Since the Ebola outbreak in West Africa was officially declared on 22 March in Guinea, it has claimed more than 10,236 lives in the region. The outbreak is the largest ever, and is currently affecting three countries in West Africa: Guinea, Liberia and Sierra Leone. Outbreaks in Mali, Nigeria and Senegal have been declared over. A separate outbreak in DRC has also ended.
The epidemic is not yet over
In Guinea and Sierra Leone there were still about 150 new cases between March 8 and 15. The vast majority of them are concentrated in Conakry, Freetown and the surrounding regions.
The number of weekly cases is still by far higher than in any other previous outbreak. At the beginning of March in Guinea, less than 30% of cases came from identified contact chains.
One case can be enough to reignite the epidemic.
Two ‘pillars’ of the response are still missing – and key to hope getting to zero cases
Regional cooperation: Given the high mobility of the population across the three most-affected countries, surveillance must be ensured across borders and coordinated on the regional level to avoid new cases to be ‘imported’ in Ebola-free zones.
Community awareness remains low in some areas, raising the risk of local people panicking, which can lead to violence against medical and aid workers. Community mobilization and sensitisation efforts supported by national and local leaders must be reinforced rapidly.
Non-Ebola needs are a persisting concern
Already weak public health systems have been seriously damaged by the epidemic. In Liberia and Sierra Leone, many hospitals have shut and there are very few places for the non-Ebola sick to turn for help.
The long period of interrupted health services has caused significant gaps in preventive activities, such as routine immunization of children, and in retention in care for people on long-term treatments such as HIV and other chronic diseases. There is a need to catch up and mitigate the consequences of the treatment interruption.
Operational Highlights MSF’s West Africa Ebola response started in March 2014 and includes activities in Guinea, Liberia, Mali and Sierra Leone. MSF currently employs 225 international and around 2 560 national locally hired staff in the region.
The organisation operates seven Ebola case management centres (CMCs), providing approximately 230 beds in isolation, and one transit centre.
Since the beginning of the epidemic:
8,351 patients admitted to MSF Ebola management centres
4,962 patients confirmed with Ebola
2,329 patients recovered from Ebola in our centres
More than 1,400 tonnes of supplies have been shipped to the affected countries since March 2014.
While there are virtually no more cases in South-eastern part of the country, cases are still reported in 5 prefectures in the West as well as in the capital, Conakry. Mid-March, the country registered the highest number of weekly cases since the beginning of the year (95), showing that the epidemic is not yet under control.
The number of unreported community death and unsafe burials remains concerning.
Between 9 and 15 March, 23 new cases were admitted in Donka ETC, which is an increase with regard to the 10 cases admitted in the previous week.
The teams are strengthening their efforts in health promotion in the city, while continuing outreach and training activities.
MSF is also setting-up a new ETC in Nongo, Conakry, whose opening is scheduled end of April.
On March 7, the trial of VSV-EBOV, one of the two experimental vaccines against Ebola, officially started in Conakry. The vaccine will be administered on a voluntary basis to both frontline Ebola workers and people having being in contact with Ebola patients, selected according to strict criteria, in order to evaluate its safety and efficacy. MSF is participating to the trial.
In the CTE that MSF runs in Guéckédou, there are no admissions since January. No cases were declared in the prefecture since more than 80 days, and MSF is considering changing the setup in the area to cover a wider part of the region.
Rapid Response Teams – Faranah
MSF deployed its rapid response team in this area, where 50% of the new cases of the country were declared week up to March 15.. After an evaluation phase, the team will focus on coordination of the response in two districts near the border with Sierra Leone.
In Kankan town, MSF set-up an ETC and ran outreach activities in the surrounding area. No cases have been declared in the area since December 2014. Cases of meningitis and measles have been declared in the area mid-March.
On Friday March 20, a patient tested positive for Ebola in the transit centre run by MSF in Liberia's Ministry of Health Redemption Hospital in Monrovia. This is the first confirmed Ebola case in Liberia since the last patient was discharged March 5th.
In the past weeks, MSF has progressively reduced its Ebola related activities, and is working today in Monrovia in two facilities: the Redemption Hospital transit centre and ELWA 3.
Support of non-Ebola healthcare remains a priority.
Monrovia: ELWA 3 ETC
The Ebola patient who was diagnosed on March 20 is currently being taken care of in this ETC, which had been previously empty. MSF is currently redefining its presence in the centre, whose capacity has been reduced to 30 beds.
Monrovia: Distribution and Outreach
In Monrovia MSF has officially opened on March 21 a 46 beds paediatric hospital, whose maximum total capacity is expected to increase up to 100 beds.
Since February 2015, MSF also runs a Survivor Clinic, to provide care to patients who recovered from Ebola. In addition to care for reported aftereffects of the disease, the clinic also offers access to primary healthcare for these patients, who often face stigma and fear when seeking for care in non-Ebola healthcare structures.
MSF is also supporting 23 Health facilities in the city, and their staff trained on Infections Prevention and Control. A team is also supporting the pediatric and maternal James Davis Junior Memorial (JDJ Hospital) in Monrovia.
Finally, more than 180 cases of measles were reported in Monrovia in the last weeks. MSF is supporting health facilities for case management, and is currently planning vaccination activities in collaboration with the ministry of Health and its partners.
Monrovia: Redemption ETU, health promotion and training
In Redemption Hospital, MSF has been running an Ebola Transit Unit, providing training on infection prevention and control, as well as outreach activities in the surrounding health centres and the communities.
MSF is currently re-evaluating its presence in the hospital, whose Emergency Unit reopened in March.
Training of healthcare staff
Since 18 March, MSF is running 3-day RITE (Rapid Isolation and Treatment of Ebola) trainings for County Health Teams staff in 4 counties (Grand Cape Mount, Bomi, Nimba and Montserrado).
The number of cases has been fluctuating in the country, after a sharp decrease in January 2015. On March 15, Sierra Leone recorded the lowest weekly number of cases (55) since June 2014. All of them were reported in north-western districts, as well as in the capital, Freetown.
However, about one-third of new cases still come from unknown contact chains, thus highlighting the need to strengthen surveillance and awareness.
MSF is refocusing its activities around outreach activities, surveillance, social mobilization, amongst others.
The last confirmed patient was admitted on January 12, while the last discharge took place on January 26. Decontamination of the wards is underway.
Last patient was discharged on 13/03. Outreach activities are ongoing to all chiefdoms in Tonkolili district. Teams are investigating measles cases in the area.
Freetown - Kissy
On January 8th, MSF opened an Ebola Treatment Center in Kissy, one of the current hotspots of the epidemic, in the outskirts of Freetown. On January 28th, the maternity section of the center (METC) opened, providing obstetric services for Ebola-positive pregnant women. The centre is located on the school grounds of Methodist Boys High School. Following the decision of the government of reopening schools, there was an agreement between the Ministry of Health and MSF to move this centre to a nearby location. A new site has been identified and the new location is being rehabilitated ahead of the move. Since the facility will still be offering specialised care for pregnant women, the plan is to leave it open until the end of the epidemic.
Freetown - Prince of Wales secondary school
The center discharged the last patient of the center the 23 of February. The team is focusing on outreach activities (disinfection, targeted health promotion and monitoring of the humanitarian situation in quarantined homes), including monitoring suspected measles cases in western Urban area. MSF is also running a Survivor clinic, providing medical follow-up to an average of 20 survivors per day. MSF is also working with local authorities for the integration of survivor’s health needs into the existing health system.
Kambia – Cross-border surveillance
End of February, MSF ran an evaluation of the needs in the area, which lead to an intervention aiming at reinforcing cross-border surveillance between Kambia district and Forécariah prefecture, in Guinea. MSF is supporting the local Ebola Response Team in contact tracing and surveillance, as well as running active surveillance at the 5 border crossings.