วันที่ : 2014-08-02

Published Date:�2014-08-01 22:56:04
Subject:�PRO/AH/EDR> Ebola virus disease - West Africa (110): WHO, Sierra Leone, Liberia, MSF, alerts�
Archive Number:�20140801.2652884

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

In this posting:
[1] WHO: speech by Director-General in Guinea
[2] Sierra Leone: new district affected
[3] Liberia: 2 sick Americans repatriated
[4] MSF staff shortage
[5] Building trust�
[6] Uganda alert
[7] Lebanon alert

[1] WHO: speech by Director-General in Guinea
Date: Fri 1 Aug 2014
Source: WHO [edited]

WHO Director-General assesses the Ebola virus disease outbreak with 4 West African presidents (Guinea, Liberia, Sierra Leone and Cote d'Ivoire)
1st, this outbreak is moving faster than our efforts to control it....

2nd, the situation in West Africa is of international concern and must receive urgent priority for decisive action at national and international levels....

3rd, this is not just a medical or public health problem. It is a social problem. Deep-seated beliefs and cultural practices are a significant cause of further spread and a significant barrier to rapid and effective containment....

4th, in some areas, chains of transmission have moved underground.... They are not being reported....

Finally, despite the absence of a vaccine or curative therapy, EVD outbreaks can most certainly be contained. Bedrocks of outbreak containment include early detection and isolation of cases, contact tracing and monitoring of contacts, and rigorous procedures for infection control.... Moreover, we do have some evidence that early detection of cases and early implementation of supportive therapy increases the chances of survival. This is another message that needs to be communicated to the public.

Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[This comprehensive survey of the regional situation and its needs is worth reading in full at the source URL. - Mod.JW]

[2] Sierra Leone: new district affected
Date: Thu 31 Jul 2014
Source: Awoko [edited]

The Bombali District [Northern Province, Sierra Leone] Disease Surveillance Officer, Sorie Bundu, has confirmed to Awoko that they have so far recorded 5 deaths of Ebola virus disease [EVD] patients in the district with 6 more suspected cases under surveillance, 5 positively confirmed and one probably dead. Sorie Bundu said nearly a week after the ebolavirus was confirmed to have killed a suspected patient who was admitted at the Government referral hospital in Makama on Friday 25 Jul 2014 under surveillance but later escaped from the hospital and died in the hands of his relatives, his department has been busy if not busier on a daily basis than other departments.

The District Disease Surveillance Officer said after all their sensitization messages through radio discussions and road shows on handling suspected EVD patients, relatives of the 1st confirmed death went on to wash and bury the victim. The victim's father, who proved very stubborn when they wanted to take him to hospital for collection of his blood sample and surveillance, later ran away and died at the Magburaka hospital.

Sorie Bundu said as at present, they have recorded 5 deaths with 6 new suspected EVD cases, of which 5 have been positively confirmed and one probably dead as his whereabouts are yet to be known. He said they have instituted committees involving stakeholders, health partners, civil society and community-based organizations to embark on a robust sensitization and daily chiefdom and areas updates.

The district was alleged to have been suffering from unavailability of chlorine, a working ambulance, personal protective equipment (PPE) for nurses and other health workers at the Government referral hospital in Makeni in readiness for EVD, if it comes to the worst in that part of the country. The District Disease Surveillance Officer confirmed that indeed there was a limited amount of chlorine for the district before now but expressed their appreciation to ADDAX Bio-energy for supporting them with a full drum of liquid chlorine which according to him, they are trying to distribute to the district's 102 Peripheral Health Units (PHU) and major public places within the city. He called on residents in the district to be vigilant and proactive to use the mixed chlorine at various points in the city and to serve as ambassadors in informing health workers of any suspected case.

[Byline: Mohamed Kabba]

Communicated by:
ProMED-mail from HealthMap Alerts

["7 others known as contacts for the index case of EVD in the district have also perished from similar EVD symptoms, but without blood samples tested before their demise. Health Ministry Spokesman Mr. Sidie Yahya Tunis told Awareness Times in a telephone interview last evening [24 Jul 2014] that the ministry was not considering the other dead patients as EVD confirmed. He said, 'For now, only one patient has been recorded in Bombali District as laboratory tested positive for EVD'... Only Kono in East, Moyamba in the South, and Koinadugu and Tonkolili in North have not recorded EVD cases."�http://news.sl/drwebsite/publish/article_200525859.shtml.

This report points out the strong probability of gross undercounting of fatal cases in the country.

A map showing all districts, with Bombali District on the northern border with Guinea, is athttp://upload.wikimedia.org/wikipedia/commons/d/d9/Sierra_Leone_Districts.png. - Mod.JW]

[3] Liberia: 2 sick Americans repatriated
Date: Thu 31 Jul 2014
Source: Daily Mail, UK [summ., edited]

Nancy Writebol and Dr. Kent Brantly are being flown to the USA inside isolation pods one by one, according to reports. At least one of the Ebola virus disease victims will be treated in a super-high containment facility at Atlanta's Emory University Hospital near the CDC. Brantly, a father of 2 from Fort Worth, Texas, ensured Writebol received the only dose of an experimental drug instead of him. But it later emerged that Mrs Writebol's condition had worsened, despite the serum she is taking.

Some Americans are outraged over the decision to bring the disease to U.S. soil.

[Byline: Helen Pow and Joshua Gardner]

Communicated by:

[4] MSF staff shortage
Date: Thu 31 Jul 2014
Source: GlobalSecurity.org, UN Integrated Regional Information Networks (IRIN) report [summ., edited]

Stephane Doyone, West Africa coordinator of NGO Medecins Sans Frontieres (MSF), which is shouldering a bulk of the case management burden in the 3 countries, told IRIN: "We are reaching the breaking point of our capacity where today we can't guarantee to do more of what we're doing -- particularly when it comes to human resources. We need more actors to get involved on the ground."

MSF has deployed 300 health workers, 80 of them expatriate staff, to work on the EVD response. "It's a huge programme but human resources are very challenging: staff must be highly trained and they have to be turned over every 4-6 weeks due to stress and fatigue," said Doyone. Thus far, MSF has spent USD 9.3 million on its EVD response and does not know how much more it will take, "but rather than focusing on more money, what is needed are more actors on the ground and implementation... Ministries, humanitarian organizations could all be doing more."

MSF has limited its Kailahun EVD treatment hospital to 88 beds because safety has to be the "overriding priority", said Anja Wolz, head of the operation there. "For us the most important thing is that we're sure about the protection of the staff -- from cleaners and drivers to doctors and nurses, and the safety of the patients."

Safety measures in place in Kailahun, where no staff members have died from the disease, involve disposing of up to EUR 5500 [about USD 7385] worth of equipment each day, with the majority of staff's protective suits only worn once, said an MSF spokesperson. When entering or exiting the compound all must pass a security post to disinfect their footwear and hands. Before entering the isolation ward, staff pass through dressing rooms where assistants ensure they are wearing protective suits properly and their gear is sprayed with disinfectant when they leave to ensure nobody contracts the virus while removing the contaminated suit.

Kenema, Sierra Leone
These safety measures were not adhered to as strictly at the Ministry of Health-run EVD treatment centre in Kenema in central-eastern Sierra Leone, where up to 20 staff have died since treatment started 2 months ago, including the hospital's top EVD doctor, Sheikh Umar Khan. In Liberia, Samuel Brisbane, a senior doctor working at the EVD treatment centre on the outskirts of the capital Monrovia, died, while a doctor working with NGO Samaritan's Purse has been infected.

In Kenema treatment centre, IRIN witnessed staff taking blood from a suspected EVD patient with their heads exposed and their protective suits unzipped to their chests. Some staff members donned their suits hurriedly without assistants, and thus were not fully protected.

Overworked and severely stressed health staff will inevitably make mistakes, said Health Ministry spokesperson Yahya Tunis. "You have to understand, the nurses at Kenema work 12 or 14 hours a day. And with EVD, the slightest mistake can be fatal.... We are very short of staff. Before this [outbreak] started, we did not have many staff to deal with EVD." The EVD operation at Kenema is currently on hold.

Communicated by:
ProMED-mail from HealthMap Alerts

[5] Building trust�
Date: Wed 30 Jul 2014
Source: Reuters [edited]

The worst-ever outbreak of EVD is spreading out of control in Guinea, Liberia, Sierra Leone, and now Nigeria, where almost 700 people have already died from the virus. Healthcare workers caring for EVD patients have themselves fallen victim to the disease, including 2 American physicians.

And, at its root, the size of this outbreak can be blamed on a lack of trust in healthcare workers.

EVD is spread through direct contact with an infected person or their body fluids, which may include sweat, blood, urine, feces or vomit, making it difficult to contain outside of proper medical facilities. There is no cure for EVD, though supportive measures like intravenous fluids and antibiotics may be helpful in treating some of the complications of the disease. There is no vaccine to halt the spread of the virus. The only way to stop the transmission of EVD is to identify and quarantine infected persons. But people aren't likely to come forward with a deadly, stigmatized infectious disease when there's an absence of trust.

In the African nations currently experiencing the outbreak, patients don't trust their local healthcare systems -- sometimes with good reason. Their clinics and hospitals are understaffed and have inadequate stocks of drugs and other supplies. Healthcare workers suffer from poor morale in difficult working conditions. In such settings, people turn to traditional healers. These healers may not be able to cure their illnesses, but they offer care and empathy that healthcare workers may not. Affected communities don't trust the foreign doctors who have come to help treat patients with EVD, sometimes because they believe they are the very source of the disease. They conflate healthcare workers' arrival to help treat EVD with the coming of the illness itself.

EVD's harsh outcomes do nothing to inspire trust. Those who are hospitalized for EVD -- often too late in the course of disease, when mortality rates may be as high as 90 percent -- are more likely to come out in a body bag than alive. Families have been told not to care for sick relatives or to engage in traditional burial practices because of fears of contagion, but lack of trust leads communities to hide the sick from medical attention. When they come to help, Doctors Without Borders and Red Cross workers have been threatened and attacked by locals suspicious of their activities.

Of course, it's not just the healthcare system people don't trust. EVD is spreading in countries that have suffered from poor governance and civil war, where people don't trust their own public officials, adding to the chaos.

The question is, how do you create trust?
Efforts to fight other stigmatized infectious diseases, like HIV and tuberculosis, have taught us that advocates from affected communities have an important role to play. Public health workers need to enlist the help of recovered patients and their families to speak about their experiences with medical treatment for the disease. Religious leaders and traditional healers should also be recruited and trained to educate communities about EVD.

In the absence of trusted spokespersons, EVD will continue to spread. Halting transmission of the EVD virus will require isolation of infected persons. And no one will submit to quarantine if they believe that foreign aid workers are spreading the virus or that they are being doomed to die horribly and alone without their families at their bedsides.

[Byline: Celine Gounder]

Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[6] Uganda alert
Date: Thu 31 Jul 2014�
Source: ReliefWeb, Government of Uganda report [edited]

Ministry of Health Takes Preventive Measures on EVD Spread
3 countries of West Africa, Guinea, Liberia and Sierra Leone have for the last 4 months been devastated by an outbreak of Ebola [virus disease, EVD]. As of 27 Jul 2014, there were 1323 registered cases including 729 deaths.

The epidemic has since spilled over to Nigeria, and we have just received information of a new unconfirmed case in Nairobi, Kenya [since tested negative]. This outbreak affected Monrovia, the capital city of Liberia, hence the escalating cases and the transmission by international travellers. This has caused panic among Ugandans with a fear that EVD could spread to Uganda.

The Government of Uganda wishes to clarify the following:

There is no confirmed case of EVD in Uganda. Media reports of reported cases in Kitgum and Kampala districts are false. Any reported case will be investigated promptly and the public will be informed. I wish to reaffirm that no case has been reported in the country since the outbreak was declared in West Africa. Our National Taskforce on Epidemics and Disease Surveillance is on alert to watch out on any EVD alerts throughout the county.

The Ministry of Health will regularly update the country on the outbreak.

Communicated by:

[7] Lebanon alert
Date: Fri 1 Aug 2014�
Source: Middle East Eye [edited]

Lebanon takes steps to guard against entry of EVD
With 20 000 citizens living in 3 countries affected by an Ebola virus disease [EVD] outbreak, Lebanon is taking a series of measures to prevent the virus reaching its shores, government officials said Friday [1 Aug 2014]. Health Minister Wael Abu Faour, during a tour of Beirut airport, said the ministry "has asked all airlines, particularly those bringing people from Sierra Leone, Guinea and Liberia, to inform Lebanese authorities about anyone displaying suspicious symptoms." Any traveller with such symptoms would be turned over for assessment to an 18-person team of doctors and nurses posted at the airport. The foreign ministry, meanwhile, called on Lebanese embassies to ensure that citizens abroad were kept informed of the outbreak, taking appropriate precautions and being given assistance if they wanted to return home.

Nearly 12 000 Lebanese citizens live in Sierra Leone, with another 6500 in Liberia and 3500 in Guinea, the 3 African nations worst affected by the EVD outbreak that has killed nearly 730 people so far. For its part, the labour ministry said Friday [1 Aug 2014] it has suspended the delivery of work permits to residents of the 3 countries.

Communicated by:
ProMED-mail Rapporteurs Kunihiko Iizuka and Mary Marshall

[The following are additional excerpts and summaries from media reports:

Ghana has banned flights from other West African countries following the outbreak of Ebola virus disease [EVD].... In addition to this, restrictions have been imposed on the movement of Liberian refugees still at the Buduburam Refugee Camp. Ghana's Health Ministry has announced that efforts are underway to establish EVD treatment centres across the country, to be located in Accra, Kumasi and Tamale to cater for the southern, middle and northern zones of Ghana. Even though a suspected fever case which was reported at a clinic in Ghana was negative, Ghanaians have expressed fear about the possible spread of the disease in the country due to closeness to the 4 countries where deaths have been recorded.http://cajnewsafrica.com/2014/08/01/ebola-outbreak-ghana-bans-west-african-flights/.

United Kingdom
There was a false alarm among the athletes at the Commonwealth Games in Glasgow, Scotland. Sierra Leone cyclist Moses Sesay was tested for virus and other conditions after being admitted to hospital in Glasgow feeling ill. But after 4 days he was negative for EVD by repeat testing. A spokeswoman for Health Protection Scotland (HPS) said that no one has tested positive for EVD in Scotland. Dr Colin Ramsay of HPS said medical staff at the Games and more widely had been briefed to look out for EVD. "Steps have been taken to remind healthcare practitioners across the whole of the UK about being aware of EVD infection, particularly in people coming from these affected countries," he told BBC Radio Scotland.http://www.theguardian.com/society/2014/aug/01/ebola-commonwealth-games-dismissed-cyclist-sierra-leone-tests-negative.

"WaterAid UK is deeply concerned by the spread of EVD, which has affected communities in Sierra Leone, Liberia and Guinea. To help protect our staff and the people we work with against the virus, we have put a response plan in place and temporarily closed our offices in Sierra Leone and Liberia. Our programme work has also been suspended in these countries."�http://www.wateraid.org/uk/news/news/ebola-statement.

"The Health Ministry has cautioned Malaysians that have travel plans to West Africa to take necessary preventive measures against the deadly Ebola virus disease. He said although the World Health Organisation (WHO) has not issued any travel advisory, precaution and preventive measures should be taken seriously, and not lightly."�http://www.nst.com.my/node/19201. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at:�http://healthmap.org/promed/p/54.]

See Also

Ebola virus disease - West Africa (109): Sierra Leone, MOH statement�20140801.2652930
Ebola virus disease - West Africa (108): WHO, situation, Guinea-Bissau alert�20140731.2650008
Ebola virus disease - West Africa (107): WHO, China & UK NOT, Nigeria, airlines�20140730.2646645
Undiagnosed illness - China: (HK) ex Kenya, EVD susp�20140730.2645280
Ebola virus disease - West Africa (104): WHO, Nigeria, Togo alert, Sierra Leone�20140727.2638658
Ebola virus disease - West Africa (102): Nigeria, Sierra Leone, drugs & vaccine�20140726.2636858
Ebola virus disease - West Africa (101): Nigeria ex Liberia, WHO, Sierra Leone�20140726.2636095
Ebola virus disease - West Africa (100): Cote d'Ivoire,Tanzania, Nigeria alerts�20140724.2633437
Ebola virus disease - West Africa (99): WHO, Sierra Leone, Liberia�20140724.2632442
Ebola virus disease - West Africa (98): Nigeria susp, alert�20140724.2632831
Ebola virus disease - West Africa (97): Sierra Leone, Liberia, tests�20140723.2630441
Ebola virus disease - West Africa (95): FAO alert, Sierra Leone�20140722.2626215
Ebola virus disease - Congo DR: susp�20140721.2624831
Ebola virus disease - West Africa (94): Sierra Leone�20140720.2623966
Ebola virus disease - West Africa (93): Sierra Leone, WHO underfunded�20140719.2622727
Ebola virus disease - West Africa (92): Sierra Leone, drugs, EU disease ctr.�20140718.2620802
Ebola virus disease - West Africa (91): WHO, Guinea,Sierra Leone,Liberia, border�20140717.2618525
Ebola virus disease - West Africa (90): Sierra Leone, Ghana meeting, historical�20140716.2615640
Ebola virus disease - West Africa (89): WHO update, Sierra Leone, Liberia, risk�20140715.2613043
Ebola virus disease - West Africa (88): WHO, Liberia, prevention, challenges�20140713.2607118
Ebola virus disease - West Africa (87): Liberia, Sierra Leone, MSF, drugs, vaccine�20140712.2605570
Ebola virus disease - West Africa (86): WHO, UNSC, ECOWAS, Guinea, Liberia�20140711.2603448
Ebola virus disease - West Africa (85): Guinea, Liberia, region�20140710.2601330
Ebola virus disease - West Africa (84): WHO update�20140708.2596192
Ebola virus disease - West Africa (83): Ghana susp, Guinea, S. Leone, Liberia�20140708.2593018
Ebola virus disease - West Africa (82): Guinea, prevention, Tanzania, UK�20140706.2591433
Ebola virus disease - West Africa (81): Guinea, Sierra Leone, Liberia, overseas�20140705.2589463
Ebola virus disease - West Africa (80): WHO update, meeting�20140704.2587114
Ebola virus disease - West Africa (79): Guinea, Nigeria prevention, drug testing�20140703.2586162
Ebola virus disease - West Africa (78): Guinea, Sierra Leone, Liberia�20140702.2583396
Ebola virus disease - West Africa (77): WHO, meeting, Sierra Leone, Liberia�20140701.2579682
Ebola virus disease - West Africa (74): CDC summary�20140626.2566502
Ebola virus disease - West Africa (73): WHO update, Sierra Leone�20140625.2566397
Ebola virus disease - West Africa (72): WHO update�20140624.2562337
Ebola virus disease - West Africa (71): Guinea, Sierra Leone, Nigeria serology�20140622.2558446
Ebola virus disease - West Africa (70): Sierra Leone, Liberia, travel advice�20140621.2556770
Ebola virus disease - West Africa (69): Guinea, Sierra Leone, region�20140621.2555351
Ebola virus disease - West Africa (68): Liberia, One Health approach�20140619.2553035
Ebola virus disease - West Africa (67): WHO update, Liberia, Sierra Leone�20140618.2550323
Ebola virus disease - West Africa (66): Liberia (Monrovia), Sierra Leone�20140617.2547352
Ebola virus disease - West Africa (63): Sierra Leone�20140613.2538970
Ebola virus disease - West Africa (58): Sierra Leone, challenges�20140607.2526192
Ebola virus disease - West Africa (57): WHO update, challenges�20140607.2525234
Ebola virus disease - West Africa (56): Sierra Leone, Liberia, WHO�20140604.2518983
Ebola virus disease - West Africa (55): MSF report, Sierra Leone�20140603.2517388
Ebola virus disease - West Africa (54): WHO update, Sierra Leone�20140603.2515262
and earlier posts beginning with
Undiagnosed viral hemorrhagic fever - Guinea (02): Ebola conf.�20140322.23496
Undiagnosed viral hemorrhagic fever - Guinea: (NZ) RFI�20140319.2342420

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