Personal note: this report has an error as the case fatality rate (CFR) is not 100% (0 deaths)
WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES
Week 33: 9 - 15 August 2021
Data as reported by: 17:00; 15 August 2021
Ebola virus disease Cote d’Ivoire
1 Cases
0 Deaths
100% CFR
EVENT DESCRIPTION
On 14 August 2021, the Ministry of Health and Public Hygiene
(MSHP) of Cote d’Ivoire confirmed a case of Ebola Virus Disease
(EVD) at Abidjan Hospital on 12 August 2021, with signs and
symptoms of fever, headache, and bleeding from her gums and
genitals which led attending clinicians to suspect viral hemorrhagic
fever infection.
On 13 August 2021, the National Institute of Hygiene of Cote d’Ivoire
was alerted, and a blood sample was collected and subsequently
sent to Institut Pasteur de Côte d’Ivoire (IPCI) for testing. Preliminary
laboratory test results on 14 August 2021 indicated Ebola virus
disease but confirmation of by IPCI is still pending. As of 15 August
2021, the patient was admitted to the Cocody university hospital in
Abidjan and undergoing supportive treatment.
Initial investigation revealed that the suspected case commenced
travel from Labé, Guinea on 8 August 2021 and arrived in Abidjan,
Cote d’Ivoire on 12 August 2021 by public transport. She reportedly
transited through Nzérékoré in Guinea, a region recently affected
by an outbreak of Ebola virus disease, where she boarded another
public transport headed for Ouaninou, Cote d’Ivoire. She arrived at
Ouaninou bus station on 12 August 2021, where she changed the
bus again and headed to her final destination in Abidjan on the same
day.
She reportedly developed signs and symptoms of fever while on
route and self-medicated with paracetamol. The patient initially
sought treatment at one local clinic on 12 August 2021, however
her condition worsened, and she was transferred to the Cocody
university hospital hospital in Abijan on the same day. A total of nine
contacts have so far been identified among family members and
hospital staff in Abidjan.
Efforts are underway to identify additional contacts including about
70 co-passengers that travelled on the same vehicle.
Currently, a second suspected case is being investigated, though
confirmatory details are still pending. Preliminary information
suggests it is a family member of the first case and a known contact.
National infection prevention and control teams were also deployed
to disinfect health care facilities attended by the patient as well as
provide advice and instruction to health care workers on use of
personal protective equipment.
Confirmation of this EVD case marks the first in Cote d’Ivoire since
1994 when a single, and thus far only human case was reported of
the especially rare Tai Forest strain of EVD which was contracted by
a scientist. Since that initial case, no other case of EVD had been
reported in Cote d’Ivoire until now despite various outbreaks in
surrounding countries throughout the years.
PUBLIC HEALTH ACTIONS
Multidisciplinary rapid response teams have been deployed to
key areas and will focus on infection prevention and control
measures, laboratory diagnostics, surveillance interventions,
and risk communication among others.
Contact tracing has been conducted with the patient’s close
contacts including health care workers and identification of
additional contacts is ongoing following further epidemiological
investigation.
National infection prevention and control teams have
disinfected health facilities visited by the patient.
Health care workers have been oriented on safety precautions
to take including the systematic use of personal protective
equipment and hygiene.
Epidemiological surveillance has been enhanced at health
structures and the border points.
Ebola vaccines (5 000 doses) are being secured to vaccinate
those at high risk of infection to include health care workers,
first responders, and contacts.
SITUATION INTERPRETATION
Cote d’Ivoire reacted swiftly to the outbreak with the necessary public
health measures such as isolation, detection, and containment for
the first EVD case in the country after more than 25 years. Detailed
investigations of the second suspect case are also underway.
While this demonstrates commendable surveillance capacity,
cross-border threats still remain a problem especially given the
recent outbreak of Marburg virus disease in Guinea. The frequent
international movement of people needs to be monitored with even
higher vigilance and especially while there are active outbreaks of
viral haemorrhagic febrile illnesses in bordering regions. Given that
the case was detected in a densely populated capital city (one of
largest metropolises on the African continent) and had recently
travelled, there are likely to be very many contacts across both
Guinea and Cote d’Ivoire. Since the patient experienced symptoms
during her journey this could also suggest that infection occurred
prior to the case’s departure or during her trip which was in an area
currently unknown to be affected by EVD. Thus, it is possible that
undetected transmission chains remain in these areas.
PROPOSED ACTIONS
The response team should fully implement plans of the EVD epidemic and
trigger partner involvement where indicated. Immediate capacity and logistical
needs should be met as rapidly as possible. Surveillance should be further
strengthened for viral haemorrhagic fever symptoms especially in bordering
regions of affected areas. Health workers and communities should be trained
and retrained on the early detection, isolation, and treatment of EVD patients as
well as practices for safe and dignified burials of the deceased. Additional
epidemiological investigations need to be improved and further efforts need to be
taken to find contacts considering the length of the journey of a symptomatic patient
with multiple transit points. Bilateral efforts need to be strengthened among countries
to have more collaborative vigilance and information exchange. Continue to conduct
risk communication about EVD among the general population, but
also specialize precautions for health workers.
https://apps.who.int/iris/bitstream/handle/10665/344261/OEW33-0915082021.pdf