January 14, 2015

HIGHLIGHTS

• New EVD cases continue to decrease in Liberia, and the number of confirmed cases has declined by 43 percent between December 22 and January 5 in Sierra Leone, according to WHO. Relief agencies continue to implement life-saving activities and underscore the importance of preventative measures.
• Since early January, USAID/OFDA partners have opened one EVD treatment unit (ETU) and four community care centers (CCCs) in Sierra Leone.
• To strengthen coordination, CDC and partner eHealth Africa are supporting the establishment of county-level emergency operation centers (EOCs) in Liberia.

KEY DEVELOPMENTS

• During the week of January 5, newly appointed U.N. Special Representative of the Secretary General (SRSG) Ismail Ould Cheikh Ahmed—the head of the U.N. Mission for Ebola Emergency Response (UNMEER)—traveled to the acutely EVD-affected countries of Guinea, Liberia, and Sierra Leone. The SRSG met with government officials, relief agencies, and international donors—including representatives from the USG Disaster Assistance Response Team (DART)—to discuss response efforts and gaps.
• According to WHO, EVD transmission rates are stabilizing in Sierra Leone, which remains the country with the highest number of EVD cases. In response to persistent needs, USAID/OFDA partner Medair opened a 20-bed ETU in Western Rural District on January 8, while Partners in Health (PiH) recently finalized the construction of three USAID/OFDA- supported CCCs in the severely affected Kono District.
• Guinea recorded 81 EVD cases countrywide—comprising 69 confirmed and 12 suspect cases—between December 29 and January 4, a 34 percent decrease from 123 cases reported during the week of December 22. Relief agencies note that EVD cases in many areas remain underreported and are expanding operations to augment contact tracing, improve referrals to treatment facilities, and support social mobilization efforts.

CURRENT SITUATION

Liberia

EVD case transmission continues to decline in Liberia, and as of January 12, the Government of Liberia (GoL) Ministry of Health (MoH) reported an average of slightly more than one confirmed case per day since late December. Despite the decline in EVD cases, relief agencies have underscored the need to continue life-saving interventions. In communities that have not recently experienced EVD cases, local non-governmental organizations (NGOs) report that some residents are no longer engaging in preventive measures and have commented that EVD is no longer a threat. Through social mobilization projects, such as the USAID/OFDA-funded Mercy Corps Ebola Community Action Platform, local NGOs are increasing EVD education and reinforcing the need to maintain EVD prevention behaviors.

The GoL—in collaboration with CDC, WHO, and USAID/OFDA partner the U.N. Children’s Fund (UNICEF)—is conducting infection prevention and control (IPC) assessments of at least 300 health care facilities in Montserrado County. The assessments aim to determine actions for restoring routine health care services at non-EVD health facilities, many of which had temporarily closed due to high infection rates among staff. The GoL and partners will evaluate each facility’s performance for minimum IPC standards, including triage services and isolation areas, as well as assess the number of staff trained in IPC protocols.

As relief actors strengthen response activities in counties outside of Montserrado County, CDC partner eHealth Africa is supporting the development of county-level EOCs to enhance local incident management systems and coordination of inter-county activities. As recent transmission patterns have illustrated, effective coordination among county health teams is essential for locating and treating cases, as well as for following contacts and implementing quarantine procedures. To set up the EOCs, eHealth is renovating office space, supplying furniture for at least eight staff members, and installing high-speed internet—which is especially important for sharing data with other counties and the national EOC. eHealth has prioritized the most EVD-affected counties, but expects all 15 counties to have functioning EOCs by early February.

The GoL MoH-led psychosocial technical working group is identifying and addressing challenges faced by EVD survivors—such as eviction and loss of employment due to the stigma of EVD; lack of financial resources to pay for needed medications; EVD-related health issues, such as vision impairment; and difficulty coping with the trauma of their experience. The GoL-supported EVD Survivors Network is coordinating relief efforts to ensure consistent assistance for survivors discharged from all ETUs.

Sierra Leone

While EVD transmission rates have stabilized countrywide, relief agencies remain concerned by hotspots and vulnerable rural areas in Sierra Leone. Following 42 consecutive days without a new confirmed EVD case in Pujehun District, the Government of Sierra Leone (GoSL) declared Pujehun—which borders Liberia’s Grand Cape Mount County—the first EVD-free district in the country. The GoSL and relief agencies have cautioned against complacency, underscoring the continued importance of preventative activities and the risk of EVD transmission from Liberia.

Improved surveillance and contact tracing have helped relief agencies identify increased EVD cases in Kono District— including EVD hotspots in the district’s Gbense, Kamara, Nimiyama, and Nimikoro chiefdoms—with 15 confirmed, 27 probable, and 54 suspected cases reported during the week of December 29. On January 8, the International Federation of Red Cross and Red Crescent Societies (IFRC) opened a 20-bed holding center and a 40-bed ETU in Kono’s Koidu town, while USAID/OFDA partner PiH had opened three 12-bed CCCs in Kono as of January 11.

On January 8, USAID/OFDA partner Medair opened the 20-bed Kontorloh ETU in Sierra Leone’s Kissy neighborhood, Western Rural District. The Kontorloh ETU is employing approximately 30 EVD survivors to support health care services, and the ETU had admitted 10 patients, including five confirmed EVD cases, as of January 12. Complementing Medair’s ongoing EVD response efforts in Kissy, Médecins Sans Frontières (MSF) opened a 20-bed ETU—with the capacity to scale up to 80 beds—in the area on January 8. MSF plans to begin providing triage services and obstetrics care for pregnant women with suspected or confirmed EVD at the ETU by January 31.

A laboratory established by the DoD Defense Threat Reduction Agency (DTRA) in southern Sierra Leone’s Moyamba District began operations on January 13. The lab serves a Médecins du Monde-managed ETU in Moyamba, as well as other EVD treatment facilities in the area. The laboratory had processed seven EVD specimens, including one specimen that tested positive for EVD, as of January 13. Including the DTRA-supported laboratory, Sierra Leone currently has 13 operational laboratories supporting critical EVD specimen and swab testing, which provide confirmation regarding whether a patient is EVD positive and if an individual was EVD-positive prior to death.

Nearly 60 percent of EVD infections among health care workers in Sierra Leone have occurred in public hospitals and health care facilities, according to recent CDC and WHO analysis released on January 5. Commonly reported modes of transmission included insufficient IPC measures in health care facilities, caring for patients outside of health care facilities, failing to use personal protective equipment (PPE) when needed, and experiencing PPE breaches. USAID/OFDA partner UNICEF—in partnership with CDC and the GoSL—continues to expand IPC and EVD screening trainings at nearly 1,200 public health units countrywide. As of December 21, UNICEF had provided IPC training for more than 7,000 HCWs and support personnel, including hygienists and security staff, and non-EVD health care facilities.

On January 6, DART personnel observed USAID/OFDA-supported EVD response training in Sierra Leone’s capital city of Freetown. USAID/OFDA partner International Organization for Migration (IOM) is providing IPC and PPE training for health care workers and other EVD response personnel, such as household disinfection staff. To ensure preparedness among EVD response workers, IOM requires trainees to complete an ETU simulation course and monitors graduates for IPC quality assurance. IOM is also providing training for African Union (A.U.) foreign medical teams to increase the number of qualified health personnel countrywide. In FY 2015, USAID/OFDA has provided nearly $3.5 million to support IOM’s EVD response activities in Sierra Leone, including $1 million to support IPC and PPE training.

Guinea

Guinea recorded 81 EVD cases countrywide—comprising 69 confirmed and 12 suspect cases—between December 29 and January 4. WHO also reported 53 EVD-related deaths, including 44 among ETU patients and 9 deaths in communities. CDC notes that the decline from the 123 cases reported during the previous week should be viewed cautiously while response efforts in Guinea are intensified.

The ETU in Forest Region’s Macenta Prefecture—operated by the French Red Cross—has received no new confirmed or suspect EVD cases since January 1, according to the National Ebola Coordination Cell. In addition, the number of patients at the ETU in Guéckédou Prefecture—where the West Africa EVD outbreak reportedly originated—decreased from 36 cases on December 30 to five cases on January 8. Although these changes may indicate an improving situation in the Forest Region, the area continues to host multiple contacts and unreported EVD cases likely exist.

The U.S. Peace Corps in Guinea is supporting CDC under an interagency agreement to implement a community EVD education effort that has reached approximately 20,000 people to date. In November, CDC trained 25 Peace Corps staff to become master trainers, and Peace Corps Guinea adapted CDC education materials into six local languages. Between December 8 and 13, the master trainers conducted sessions in Boke, Kankan, Kindia, Kissidougou, Labe, and Mamou prefectures for nearly 300 participants, including local authorities, community and youth leaders, and others, from more than 100 villages and towns.

Mali

Mali remains on schedule to receive an EVD-free designation from WHO on January 18, which marks the end of two 21- day incubation cycles with no new cases in the country. Efforts are underway to develop messages that appropriately celebrate the declaration while simultaneously reminding local populations that, as long as EVD persists in neighboring countries, communities in Mali must continue prevention efforts.

Between January 2 and 12, USAID/OFDA partner IOM registered and screened nearly 26,000 arrivals to Mali from Guinea and other neighboring countries at the 11 health screening posts it operates in Mali’s Kayes, Koulikoro, and Sikasso regions. Approximately 36 percent of new arrivals—nearly 9,300 individuals—were traveling from Guinea, including more than 6,100 Guinean nationals. The remainder of those arriving from Guinea comprised primarily returning Malians, as well as smaller numbers of nationals from various countries throughout the region. The Government of Mali and other EVD response actors in Mali remain vigilant in monitoring the possibility of EVD importation from Guinea.

FOOD SECURITY AND LIVELIHOODS

In early January, USAID/FFP provided approximately $9 million to Mercy Corps to address acute food security needs among EVD-affected communities in Liberia’s Lofa, Margibi, Montserrado, and Nimba counties. Mercy Corps will provide cash transfers to vulnerable households for the local purchase of food, as well as vouchers for agricultural inputs to support household food production during the upcoming agricultural season. The project aims to support 125,000 beneficiaries, prioritizing households with children under two years of age.

During the week of December 29, USAID/FFP partner the U.N. World Food Program (WFP) delivered food commodities to 56,000 individuals in Sierra Leone—including more than 100 EVD patients, more than 600 EVD survivor households, nearly 4,800 contacts, and more than 50,000 people in areas of widespread transmission. Since the start of the EVD emergency operation in Sierra Leone, WFP has assisted an estimated 1.3 million individuals—including more than 15,000 persons in need of EVD-related care and nearly 1.3 million individuals in quarantined or severely EVD- affected areas to date.

PUBLIC DONATION INFORMATION

• The most effective way people can assist relief efforts is by making cash contributions to humanitarian organizations that are conducting relief operations. A list of humanitarian organizations that are accepting cash donations for disaster responses around the world can be found at www.interaction.org.
• USAID encourages cash donations because they allow aid professionals to procure the exact items needed (often in the affected region); reduce the burden on scarce resources (such as transportation routes, staff time, and warehouse space); can be transferred very quickly and without transportation costs; support the economy of the disaster-stricken region; and ensure culturally, dietary, and environmentally appropriate assistance.

More information can be found at:

• The Center for International Disaster Information: www.cidi.org or +1.202.821.1999.
• Information on relief activities of the humanitarian community can be found at www.reliefweb.int.

USAID/OFDA bulletins appear on the USAID website at what-we-do/working-crises-and-conflict/responding-times-crisis/where-we-work