July 21, 2015

HIGHLIGHTS

• The Government of Liberia (GoL) reports no new EVD cases since July 12, discharges two of the four remaining EVD patients from Montserrado County EVD treatment unit (ETU)
• During the week ending July 19, the Government of Sierra Leone (GoSL) confirms three new EVD cases, a 79 percent decrease from the previous week
• From July 13–19, the Government of Guinea (GoG) reports 22 new EVD cases, a 70 percent increase from the previous week

KEY DEVELOPMENTS

• From July 13–20, the GoL reported no new EVD cases, maintaining the case total from Liberia’s recent cluster at six. Of these six cases, two patients have died, two are convalescing at Montserrado’s ELWA 3 ETU, and two were discharged as EVD survivors from ELWA 3 on July 20. The GoL was following 74 contacts of confirmed EVD cases, including 57 in Margibi County and 17 in Montserrado, as of July 19.
• In recent weeks, EVD response actors in Guinea have expressed growing concern regarding the number of missing contacts in hotspot areas, particularly due to reports of contacts evading surveillance by traveling to other prefectures. According to WHO, the mobility of high-risk contacts remains a significant barrier to ending EVD transmission in the country.
• Between July 13 and 19, the GoSL reported three new EVD-positive cases, including two in Western Area Urban District and one in Port Loko District. All three cases—including a health care worker in Western Area Urban—resulted from unknown sources of transmission.

REGIONAL

In its most recent situation report covering the period from July 6–12, WHO reported 30 confirmed cases of EVD in West Africa, including 14 cases in Sierra Leone, 13 cases in Guinea, and three cases in Liberia. While the total remains unchanged from the previous week, transmission patterns have shifted, with Sierra Leone and Guinea reporting the majority of cases from their capital cities for the first time in several months. During this period, only one case—representing approximately 3 percent of newly confirmed cases—resulted from unknown sources of infection, indicating improvements in case investigations and response actors’ understanding of transmission chains, according to WHO. However, seven cases—approximately 23 percent—were identified as EVD-positive only after routine post-mortem testing, indicating that contact tracing remains a challenge across the region.

Border surveillance between affected countries remains a key component of the EVD response, the UN reports. In June, local authorities and humanitarian organizations distributed approximately 20,000 informational posters at border crossing points between Guinea, Liberia, and Sierra Lone to reinforce community sensitization efforts.

In partnership with the African Development Bank, the African Union (AU), the E.U., and the World Bank, the UN hosted an International Ebola Recovery Conference in New York from July 9–10. Following technical consultations for recovery strategies, the international community pledged more than $5 billion on July 10 to support longterm recovery efforts in Guinea, Liberia, and Sierra Leone.

Through more than $6.4 million in assistance, USAID/FFP is supporting UNICEF’s efforts to prevent and treat severe and moderate acute malnutrition among EVD-affected children in Guinea, Liberia, and Sierra Leone. UNICEF will conduct screenings, referral, and treatment of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) among children in communities throughout the three EVD-affected countries. In addition, the UN agency plans to treat approximately 50,000 children younger than five years of age affected by SAM and MAM with ready-to-use therapeutic and supplementary food and nutritional supplements.

Liberia

The GoL reported no new EVD cases from July 13–20, holding the recent outbreak’s total number of confirmed cases at six, including five cases from Margibi and one case from Montserrado. Of these six cases, two patients have died, two are convalescing at the ELWA 3 ETU in Montserrado, and two were discharged as EVD survivors from ELWA 3 during a July 20 ceremony. Seven individuals—including the two confirmed EVD cases and five suspected cases—remained in ETUs as of July 20.

As of July 19, the GoL was following 74 contacts of confirmed EVD cases, including 57 in Margibi and 17 in Montserrado. More than 70 contacts from Margibi graduated from the contact monitoring list in recent days without developing symptoms. CDC and USAID/OFDA partners continue to assist case investigation and contact tracing in both Margibi and Montserrado, including re-training of contact tracers and supervision of monitoring activities. On July 13 and 14, the Montserrado county health team (CHT), CDC, and WHO supported a surveillance and contact tracing training for approximately 60 district health and surveillance officers and data managers.

Response priorities for the GoL Incident Management System (IMS) and Montserrado CHT include ensuring adequate human resources and operations support, as well as continuing active case finding, community engagement, and psychosocial support to EVD-affected populations. The IMS is working with partners to strengthen EVD response activities, including resuming the GoL policy of universal swabbing and safe burials. A USAID/OFDA-supported non-governmental organization (NGO) consortium led by the International Rescue Committee (IRC) continues to assist response efforts in Montserrado. USAID/OFDA recently supported IRC with nearly $4.1 million in additional assistance for constorium activities—including enhancing surveillance and infection prevention and control (IPC) protocols—in the county.

With assistance from CDC and WHO, a GoL men’s health and EVD screening program began enrolling EVD survivors on July 7 at the Redemption Hospital clinic site in Liberia’s capital city of Monrovia. The program provides male EVD survivors with semen testing and related counseling to increase awareness of potential sexual transmission of EVD and knowledge of how to protect sexual partners. On July 13, the program activated its first mobile team to collect samples; program participants are tested every four weeks until they produce two consecutive EVD-negative samples.

USAID/OFDA partner IOM continues to provide EVD response assistance—including surveillance, coordination, and capacity building; psychosocial services and survivor reintegration; and social mobilization support—to multiple affeted counties in Liberia. Between July 3 and 10, IOM supported official and unofficial county and national border crossing points and county checkpoints, delivered triage materials, and held refresher infection prevention and control trainings. In response to the recent cluster of new confirmed EVD cases in Margibi and Montserrado, IOM is working to scale up checkpoint support and social mobilization activities in and near the affected counties.

Sierra Leone

Between July 13 and 19, the GoSL Ministry of Health and Sanitation (MoHS) confirmed three new EVD cases, including two in Western Area Urban and one in Port Loko. All three cases resulted from an unknown contact with the sources of transmission under investigation as of July 20. Kambia District has not reported a new EVD case since July 10.

One of Western Area Urban’s cases, confirmed on July 14, was a health care worker. The patient had undergone a 21-day quarantine at the voluntary quarantine facility before being released and contracting EVD from an unknown transmission source.

On July 20, USG Disaster Assistance Response Team (DART) and CDC staff traveled to Port Loko with high-level representatives from the National Ebola Response Center (NERC), as well as staff from NGOs and UN agencies. 3 During the visit, the Port Loko District Emergency Response Center (DERC) reported successful efforts under the ongoing Operation Northern Push surge response, including improved IPC in Port Loko health facilties as EVD response partners coordinate IPC and water, sanitation, and hygiene (WASH) interventions. The DERC also affirmed support for the Paramount Chief-led and community-owned local response, including the establishment of a sub-office that, alongside multi-disciplinary teams, helps facilitate EVD-related rapid responses. In addition, the DERC continues to strengthen surveillance efforts and community engagement.

USAID/OFDA partner IOM continues to to support the ring IPC approach in peripheral health units (PHUs) around Freetown’s Magazine Wharf community. The ring IPC approach—undertaken in collaboration with NGOs Concern, GOAL, and Save the Children, alongside assistance from CDC and the UK Department for International Development (DFID)—provides intensive IPC support to targeted PHUs to help break ongoing chains of transmission. The strategy targets health facilities based on known health care worker exposure to EVD, including health care facilities near the site that treated the patient and those in close proximity to the patient’s home. IOM reports that, in recent weeks, ongoing and intensive transmission of new EVD cases in Magazine Wharf resulted in a total of 15 confirmed EVD cases and 22 people receiving treatment or under observation in the area’s holding center. As of July 20, surveillance and contact tracing teams were monitoring nearly 370 contacts in Western Area Urban.

Guinea

During the week ending July 19, the GoG reported 22 new EVD cases, including 13 from Guinea’s capital city of Conakry, seven from Forécariah Prefecture, and two from Coyah Prefecture. The total represents an approximately 70 percent increase from the previous week.

From July 16–18, prefectural authorities reported 10 new cases—including two health care workers—in Conakry’s Ratoma sub-prefecture. As of July 19, authorities in Conakry had identified 23 confirmed EVD cases in Ratoma and Matam sub-prefectures during the previous 21 days.

As of July 19, the GoG and WHO reported that ETUs across Guinea were treating 36 suspected and confirmed EVD patients, including 21 EVD-positive patients at Conakry’s Nongo ETU. The Nongo ETU—which opened on July 5—currently has the capacity for 48 suspected and confirmed EVD patients, according to the GoG and WHO.

In recent weeks, EVD response actors have expressed growing concern regarding the number of missing contacts in hotspot areas, particularly due to reports of contacts evading surveillance by traveling to other prefectures. As of July 14, the National Ebola Coordination Cell reported that 33 contacts―of whom 16 were considered high-risk due to their recent exposure to a confirmed EVD case―remained missing. The high-risk contacts include 10 registered in Boké, four in Forécariah, and two in Conakry. According to WHO, the mobility of high-risk contacts remains a significant barrier to ending EVD transmission in Guinea.

On July 20, the GoG launched a micro-cerclage—or de-facto quarantine—targeting approximately 90 households containing high-risk contacts in hotspot areas of Conakry’s Matam and Ratoma. The micro-cerclage seeks to identify new suspected cases and reduce the risk of further EVD transmission through activities including enhanced monitoring and surveillance, door-to-door hygiene promotion activities, the distribution of soap and other sanitation supplies, the deployment of four mobile health care teams, the provision of free health care and psychosocial services, and social mobilization activities. Targeted households must remain at home until their respective 21-day monitoring periods elapse, but will receive distributions of food and cash to offset the economic impact on families. According to the UN World Food Program (WFP), the organization distributed 100 kilograms (kg) of rice, 50 kg of high-nutrient corn soy blend, and five liters of cooking oil to each of the targeted households during the July 20 launch.

DART staff in Guinea, in collaboration with OCHA, recently launched a pilot online repository to collect and share data on ongoing and planned EVD response activities related to IPC. The online tool will enable the GoG and EVD response actors to visualize real-time information related to IPC interventions, including various performance indicators, to ensure accountability and effective response coordination.

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