RMI Health Alert: Ebola Updates by Country

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Democratic Republic of Congo

According to the CDC as of October 9, 2014, there have been 68 cases of the Ebola virus reported in the Democratic Republic of the Congo (DRC). In total, 49 deaths have been reported. According to the DRC’s Ministry of Health, cases of Ebola have been confirmed in Lokolia, Boende, and Watshikengo. The outbreak has been traced to a single patient who became infected after preparing bush meat. This outbreak is not related to the ongoing Ebola outbreaks in Guinea, Liberia, and Sierra Leone. The DRC Minister of Health announced a series of preventive measures taken to stop the spread of the outbreak, including contact tracing and follow-up, treatment of patients, and infection prevention and control measures. It is not yet known if these actions will be successful.

Guinea

The outbreak in Guinea is less severe than in Liberia. Public awareness of the facts about Ebola are high, and community leaders have been active in securing cooperation of resistant villages. Through their efforts 26 villages were opened to outside help resulting in a surge of reported cases that were previously concealed.

On 9 August, Guinean officials announced the closure of its land borders with Sierra Leone and Liberia to help prevent the spread of Ebola. The government has also instituted enhanced medical screening for air travellers. At Conakry International Airport 5 to 10 people are prevented from flying each week due to elevated body temperatures. Many international flight carriers have suspended flights into Guinea.

According to the CDC, the affected districts are Conakry, Gueckedou, Macenta, Kissidougou, Dabola, Djingaraye, Télimélé, Boffa, Kouroussa, Dubreka, Fria and, Siguiri; several are no longer active areas of Ebola transmission.

Liberia

Liberia has closed all borders except major entry points including Roberts International Airport, James Spriggs Payne Airport, Foya Crossing, Bo Waterside Crossing, and Ganta Crossing. People traveling into or out of these ports will be subject to enhanced medical screening for signs of infection. The government has also placed restrictions on mass gatherings and has quarantined communities that have been heavily affected by Ebola. Military personnel have been authorized to enforce these control measures.

The United States Navy has opened a mobile laboratory near the Island Clinic in Monrovia. This new lab cuts down the lag time for diagnosing Ebola from 2 to 5 days to 3 to 5 hours. Speeding up the diagnostic process minimizes the time that non-infected patients are exposed to potential infection sources. Since the mobile lab opened in October more than 500 blood samples have been tested, approximately half have tested positive for Ebola.

A new 200 bed Ebola treatment center is set to open at the end of October. 150 local construction workers have been constructing the 6 large tents at the former Ministry of Defence compound outside of Monrovia.

Fear of Ebola has caused many villages in Liberia to become hostile to healthcare workers and ambulances. Dr. Peter Clemet has spent weeks traveling through these hostile communities listening to their fears and educating groups of people about how to prevent infection. Dr. Clemet’s work has been successful. Today 30 villages now contact the WHO as soon as someone becomes ill, and the number of suspected Ebola cases at the local clinic has dropped significantly.

The threat of Ebola is still very serious in Liberia. Recently Liberian President Ellen Johnson Sirleaf read a ‘letter to the world’ on the BBC stating that international aid was initially inconsistent, and lacked direction and urgency. She also appealed for more financial aid. The WHO estimates that it will take 1 billion dollars to fight Ebola in Liberia.

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Nigeria

As of 20 October 2014 The WHO announced that Nigeria is free from Ebola virus transmissions, and has been for the past 42 days.

Ebola entered Nigeria on 20 July 2014 via an air passenger who was travelling from Liberia to Lagos, Nigeria. The man was said to have been visibly ill while awaiting the flight. He vomited while in flight and again in a private vehicle on the way to the hospital. The man told hospital staff that he had malaria. Malaria is not transmitted from person to person so hospital staff did not take personal protective precautions. Laboratory test confirmed Ebola on 23 July and the man died on 25 July. Over the following days 9 doctors and nurses were diagnosed with Ebola and 4 died of the disease.

A second case was diagnosed in Nigeria’s oil hub, Port Harcourt. A man who was on the same flight from Liberia became ill on 1 August. He sought treatment from a private doctor who contracted the disease and dies on 23 August. Ebola was confirmed by laboratory tests on 27 August.

The Nigerian Center for Disease Control (NCDC) discovered a large number of high-risk, and very high-risk potential exposures.

Through effective coordination lead by the NCDC and rapid utilization of resources within Nigeria including the virology laboratory at Lagos University Hospital Ebola containment efforts were successful. Nigeria also utilized experienced epidemiologists to perform contact tracing to ensure that the disease did not spread.

The CDC along with the NCDC and other government heath officials worked diligently to track down and monitor 100% of known contacts in Lagos and 99.8% of known contacts in Port Harcourt. Special intervention teams were mobilized to track and monitor the few people who tried to elude the monitoring system.

Senegal

As of 20 October 2014 The WHO announced that Senegal is free from Ebola virus transmissions, and has been for the past 42 days.

On 29 August 2014 Senegal diagnosed its first case of Ebola in a Guinean man who had travelled from Guinea to Dakar by road. Before this occurrence the Senegalese Ministry of Health had been preparing for the possibility of an imported infection. Healthcare workers had been trained on infection control and case investigation, and a detailed response plan had been in place since March.

Although only a single case of Ebola had been diagnosed the Senegalese government deployed their Ebola response plan nationwide. A National Crisis Committee was established as the command center for the emergency response efforts. The government also established a humanitarian corridor in Dakar to facilitate the movement of food, medicines, and other supplies into the country.

A total of 67 contacts of the patient were identified and quarantined for a 21-day monitoring period. All 67 contacts completed the 21-day follow-up on September 18 with no further confirmed Ebola cases. The patient recovered and was released from isolation on September 19. Before the confirmation of this case and during the contact follow-up, numerous unrelated suspected cases were identified, tested, and found to be negative.

Sierra Leone 

In Sierra Leone, officials have declared a public health emergency. The government has set up protocols for arrivals and departures out of the international airport. There are restrictions to public and mass gatherings. The president has authorized the military to go door to door to enforce the new Ebola control measures.

As in Liberia Ebola facilities are quickly filling once they are open. The medical facilities in Sierra Leone were not well prepared and many healthcare workers are falling ill. This is putting extra strain on a health care system that was already struggling with limited resources.

International teams of health workers are arriving in Sierra Leon. The Chinese government has sent a mobile laboratory and a team of 59 health experts from the Chinese Center for Disease Control to support the Ebola response. The government of Cuba has provided 165 health care workers including doctors, nurses, epidemiologists, and intensive care specialists.

Emergency coordinators are working to find all of the chains of transmission in villages that already had dozens of cases upon their arrival

Spain

On 6 October 2014 The WHO was informed of the first case of Ebola Diagnosed in Spain. This case was the first person to person transmission outside of Africa. The patient is a Spanish healthcare worker with no travel history to West Africa. She had been treating an Ebola patient who had contracted the disease in Sierra Leon and was evacuated to Madrid and later died of the disease on 25 September.

The healthcare worker had 2 contacts with the patient and was reported to be wearing appropriate personal protective equipment at the time. She developed a fever on 29 September and was admitted to Alcorcon Hospital in Madrid and isolated on 6 October.

The patient is being treated and her contacts are being traced and monitored for 21 days.

United States

There have been 3 confirmed cases of Ebola in the United States. A Thomas Duncan arrived in the United States from Liberia on 20 September was hospitalized in Dallas eight days later, was diagnosed with Ebola on 30 September.

Duncan travelled from Liberia to Texas, USA to visit relatives. He is believed to have been infected before travelling, while in Liberia. He is not a health care worker but appears to have helped transport a sick, pregnant friend to a hospital in Monrovia, Liberia on 15 September. She was unable to be admitted for care, and later died in her home.

Duncan did not have any symptoms when he left Liberia on 19 September. He was well during his flight and when he entered the United States on 20 September. He started to feel ill about 24 September. He first sought care on 25 September, and was hospitalized at the Texas Health Presbyterian Hospital in Dallas on 28 September. Tests performed by the CDC confirmed Ebola on 30 September. Thomas Duncan died on 8 October.

On 11 October a nurse, Nina Pham, who had been caring for Mr. Duncan was diagnosed with Ebola. This was the first case of Ebola contracted in the United States. Ms. Pham was transferred to the National Institute of Heath in Bethesda Maryland on 16 October.

On 14 October another nurse, Amber Vinson, who had been caring for Mr. Duncan reported a fever and was diagnosed with Ebola the following day. Ms. Vinson had traveled to Ohio and back with the permission of the CDC before she was diagnosed.

320 people in the United States have been identified as possible contacts and are under surveillance.