Ebola Situation Report - 18 March 2015
Corrected on 19 March 2015
SUMMARY
A total of 150 new confirmed cases of Ebola virus disease (EVD) were reported in the week to 15 March, compared with 116 the previous week. There were 95 new confirmed cases reported in Guinea: the highest weekly total for the country in 2015. Sierra Leone reported 55 new confirmed cases over the same period: the country?s lowest weekly total since late June 2014. Liberia reported no new confirmed cases for the third consecutive week. March 15 was day 12 since the final patient in Liberia had a second negative test for EVD (42 days must elapse before transmission can be considered to have ended).
A total of 12 districts in Guinea and Sierra Leone reported a confirmed case in the week to 15 March, all of which lie on a geographically contiguous arc in and around Conakry to the north and Freetown to the south. An additional 4 districts have reported a confirmed case in the past 21 days: Kono and Tonkolili in central and eastern Sierra Leone, and Lola and Macenta in eastern Guinea.
Though transmission is currently confined to a relatively narrow geographic corridor, the population is highly mobile, with a great deal of movement throughout surrounding districts and countries. Limiting the movements of cases and contacts is challenging but essential to prevent the seeding of new outbreaks.
Key response indicators for Guinea suggest that there remain significant challenges to overcome before transmission is brought under control. Of 49 total reported EVD deaths in the week to 15 March, almost half (23) were identified post-mortem in the community. In the week to 8 March, a low proportion (28%) of confirmed cases arose from registered contacts, and there were a reported 18 unsafe burials. Taken together, these indicators suggest that the outbreak in Guinea is still being driven by unknown chains of transmission.
In the week to 15 March a total of 125 suspected cases of EVD were reported in Liberia, none of whom tested positive for EVD. All contacts associated with the last known chain of transmission have now completed 21-day follow-up.
By contrast with Guinea, key response indicators for Sierra Leone present a more promising outlook. In the week to 8 March over two-thirds (67%) of confirmed cases came from registered contacts, whilst in the week to 15 March, 6 of 62 total EVD-confirmed deaths were identified post-mortem in the community. There was 1 reported unsafe burial over the same period. However, there are still areas where most new cases arise from unknown chains of transmission. Kambia, a district north of Freetown on the border with the Guinean prefecture of Forecariah, reported 7 new cases in the week to 8 March, 5 of which came from post-mortem testing of people who had died in the community and who were not known to be contacts of a previous case.
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COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
There have been over 25 000 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (table 1), with over 10 000 reported deaths (outcomes for many cases are unknown). A total of 95 new confirmed cases were reported in Guinea, 0 in Liberia, and 55 in Sierra Leone in the 7 days to 15 March.
The total number of confirmed and probable cases is similar in males and females (table 3). Compared with children (people aged 14 years and under), people aged 15 to 44 are approximately three times more likely to be affected. People aged 45 and over are nearly four times more likely to be affected than children.
A total of 852 confirmed health worker infections have been reported in Guinea, Liberia, and Sierra Leone; there have been 492 reported deaths (table 5).
Table 1: Confirmed, probable, and suspected cases reported by Guinea, Liberia, and Sierra Leone
Data are based on official information reported by ministries of health. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results. *Not reported due to the high proportion of probable and suspected cases that are reclassified. ?Data not available.
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GUINEA
Key performance indicators for the EVD response in Guinea are shown in table 2.
A total of 95 confirmed cases were reported in the 7 days to 15 March (figure 1), compared with 58 cases the week before.
At present transmission is confined to an area around and including the capital Conakry (25 confirmed cases), with the nearby prefectures of Boffa (3 cases), Coyah (20 cases), Dubreka (2 cases), Forecariah (42 cases), and Kindia (3 cases) being the only other prefectures to report cases (figure 1, figure 4). Lola and Macenta in the east of the country and the northern prefecture of Mali have reported confirmed cases in the past 21 days.
Limiting the movements of cases and contacts is essential but challenging in the context of a highly mobile population.
Challenges engaging effectively with communities are affecting several crucial aspects of the response. In the week to 8 March, a relatively low proportion of confirmed EVD cases arose among known contacts (16 of 58 cases: 28%), whilst almost half (23 of 49) of EVD-positive deaths occurred in the community in the week to 15 March. Of 425 samples that were tested in the week to 15 March, a high proportion (32%) tested positive for EVD. A total of 18 unsafe burials were reported over the same period. A total of 4 prefectures reported at least one instance of community resistance.
Locations of 8 operational Ebola treatment centres (ETCs) are shown in figure 6. Two ETCs have been assessed and have met minimum standards for infection prevention and control (IPC). Four new health worker infections were reported in the week to 15 March, 3 from Conakry and 1 from Forecariah.
Locations of the 9 operational laboratories in Guinea are shown in figure 7. Over 99% of samples were processed within 1 day of arrival at a laboratory in the week to 15 March.
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Corrected on 19 March 2015
SUMMARY
A total of 150 new confirmed cases of Ebola virus disease (EVD) were reported in the week to 15 March, compared with 116 the previous week. There were 95 new confirmed cases reported in Guinea: the highest weekly total for the country in 2015. Sierra Leone reported 55 new confirmed cases over the same period: the country?s lowest weekly total since late June 2014. Liberia reported no new confirmed cases for the third consecutive week. March 15 was day 12 since the final patient in Liberia had a second negative test for EVD (42 days must elapse before transmission can be considered to have ended).
A total of 12 districts in Guinea and Sierra Leone reported a confirmed case in the week to 15 March, all of which lie on a geographically contiguous arc in and around Conakry to the north and Freetown to the south. An additional 4 districts have reported a confirmed case in the past 21 days: Kono and Tonkolili in central and eastern Sierra Leone, and Lola and Macenta in eastern Guinea.
Though transmission is currently confined to a relatively narrow geographic corridor, the population is highly mobile, with a great deal of movement throughout surrounding districts and countries. Limiting the movements of cases and contacts is challenging but essential to prevent the seeding of new outbreaks.
Key response indicators for Guinea suggest that there remain significant challenges to overcome before transmission is brought under control. Of 49 total reported EVD deaths in the week to 15 March, almost half (23) were identified post-mortem in the community. In the week to 8 March, a low proportion (28%) of confirmed cases arose from registered contacts, and there were a reported 18 unsafe burials. Taken together, these indicators suggest that the outbreak in Guinea is still being driven by unknown chains of transmission.
In the week to 15 March a total of 125 suspected cases of EVD were reported in Liberia, none of whom tested positive for EVD. All contacts associated with the last known chain of transmission have now completed 21-day follow-up.
By contrast with Guinea, key response indicators for Sierra Leone present a more promising outlook. In the week to 8 March over two-thirds (67%) of confirmed cases came from registered contacts, whilst in the week to 15 March, 6 of 62 total EVD-confirmed deaths were identified post-mortem in the community. There was 1 reported unsafe burial over the same period. However, there are still areas where most new cases arise from unknown chains of transmission. Kambia, a district north of Freetown on the border with the Guinean prefecture of Forecariah, reported 7 new cases in the week to 8 March, 5 of which came from post-mortem testing of people who had died in the community and who were not known to be contacts of a previous case.
...
COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
There have been over 25 000 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (table 1), with over 10 000 reported deaths (outcomes for many cases are unknown). A total of 95 new confirmed cases were reported in Guinea, 0 in Liberia, and 55 in Sierra Leone in the 7 days to 15 March.
The total number of confirmed and probable cases is similar in males and females (table 3). Compared with children (people aged 14 years and under), people aged 15 to 44 are approximately three times more likely to be affected. People aged 45 and over are nearly four times more likely to be affected than children.
A total of 852 confirmed health worker infections have been reported in Guinea, Liberia, and Sierra Leone; there have been 492 reported deaths (table 5).
Table 1: Confirmed, probable, and suspected cases reported by Guinea, Liberia, and Sierra Leone
Guinea | Confirmed | 2966 | 204 | 1829 |
Probable | 395 | * | 395 | |
Suspected | 28 | * | ? | |
Total | 3389 | 204 | 2224 | |
Liberia** | Confirmed | 3150 | 0 | ? |
Probable | 1879 | * | ? | |
Suspected | 4497 | * | ? | |
Total | 9526 | 0 | 4264 | |
Sierra Leone | Confirmed | 8487 | 194 | 3325 |
Probable | 287 | * | 208 | |
Suspected | 2977 | * | 158 | |
Total | 11 751 | 194 | 3691 | |
Total | Confirmed | 14 603 | 398 | ? |
Probable | 2561 | * | ? | |
Suspected | 7502 | * | ? | |
Total | 24 666 | 398 | 10 179 |
Data are based on official information reported by ministries of health. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results. *Not reported due to the high proportion of probable and suspected cases that are reclassified. ?Data not available.
...
GUINEA
Key performance indicators for the EVD response in Guinea are shown in table 2.
A total of 95 confirmed cases were reported in the 7 days to 15 March (figure 1), compared with 58 cases the week before.
At present transmission is confined to an area around and including the capital Conakry (25 confirmed cases), with the nearby prefectures of Boffa (3 cases), Coyah (20 cases), Dubreka (2 cases), Forecariah (42 cases), and Kindia (3 cases) being the only other prefectures to report cases (figure 1, figure 4). Lola and Macenta in the east of the country and the northern prefecture of Mali have reported confirmed cases in the past 21 days.
Limiting the movements of cases and contacts is essential but challenging in the context of a highly mobile population.
Challenges engaging effectively with communities are affecting several crucial aspects of the response. In the week to 8 March, a relatively low proportion of confirmed EVD cases arose among known contacts (16 of 58 cases: 28%), whilst almost half (23 of 49) of EVD-positive deaths occurred in the community in the week to 15 March. Of 425 samples that were tested in the week to 15 March, a high proportion (32%) tested positive for EVD. A total of 18 unsafe burials were reported over the same period. A total of 4 prefectures reported at least one instance of community resistance.
Locations of 8 operational Ebola treatment centres (ETCs) are shown in figure 6. Two ETCs have been assessed and have met minimum standards for infection prevention and control (IPC). Four new health worker infections were reported in the week to 15 March, 3 from Conakry and 1 from Forecariah.
Locations of the 9 operational laboratories in Guinea are shown in figure 7. Over 99% of samples were processed within 1 day of arrival at a laboratory in the week to 15 March.
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