Nzérékoré, Guinea — More than 800 contacts of recently confirmed Ebola cases in Guinea’s southern prefecture of Nzérékoré have been identified and placed under medical monitoring in a bid to contain a new flare-up of Ebola virus disease.
A community in Dubreka Prefecture, Guinea, gathers for Ebola-awareness meeting.
On 16 March, Guinean health authorities alerted WHO and partners to 3 probable Ebola deaths and 2 suspect Ebola cases in the village of Koropara Centre, all from the same family. The following day, the 2 suspect cases, a mother and her 8-year-old daughter, tested positive for Ebola virus disease. The child has since died in a treatment facility and the mother is reported seriously ill. A high-risk contact, who travelled to the neighbouring prefecture of Macenta to consult a healer, has also died and has since tested positive for Ebola, bringing the total number of probable and confirmed Ebola deaths in the flare-up to 5.
Local health authorities have reactivated the emergency coordination mechanism that was in place during the height of the Ebola epidemic in Nzérékoré, and a rapidly growing inter-agency response is in full motion. WHO has deployed dozens of epidemiologists, surveillance experts, contact tracers, vaccinators, social mobilizers, health promoters, and infection prevention and control experts to support the effort.
As of today, 816 contacts have been identified from 107 households in the immediate vicinity of the home of the confirmed and probable cases in Koropara. More than 100 of the contacts are considered high risk. Their movements to and from the area will be restricted while they are under medical observation. Vaccination teams will also begin administering the Ebola vaccine to contacts and contacts of contacts today to prevent possible spread of the disease. A door-to-door case search is planned for surrounding villages.
More than 50 contacts of the man who travelled to and died in the Macenta prefecture have been identified, and additional contact tracing and case investigation is underway.
Infection prevention and disease control measures, including a public awareness campaign and other health promotion and community engagement activities, are being stepped up in all affected areas.
Samples from the confirmed cases and some high-risk contacts have been sent to a lab in Conakry for testing. Initial tests indicate that the cases stem from known transmission chains and are not an introduction of the virus from the animal population.
The sub-prefecture of Koropara, which has a population of about 8200 residents, was originally hit by Ebola from October to December 2014. There were 24 Ebola cases, 15 deaths and 9 survivors. This re-emergence of Ebola in Guinea is the first since the original outbreak in the country was declared over on 29 December 2015.
These new Ebola infections in Guinea were confirmed on the same day, 17 March, that WHO declared the end of the latest Ebola flare-up in neighbouring Sierra Leone. In a statement, WHO said recurrences of the disease must be be anticipated, largely due to virus persistence in some survivors, and that the three Ebola-affected countries must maintain strong capacity to prevent, detect, and respond to further outbreaks.
More than 28 500 people have been infected and 11 300 have died in the world’s worst recorded Ebola epidemic in Guinea, Liberia, and Sierra Leone.
Conakry, Guinea — WHO has dispatched a team of specialists to the southern prefecture of Nzérékoré after 2 new cases of Ebola were detected and confirmed in a rural village.
Guinean health officials in the region alerted WHO and partners on 16 March to 3 unexplained deaths in recent weeks in the village of Koropara and said other members of the same family are currently showing symptoms characteristic of Ebola.
Guinea’s Ministry of Health, WHO, the US Centers for Disease Control and UNICEF sent in investigators on 17 March. Samples were taken from 4 individuals. A mother and her 5-year-old son, relatives of the deceased, confirmed positive for Ebola virus disease in lab tests. The 2 have been taken to a treatment facility.
In coordination with Guinea’s Ministry of Health, WHO has deployed an initial team of epidemiologists, surveillance experts, vaccinators, social mobilizers, contact tracers and an anthropologist today to support an inter-agency response. More specialists are expected to arrive in the coming days. Response teams will work to investigate the origin of the new infections and to identify, isolate, vaccinate and monitor all contacts of the new cases and those who died.
Guinea’s National Emergency Response Centre is convening a meeting 18 March to further coordinate a rapid response to contain the country’s first re-emergence of Ebola since its original outbreak was declared over on 29 December 2015.
The new infections in Guinea were confirmed the same day that WHO declared the end of the latest Ebola flare-up in neighbouring Sierra Leone. WHO said recurrences of the disease should be anticipated and that the 3 Ebola-affected countries must maintain strong capacity to prevent, detect and respond to disease outbreaks.
“WHO continues to stress that Sierra Leone, as well as Liberia and Guinea, are still at risk of Ebola flare-ups, largely due to virus persistence in some survivors, and must remain on high alert and ready to respond,” WHO said in a statement.
The worst Ebola outbreak in history first began in Guinea in December 2013 and has since claimed more than 11 300 lives, mostly in Guinea, Liberia and Sierra Leone.
Health authorities from Guinea, Liberia and Sierra Leone and representatives of partner organizations have expressed confidence in the capacity of the 3 Ebola-impacted countries to effectively manage residual risks of new Ebola infections—pointing to the rapid government-led containment of recent flare-ups of the disease.
Dr Abou Beckr Gaye, WHO Representative, Guinea (left) Dr Sakoba Keita, Ebola Response National Coordinator, Guinea (center) Dr Bruce Aylward, WHO Executive Director ai, Outbreaks and Health Emergencies (right)
Meeting in Conakry
The review of prevention, detection and response capabilities of the three countries, as well as progress in expanding clinical care and screening for survivors came at a meeting 1 – 2 March in Conakry, Guinea, convened by WHO and attended by some 80 participants. WHO, partners and Ministry of Health staff from the three countries have been meeting regularly throughout the epidemic to assess tactics, tools, research and operations and chart strategies accordingly.
Dr Sakoba Keita, Guinea’s National Ebola Response Coordinator, opened the meeting, asserting collective progress in meeting “Phase 3” response goals: “We have enhanced our systems, are detecting and stopping small outbreaks of Ebola, identifying weak links and working together to minimize and manage risks of Ebola,” he said. “We are currently at zero cases, but we hope to be at zero risk.”
WHO believes that all original chains of transmission in the epidemic have been halted, but it continues to stress that small flare-ups are anticipated due to virus persistence in the fluids and tissues of some survivors. While the risk is declining as the virus clears from survivors, it still necessitates strong surveillance and response capacity, including the ability to detect new and suspect cases, rapid diagnosis, case isolation and management, contact tracing, community awareness and participation, safe burials and care, counselling and screening for survivors.
Dr Thelma Nelson, Emergency Preparedness and Response Coordinator and Dr Philip Bemah, Case Management Programme Coordinator, Ministry of Health, Liberia
At the Conakry meeting, representatives of the three countries and partners provided detailed assessments of advancements, challenges and resource needs in these areas, as well as efforts to adapt and integrate Ebola-focused programmes into broader national strategies to address other diseases and health emergencies.
Evaluation of response to recent flare-ups
As an example of progress, participants evaluated the swift containment of recent flare-ups of Ebola in Liberia and Sierra Leone and the response to suspect cases in Guinea, and reviewed real-time tests of investments made in lab strengthening and diagnostics, simulations and training, rapid response teams and infection prevention and disease control at health facilities.
“These recent events show us what these countries are capable of when there is strong government leadership, experienced responders, ongoing support from partners and regional coordination, ” said Peter Graaff, director of WHO’s Ebola response, noting that Guinea deployed a ring vaccination team to Sierra Leone to vaccinate contacts while both Liberia and Sierra Leone dispatched veteran epidemiologists to each other’s country to support case investigations and testing —“drawing on the region’s expertise to curb the potential spread of Ebola to affected communities.”
All three countries pointed to community engagement and surveillance as one of the biggest gaps and challenges.
“We need to do much more to allay fear and improve communication and confidence at the community level,” said Dr Roland Conteh, head of disease surveillance programmes in Sierra Leone’s Ministry of Health. “When there is community involvement and when focal points and health workers are trained at the community level, we know it improves cooperation and surveillance. But massive training is needed.”
Dr Ian Crozier, WHO advisor, clinical care for survivors
Need for ongoing training, system testing and survivor care
Concerns about human resources and long-term funding streams were repeatedly raised—to maintain lab capacity, to establish and train rapid response teams and Infectious Diseases Surveillance and Response systems and to ensure Ebola survivors have access to specialized services for health complications like eye and neurology care, as well as semen and breast milk testing programmes.
Participants stressed the need to track unregistered survivors and monitor the health of all survivors, to ensure they have proper clinical care, mental health services and other counselling, as well as to garner their assistance in understanding short and long-term health implications of Ebola.
The overarching goals of “Phase 3” are to interrupt all remaining chains of transmission and to identify, manage and respond to the consequences of residual Ebola risks.
Since July 2014 unparalleled progress has been made by WHO in establishing systems and tools that allowed rapid response. Thanks to the diligence and dedication of tens of thousands of responders, scientists, researchers, developers, volunteers, and manufacturers, we now have diagnostics, a vaccine, registered foreign medical teams, and thousands of trained responders who can rapidly deploy to outbreaks.
WHO and partners are now in Phase 3 of the Ebola response, from August 2015 to mid-year 2016. The overarching goal is to interrupt all remaining chains of Ebola transmission, and to respond to the consequences of residual risks. To do this, several objectives have been outlined and we are working towards enhancing the rapid identification of all cases and contacts, improving Ebola survivor engagement and support, among others.
CARING FOR EBOLA SURVIVORS
Today, there are over 10,000 survivors of Ebola virus disease. A number of medical problems have been reported in survivors, including mental health issues. Ebola virus may persist in some body fluids, including semen. Ebola survivors need comprehensive support for the medical and psychosocial challenges they face and also to minimize the risk of continued Ebola virus transmission.
ON THE GROUND
WHO continues to deploy technical experts in the 3 most affected countries and engage not only in response activities, but also in early recovery and survivor support efforts.
WHO and the Global Alert and Response Network have deployed nearly 4,000 technical experts, including Ebola vaccination teams, on the ground in more than 70 field sites in the 3 most affected countries. There are currently over 1,180 personnel in the field supporting the response and recovery efforts.
45 laboratories have been deployed since the start of the Ebola outbreak with WHO and Emerging and Dangerous Pathogens Laboratory Network supporting 29 laboratories; we provided an additional 16 laboratories through bilateral agreements. All of these laboratories tested more than 200,000 patient samples.
WHO continues to support health systems in the affected countries with a focus on early recovery and rebuilding efforts.
WHO has distributed more than 1.48 million sets of personal protective equipment for the Ebola response.
WHO was instrumental in the construction of 70 Ebola treatment centres (ETUs) and more than 800 community care centres (CCCs) and provided 730 hospital beds to ETUs and CCCs
Logisticians have delivered over 42,000 body bags for safe and dignified burials. WHO managed a fleet of more than 600 vehicles to support surveillance and response operations activities and strengthen transportation resources during outbreaks.
WHO manages global supplies of personal protective equipment for rapid deployment to any country in the world. 500 sets of personal protective equipment were delivered to each of 138 countries. Additional stockpiles of personal protective equipment have been placed in warehouses in Accra, Ghana (30,000 sets) and Dubai (50,000 sets).
DISEASE DETECTION AND SURVEILLANCE
Surveillance and monitoring remain a critical component towards ensuring all Ebola cases and deaths are reported and followed-up.
We reduced Ebola case incidence from more than 950 cases per week in September 2014 to 5 cases or fewer by July 2015.
The average time from identification of Ebola cases to hospitalization across the 3 countries reduced from 4 in August 2014 to less than 2 days for Liberia and Sierra Leone and 2.5 days for Guinea in April 2015.
PREPAREDNESS OF COUNTRIES
We are supporting more than 150 countries worldwide to ensure they are ready to respond to Ebola or other public health emergency.
WHO is providing dedicated and on-the-ground preparedness support to 15 priority countries in Africa to strengthen emergency response systems.
Since October 2014, WHO has conducted 336 multi-partner deployments to priority countries in the African region, covering a total of 3223 days in the field.
Over 79% of priority countries have achieved at least 50% of the preparedness tasks on the Ebola Preparedness Checklist. This is up from 7% in December 2014.
Field exercises and simulations to test response systems have been carried out in 9 priority countries in Africa.
In Guinea, Liberia and Sierra Leone the focus is increasingly on recovery and preparedness. For example, in Sierra Leone, simulation exercises are being used to validate and test rapid response plans.
WHO and partners provided a range of training packages, including training on infection prevention and control, clinical management, environmental health systems, and management of healthcare waste and sanitation.
Together with partners, WHO has contributed to the training of more than 8,600 medical, technical and public health Ebola responders with pre-deployment curricula.
More than 4,500 health responders received clinical management training in the affected countries.
WHO produced 50 technical guidance documents on case management, infection prevention and control, surveillance, safe and dignified burials, and community engagement.
RESEARCH AND DEVELOPMENT
We now have diagnostic tools and services that give results in hours rather than days.
In July 2015, results from an interim analysis of the Guinea Phase III efficacy vaccine trial showed that VSV-EBOV (Merck, Sharp & Dohme) is highly effective against Ebola.
We have an effective global registry of Foreign Medical Teams that continues to grow and is now being used to respond to Ebola and other emergencies.
We have thousands of experts from 120 countries trained in clinical management and infection prevention and control, and more.
Support from donors has been crucial for the rapid scale-up and evolution of the Ebola response. Between March 2014 and 31 December 2015 WHO received over US$ 450 million in direct and in-kind contributions from over 60 donors. This generous support has enabled WHO, in collaboration with the governments and ministries of health of the affected countries, and in concert with international partners, to implement a wide-ranging package of activities and interventions to end transmission of Ebola virus in West Africa.
Every facet of the response — from tracing the contacts of patients with EVD, to helping to design and run clinical trials to test an Ebola vaccine, to coordinating the medical evacuation of international responders — has only been possible thanks to the generosity of our donors.