Since the Ebola outbreak in West Africa was officially declared on 22 March in Guinea, it has claimed more than 8,600 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.
During the last weeks, a downward trend of new cases has been reported in Médecins Sans Frontières (MSF) Ebola management centres across the three affected countries, with 50 confirmed cases in its eight centres last week. While this is a promising development, the World Health Organization reported that only about half of new cases in both Guinea and Liberia are from known Ebola contacts, while in Sierra Leone there is no data available. There is almost no information sharing for tracing Ebola contacts between the three most-affected countries. Since a single new case is enough to reignite an outbreak, the level of vigilance should remain high in order not to jeopardise the progress made in stemming the epidemic.
MSF staff on ground (as of 27 January)
307 international and about 4 000 national
Guinea (OCB + OCP)
70 international, around 800 national
Sierra Leone (OCA + OCBA + OCG)
145 international, around 1 600 national
Liberia (OCB + OCG + OCP)
92 international, around 1 600 national
MSF’s West Africa Ebola response started in March 2014 and includes activities in Guinea, Liberia, Mali and Sierra Leone. MSF currently employs 302 international and around 4000 national locally hired staff in the region. The organisation operates eight Ebola case management centres (CMCs), providing approximately 650 beds in isolation, and one transit centre. Since the beginning of the outbreak, MSF has admitted more than 8,100 patients, among whom around 4,960 were confirmed as having Ebola. More than 2,300 patients have survived.
More than 1,400 tonnes of supplies have been shipped to the affected countries since March.
While the total number of new cases has considerably decreased during the last weeks - reaching 9 confirmed cases over 17 hospitalisations in the whole country - with 13 of the country’s prefectures considered as “active”, the epidemic is still geographically spread out. Moreover, new chains of transmission have been reported in areas previously considered as Ebola-free. To respond to this new dynamic, MSF deployed a rapid response team to intervene in the new hotspots. This team is currently intervening in Faranah where new cases have been reported. A second rapid response team should arrive shortly in the country. These teams are able to quickly identify, investigate and follow new cases and contacts, as well as quickly setting up isolation units within existing health structures.
On January 17th, the government officially launched the “0 cases in 60 days” plan.
The number and rate of health staff infections remains high, especially in private structures
There has been a slight increase in cases with 8 new admissions at Donka CTE. MSF continues outreach and community sensitization activities in the city but the level of acceptance remains low.
With 2 admissions (of which 1 confirmed case, the only one in the ETC) during the last days, the number of patients remains low. MSF launched a support intervention in the nearby town of Kissidougou, where new cases have been reported.
The favipiravir trial led by INSERM is ongoing.
Liberia has seen a sharp decline in Ebola cases. Due to the overall improvement of the situation in the country, MSF has progressively reduced its activities, and is working today in Monrovia in two facilities: the Redemption Hospital transit centre and ELWA 3. The main focus is now on surveillance, infection control and prevention, health promotion and training activities. Support of non-Ebola healthcare remains a priority.
Monrovia: ELWA 3 ETC
On 17 January, there were no Ebola patients in ELWA 3 for the first time since it opened. Currently this ETC hosts only one patient. The downsizing of the centre has begun with a first reduction from 200 to 60 beds. An additional downsizing to 30 beds is planned for the beginning of February. In the meantime, MSF started the decommissioning of an old part of the ETC. A survivors’ clinic, aiming to offer psychosocial support, health screening and primary health care to Ebola survivors started this week.
The brincidofovir trial: The trial group is following a case by case approach for the inclusion of new patients. Trial may be resumed sooner than expected due the reduced number of patients.
Monrovia: Distribution and Outreach
13 health facilities are being followed on Infections Prevention and Control. 234 health staff have been trained. A team is also supporting the James Davis Junior Memorial Hospital (JDJ Hospital) in Monrovia. Rehabilitation is ongoing to set up infection control and to upgrade the equipment in triage, consultation rooms, pediatrics ward, and maternity ward. MSF staff started to work inside JDJ in order to support MoH staff.
Monrovia: Redemption ETU, health promotion and training
Coordination on rapid and effective implementation of infection control trainings in health centres/clinics surrounding MSF Transit Unit is ongoing.
A total of 10 health promotion 2-day Training of Trainers have been carried out since December 2014 and are now finished for the Western Montserrado area. Follow-up of participants and their trainings is now ongoing.
In the past three weeks, Sierra Leone has reported declines in cases nationwide. In Freetown and the surrounding Western area, fewer than 10 Ebola cases have been confirmed per day since January 14th; down from an average of 23 per day in late December according to data reported from the Ministry of Health and Sanitation. Corpse positivity rates have also declined with only 4 Ebola-positive community deaths reported in Western Urban the last week. Despite these promising signs, hotspots persist, with the UN highlighting 50 Ebola hotspots across the region, and under-reporting remains an issue.
On Jan 19th, the NERC launched Phase II of the Western area surge, an intensification of ongoing social mobilization efforts as well as the strengthening of contact tracing. With many actors operating in this area, coordination improvements are needed. In Freetown, MSF is engaging into an Ebola community outreach strategy, including support for epidemiological surveillance related activities, health promotion, and house disinfection.
On 22 January, Kailahun district was declared Ebola-free after 42 consecutive days without an Ebola case. MSF and the Ministry of Health are looking together at Kailahun hospital taking over responsibility for future suspected cases, which would allow MSF to close its project in Kailahun. MSF is building an isolation unit in the grounds of the local hospital and training MoH staff. In the meantime, the EMC in Kailahun has been transformed into a transit centre, which could be upgraded to an EMC if needed. Outreach activities are coming to an end as all chiefdoms in Kailahun districts have had numerous visits from MSF’s outreach teams.
The MSF EMC in Bo saw a decrease of cases in late December following the opening of more treatment facilities in different regions of the country. There are currently no patients in the EMC. MSF continues to provide mental health services in the EMC as well as strengthening health promotion activities, training community health workers and visiting quarantined houses in the district, as well as supporting the local alerts team. With some capacity freed up due to the decline in patients in the EMC, the teams are expanding outreach activities to all chiefdoms in Bo district.
Six patients are currently in isolation in the EMC. Since opening, 17 survivors have been discharged. The Winnipeg Laboratory, installed inside the EMC, is operating as district lab, working with three other holding centers and 11 community care centres in the area. It has a turnaround time on lab samples of four hours, which has helped reduce the number of patients in holding centres. Outreach activities are ongoing to all chiefdoms in Tonkolili district.
On January 8th, MSF opened 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 a capacity of up to 80 beds including a 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. On January 28th, the maternity section opened, providing obstetric services for Ebola-positive pregnant women. An Ebola positive pregnant patient was discharged as a survivor Jan 20th and on January 28th, the youngest survivor was discharged, an 18 month-old child.
MSF completed the second round of antimalarial distribution on January 16-19th for a target population of 1.8 million people. Social mobilization teams completed a house-to-house sensitization on the distribution of antimalarial drugs, with information on the purpose of the campaign and instructions on how to use these medications should be used for malaria prevention. Following this sensitization, a four-day house-to-house distribution of antimalarials was undertaken, where recipients were encouraged to take the artesunate amodiaquine with directly observed therapy (DOT) to support adherence. Preliminary results indicate high levels of coverage and compliance, and MSF has undertaken a survey to assess outcomes.
Freetown/ Prince of Wales secondary school
The Ebola Treatment Center at Prince of Wales School has 100 beds capacity, though only 17 patients were in the facility on Jan 27th. 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. Since the centre opened on December 10, there have been 319 admissions, 154 Ebola confirmed patients, 71 Ebola deaths and 67 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.
An Ebola community outreach strategy is underway, including support for epidemiological surveillance related activities, health promotion, and house disinfection.