 50 2386
Liberia Confirmed 3151 0
Probable 1879 *
Suspected 5534 *
Total 10 564 0 4716
Sierra Leone Confirmed 8595 32 3537
Probable 287 * 208
Suspected 3558 * 158
Total 12 440 32 3903
Total Confirmed 14 913 83
Probable 2581 *
Suspected 9099 *
Total 26 593 82 11 005

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Table 2: Cumulative number of confirmed and probable 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 1711
(31)
1862
(34)
560
(12)
1983
(43)
982
(63)
Liberia 2959
(149)
2893
(147)
994
(58)
3171
(186)
1209
(226)
Sierra Leone 5532
(194)
5885
(203)
2376
(98)
6331
(245)
2498
(338)

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Figure 2: Geographical distribution of confirmed cases reported in the week to 3 May 2015

Geographical distribution of new and total confirmed cases

 

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

  Prefecture/district Sub-prefecture/Chiefdom    Cases Contact list Epi-Link Unknown source of infection Community death
Guinea Forecariah Allasoyah      1          1 1
Farmoriah 3     3 2
Forecariah-centre       1 1      
Kallia 1 1     1
Moussayah 2 1   1 1
Sikhourou 1 1      
Total     9 4 0 5 5
Sierra Leone  Kambia Magbema 4 2   2 2
Gbleh Dixing 1   1    
Western Area Urban      Moa Wharf 4   4   1
Total     9 2 5  2 3
Grand total     18 6 5 7 8

 

Figure 3: Geographical distribution of new and total confirmed cases

Geographical distribution of new and total confirmed cases

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GUINEA

  • Key performance indicators for the EVD response in Guinea are shown in table 4.
  • A total of 9 confirmed cases were reported in the 7 days to 3 May (figure 4), compared with 22 cases the previous week.
  • The western prefecture of Forecariah, which in the previous week accounted for 77% of all cases, was the only prefecture to report confirmed cases in the week to 3 May (figure 2; figure 3; figure 7). By contrast, 5 prefectures reported at least one case the previous week. The last time that just a single prefecture reported a confirmed case was July 2014. 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 over 6 weeks (figure 7).
  • Forecariah is a large prefecture which borders the Sierra Leonean district of Kambia to the south and the Guinean prefectures of Conakry, Coyah, and Kindia to the north (figure 2). The 9 cases reported from the prefecture were widely distributed, with cases reported from 6 of 9 sub-prefectures (table 3; figure 2). However, 3 of all cases occurred in the southern sub-prefecture of Farmoriah, which directly borders the Kambian Chiefdom of Gbinle Dixing, in Sierra Leone, which also reported a confirmed case in the week to 3 May.
  • Despite the low number of cases, a substantial proportion arose from unknown sources of infection. A total of 5 of the 9 reported cases were identified post mortem after the investigation of deaths in community settings, although 1 of these cases was a registered contact. In total, 4 of the 9 cases was a registered contact of a previous case. Of the 5 cases that were not previously registered contacts, none have so far had an epidemiological link to a known case established, although investigations are ongoing.
  • There were also 36 unsafe burials reported from 7 prefectures in the week to 3 May. This represents 10% of a total of 368 recorded deaths in the 7 prefectures, compared with 20% of a total of 328 recorded deaths the previous week.
  • A total of 374 laboratory samples were tested in the week to 3 May, although data are missing from 1 laboratory. Of those 374 samples, 4% tested positive for EVD (this includes repeat testing). A total of 368 (99%) were tested within one day of collection.
  • Locations of 8 operational Ebola treatment centres (ETCs) are shown in figure 8. For the third consecutive week, no health worker infections were reported in the week to 3 May.
  • Locations of the 10 operational laboratories in Guinea are shown in figure 9. Two new laboratories opened in Conakry in the week to 3 May.

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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LIBERIA

  • Key performance indicators for the EVD response in Liberia are shown in table 5.
  • No new confirmed cases were reported from Liberia in the week to 3 May (figure 3; figure 5). The last confirmed case died on 27 March and was buried on 28 March. On 9 May, 42 days will have elapsed since the burial of the last confirmed case (figure 7) and the outbreak of EVD will be declared over in the country.
  • Heightened vigilance is being maintained throughout the country. In the week to 3 May, 319 new laboratory samples were tested for EVD, with no confirmed cases. Of 197 samples with a known processing time, 77% were tested within one day of collection. No counties have reported a new confirmed case for over 6 weeks.
  • Locations of the 13 operational Ebola treatment centres (ETCs) in Liberia are shown in figure 8.
  • Locations of the 4 operational laboratories in Liberia are shown in figure 9. 

Table 5: Key performance indicators for Liberia for Phase 2 of the Ebola Response

 

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

Liberia_facet_plot.png

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Table 6: Ebola virus disease infections in health workers in the three countries with intense transmission

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 7.
  • A total of 9 confirmed cases were reported in the week to 3 May, compared with 11 the previous week.
  • Two districts reported cases, compared with 3 districts the previous week (figure 3; figure 6). Of 14 districts that have ever reported a confirmed case since the beginning of the outbreak, 8 have not reported a confirmed case for over 6 weeks. The last time only 2 districts from Sierra Leone reported a confirmed case was May 2014.
  • Just over half (5) of all confirmed cases were reported from the north-western district of Kambia, which borders the Guinean prefecture of Forecariah. Of these, 4 cases were reported from the central Chiefdom of Magbema, with one additional case reported from the Chiefdom of Gbinle Dixing, which borders Magbema to the south and the Guinean prefecture of Forecariah to the north (table 3; figure 2).
  • The remaining 4 cases were reported from the Moa Wharf area of the East 1 Chiefdom of Freetown (table 3; figure 2).
  • Of the 9 reported cases, 3 were identified after post-mortem testing of deaths in the community, whilst only 2 of the 9 cases had been registered as contacts of a previous case. However, subsequent investigations have established an epidemiological link with previous cases for an additional 5 of the 9 cases. Both cases for which no link with a previous case has yet been established are from Kambia.
  • Laboratory indicators continue to reflect a heightened degree of vigilance, with 1654 new samples tested in the week to 3 May. Less than 1% tested positive. Of the 1635 samples with a known processing time, 74% were tested within 1 day of collection.
  • Locations of the 14 operational Ebola treatment centres (ETCs) in Sierra Leone are shown in figure 8. No new health worker infections were reported for the fourth consecutive week.
  • Locations of the 12 operational laboratories in Sierra Leone are shown in figure 9. 

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

 

Figure 6: Confirmed weekly Ebola virus disease cases reported nationally and by district from Sierra Leone

SL_facet_plot.png

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Figure 7: 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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COUNTRIES WITH AN INITIAL CASE OR CASES, OR WITH LOCALIZED TRANSMISSION

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.

 

Figure 8: 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 9: Location of laboratories in Guinea, Liberia, and Sierra Leone

Location of laboratories in Guinea, Liberia, and Sierra Leone

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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, Mauritania, and Ethiopia. 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 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 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 logistical capacity and 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 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.

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

Liberia / 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

Liberia / 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

Liberia / 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

Liberia/Sierra Leone: Daily Ministry of Health Ebola situation reports

N/A

# of new samples tested

Guinea: Laboratory database

Liberia/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

Liberia: Daily Ministry of Health Ebola situation reports

Sierra Leone: Weekly Ministry of Health Surveillance Report

of new confirmed cases

Guinea: Daily WHO situation reports

Liberia / 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

Liberia: Daily Ministry of Health Ebola 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

Liberia / Sierra Leone: Ministry of Health 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

Liberia / Sierra Leone: UNICEF

N/A N/A