Ebola crisis update - 13th January 2015
Since the Ebola outbreak in West Africa was officially declared on 22 March in Guinea, it has claimed more than 8,200 lives in the region. The outbreak is the largest ever, and is currently affecting four countries in West Africa: Guinea, Liberia, Sierra Leone and Mali. Outbreaks in Nigeria and Senegal have been declared over. A separate outbreak in DRC has also ended.
In September, 2014, MSF called for states with biological-disaster response capacity to urgently dispatch human and material resources to West Africa, all three of the worst-hit countries have received some assistance from the international community. But foreign governments have focused primarily on financing or building Ebola case management structures, leaving staffing them up to national authorities, local healthcare staff and NGOs.
Across the region, there are still not adequate facilities for isolating and diagnosing patients where they are needed. Other elements that are essential to an Ebola response – such as awareness-raising and community acceptance, safe burials, contact tracing, alert and surveillance, access to health care for non-Ebola patients – are still lacking in parts of West Africa.
Two (1,2) of the three clinical trials for different treatments led by MSF and three research institutions have started, while the third should start soon at MSF sites in West Africa. The French National Institute of Health and Medical Research (INSERM) is leading a trial for antiviral drug favipiravir at MSF’s facility in Guéckédou, Guinea. The inclusion of patients at this site has started mid-December. The University of Oxford leads, on behalf of the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), a Wellcome Trust-funded trial of the antiviral drug brincidofovir at Elwa3 in Monrovia. The inclusion of patients started on January, 1st.
The Antwerp Institute of Tropical Medicine (ITM) will lead a trial of convalescent plasma therapy at MSF’s Donka Ebola centre in Conakry, Guinea. This trial is expected to start in the coming weeks.
The United Nations Mission for Ebola Emergency Response (UNMEER) is based in Ghana to pursue five strategic priorities: stop the spread of the disease; treat the infected; ensure essential services; preserve stability; and prevent the spread of the disease to countries currently unaffected.
MSF has been responding to the outbreak since March. On December 30, there was almost 3,800 staff working in Guinea, Liberia, Sierra Leone and Mali. Since the response began, 27 MSF staff members have fallen ill with Ebola, 14 of whom have recovered and 13 have died. The vast majority of these infections were found to have occurred in the community.
MSF’s West Africa Ebola response started in March 2014 and counts activities in Guinea, Liberia, Mali and Sierra Leone. MSF currently employs 302 international and around 3 600 national locally hired staff in the region. The organisation operates eight Ebola case management centres (CMCs), providing approximately 650 beds in isolation, and two transit centres. Since the beginning of the outbreak, MSF has admitted more than 7,700 patients, among whom around 4,800 were confirmed as having Ebola. More than 2,200 patients have survived.
More than 1,400 tonnes of supplies have been shipped to the affected countries since March.
The overall situation in Guinea remains concerning. While the total number of new cases has been relatively stable during the last three weeks, the epidemic continues to spread geographically, with new districts declaring cases for the first time.
Conakry and the surrounding areas account for approximately half of the cases in the country.
Donka Ebola Management Centre in Conakry is admitting an average of 5 patients per day, mostly from Conakry.
Since last week, MSF teams are involved in contact tracing activities too, in collaboration with MSF is looking for an appropriate site to setup a bigger Ebola Management Centre that will serve the Conakry area.
MSF completed the handover of the Macenta center to French Red Cross in December. MSF teams left Macenta on 10 December.
The number of admissions remains stable on the low side. As an average, 4 patients were hospitalized during the last days. The number of admitted patients has also decreased in surrounding Ebola centers in the region.
Kankan A new 20 beds CMC is being built in Kankan and Infection control has started in the Kankan General Hospital. Outreach activities have also started in Kankan and its surroundings.
Monrovia - Elwa 3
Following the decrease in the number of patients in ELWA 3 (currently 3 confirmed and 4 suspect), teams have downsized ELWA 3 from a 250 bed facility to a 60 bed facility. The teams have also built a laboratory to help better monitor patients – it is expect the lab will open in the coming week.
On the 9th of January a “stabilisation centre” for patients with acute illnesses who do not meet the Ebola case definition was open at ELWA 3. The idea is that patients will be stabilised (using universal precautions but not full PPE) before being transferred to an available hospital bed at another facility. This is to mitigate problems surrounding the transfer of untested non-cases to other hospitals which usually face lengthy delays and have in some cases resulted in the death of the patient.
The trial of brincidofovir, led by an Oxford university team, started on January 1st.
Ambulance service have been set up with a dedicated hotline that the community can call if they have Ebola suspected cases. Teams refer Ebola patients from Gardnersville, New Georgia, Barnesville and Paynesville in Monrovia, to EMCs.
Monrovia / Support to non-Ebola health facilities
An MSF team is supporting five health centres in Monrovia with expertise in infection prevention and control; A team is also supporting the James Davis Junior Memorial Hospital (JDJ Hospital) in Monrovia providing expertise in paediatrics, infection control and triage. Rehabilitation of the premises has started to set up stringent infection control measures.
Meanwhile, teams are working at the set-up of a MSF-run paediatric hospital in Monrovia.
Monrovia/Transit Unit (Redemption Hospital)
Since the opening of the Ebola Transit Unit at the Redemption hospital site in New Kru Town on 19 November, MSF has triaged 100 patients and admitted 51 to its Transit Unit.. Patients who are admitted and test positive for Ebola and those who are clinically unstable upon arrival, are transferred to ELWA3 immediately. Patients are followed up by the staff of the Redemption Unit throughout their time in treatment. Their families are offered psycho social support, including transport to visit patients at ELWA 3, which can be up to an hour journey in traffic. Those who recover continue to receive support from MSF in the weeks following discharge.
In addition to running the ten-bed transit unit, MSF also supports the triage at Redemption Hospital's OPD. This is an extremely important step in the rebuilding of non-Ebola health services in Monrovia as Redemption Hospital has, been unable to run its normal operations since it was used as a holding centre for Ebola patients in August.
Monrovia/ Health Promotion activities
Health promotion teams are out in the community engaging in dialogue with interested community members about Ebola as well as running “training for trainers” for community based organisations and other actors, with the aim of continuing to spread correct messaging on Ebola through communities across Monrovia.
Monrovia / Treatment and prevention of malaria
The first two rounds of malaria drug distribution were completed, on November 21 and December 19, respectively. In total, more than 500 000 people have received their drugs in four neighbourhoods. A distribution of mosquito nets will take place early January.
Rapid response teams / River Cess
MSF has handed over to Partners in Health the 7 triage centres, set up at local health centres, as well as health promotion activities in the area end of December. Health staff in the area has been trained by MSF to recognise the symptoms of Ebola and to react accordingly.
Rapid response teams / Grand Bassa
The MSF intervention in Quewein, Grand Bassa County started on 2 December and was handed over at the beginning of January to Concern Worldwide and local Health authorities. MSF teams took in charge or organized the referral of about 50 patients in the area.
Rapid response teams / Grand Cape Mount
There are currently up to three trains of active transmission in Grand Cape Mount county including one in an open cut mine. Following an evaluation, the team has decided to run mobile clinics in villages across the region to find active cases, train local health staff in proper triage and infection control procedures and fill a gap in primary health care.
After not having had any Ebola patients since October 30th and with new actors arriving in the area to support, MSF’s Ebola Management Center in Foya, Lofa County, was handed over on December 10th. In the lead up to handing the structure back to the NGO Samaritan Purse, MSF invested strongly in health promotion activities and in the training of health staff in the districts of Foya, Kolahun and Vahun. This will ensure a robust response should cases reappear in the area.
Between 2 August and 10 December, 695 patients were admitted to the centre, 384 of whom were confirmed Ebola cases, 154 recovered from the virus and were discharged home.
Operation Western Area Surge was launched December 16th, as an intensified effort to mobilize communities to identify potential Ebola cases and link them with care. The surge focused on door-to-door social mobilization as well as engagement with community leaders, including government, religious, and tribal groups, as well as youth leaders and women.
The outcomes of the Surge are currently unknown, though there has been a 10% increase in calls to the Ebola hotline and a slight increase in Ebola-positive cases in MSF’s Ebola Treatment Center in Freetown. These increases are substantially less than expected, indicating a potential shortfall in the social mobilization effort.
On New Year’s Eve, President Koroma extended the surge for another two weeks and expressed hope that schools would reopen soon.
Teams continue to reinforce outreach activities, including monitoring of surveillance activities by other actors and assistance where needed. The MSF EMC in Kailahun has admitted no positive cases since December 11th. Following the opening and increased capacity of treatment centres in other districts both by MSF (Bo, Magburaka, Freetown) and other actors (Kenema, Makeni), no patients from other districts have been admitted since November 30th. A small but significant number of patients presenting with Ebola like symptoms continues, but since 11th December all have tested negative to Ebola. While Ebola is still present in other districts, the possibility will remain that travelers may present with Ebola in Kailahun. The bed capacity in the EMC was reduced to 20 beds – although it can still be upgraded to 100 beds again in the future if needed.
The MSF EMC centre in Bo saw a decrease of cases in late December following the opening of more treatment facilities in different regions of the country, although the current situation in Kono led to a slight increase of patients last week. As of January 4, there are 20 patients in isolation – 16 confirmed cases, one probable and three suspects. MSF continues to provide Mental Health services in the EMC as well as strengthening Health Promotion activities focusing in hotspot, training community health workers and visiting all quarantine houses, as well as support to the organization and dispatching of the alerts team.
15 confirmed patients and 5 suspects are currently present in the EMC. Last week, the first cured patient was discharged. Since then, 4 cured patients have been discharged in total. The Winnipeg Laboratory, installed inside the EMC, is operating as district lab - working with three other holding centers and 11 CCCs in the area. It has a turnaround time on lab samples of 4 hours, which helped reduced the number of patients in holding centers. The team is currently evaluating the possibility of starting outreach activities.
MSF has opened this week an Ebola Treatment Center in Kissy, one of the current hotspots of the epidemic, in the outskirts of Freetown. The current capacity is of 20 beds, but the centre will expand to become a 80-bed referral center for Ebola positive pregnant women, with an isolation ward for suspect Ebola-infected pregnant women, where they will be able to receive obstetric care.
Freetown/antimalarial distribution MSF will begin the second round of antimalarial distribution on January 16-19th for a target population of 1,8 million people. Teams will run house-to-house distribution of antimalarial drugs, sensitization on how these medications should be used for malaria prevention, and directly observed therapy (DOT) to support adherence. A large campaign of social mobilization has been run (radio, TV, posters, banners, as well as meetings with community leaders and stakeholders).
Freetown/ Prince of Wales secondary school
The Ebola Treatment Center at Prince of Wales School has reached its full capacity of 100 beds, though the centre was only one-third full last week. The center includes 30 individual rooms for suspect cases to prevent cross-infection, as well as 70 treatment beds, including an intensive care ward with a Plexiglas corridor to enable more intensive monitoring. Delays between onset of symptoms and access to treatment remain the most significant factor related to mortality. Since the centre opened on December 10, there have been 178 admissions, 82 Ebola confirmed patients, 30 Ebola deaths and 32 survivors.
The center has a mobile lab on premises which currently tests 30 samples per day, and can scale to 50 samples tested per day
Outreach activities have begun in the neighboring areas of Kroo Bay and Congotown. MSF is also supporting infection prevention and control (IPC) training for NGOs that are responding to Ebola cases alerts. MSF will add an additional car to this alert response, providing health promotion, as well as additional IPC support.
Mali confirmed its first case of Ebola on 23 October. In total, 8 cases were confirmed, and 6 deaths. There are no more contacts-people followed, as the last 13 contacts completed the 21-days of surveillance on 15 December.
MSF emergency response unit, who was running a case management centre (CMC) in Bamako collaboration with CNAM, Mali’s national disease centre, left on January 5.
WHO declared 20 October as the official end of the epidemic after 42 days without a case. The MSF intervention has been closed.
WHO declared 17 October as the official end of the epidemic after 42 days without a case. The MSF intervention has been closed. MSF’s West Africa Unit (Dakar) will keep in contact with the government for follow up as part of their routine activities.
Democratic Republic of Congo (DRC)
The outbreak in DRC’s Equateur province, which was unrelated to the one in West Africa, was declared over on November 21. Around 60 MSF staff worked on this outbreak and two case management centres were established. The MSF teams have activated an exit plan.
On September 29, a case of Marburg fever was declared in Uganda. MSF has helped reinforce local capacities for treating confirmed cases and for infection control. No new cases of the disease have been declared since.