West Africa Ebola Outbreak Fact Sheet #38

July 7, 2015

HIGHLIGHTS

• The Government of Liberia (GoL) reports two additional confirmed EVD cases in Liberia’s Margibi County; new confirmed case total remains at three.
• The Government of Sierra Leone (GoSL) extends surge response in EVD-affected areas of northern Sierra Leone.
• The Government of Guinea (GoG) expands 21-day EVD case finding and social mobilization campaign to include additional hotspot area in Forécariah Prefecture.

KEY DEVELOPMENTS

• On June 30 and July 1, the GoL confirmed the identification of two additional EVD-positive cases in Liberia’s Margibi County; both newly confirmed cases share an epidemiological link with the EVD case confirmed post-mortem in Margibi County’s Nedowein village on June 29.
• Active EVD transmission continues in Guinea and Sierra Leone, with a slight increase in new confirmed cases since June 28—particularly in Guinea’s Boké and Forécariah prefectures. The GoG recently announced the expansion of case investigation and social mobilization activities to Forécariah’s Benty sub-prefecture, a new hotspot area.
• On July 6, the GoSL announced the 90-day extension of Operation Northern Push, a GoSLled surge operation initially launched on June 16 for a 21-day period.
• The UN Mission for Ebola Emergency Response (UNMEER) has begun scaling down operations in Sierra Leone in recent weeks; however, several UN and partner agencies are maintaining critical response efforts in EVD-affected areas.

REGIONAL

Between June 22–28, WHO reported the number of newly confirmed EVD cases remained at 20 cases across West Africa, including 12 cases in Guinea and eight cases in Sierra Leone. The new cases originated in three Guinean prefectures and three districts in Sierra Leone; two Guinean health care workers were among the recently identified EVDpositive cases. During the week ending June 28, known contacts were not among the sources of infection for six people, or 30 percent of newly confirmed cases, highlighting ongoing undetected chains of transmission, according to WHO.

USAID/OFDA continues to support EVD preparedness efforts in Guinea-Bissau, particularly in areas along the border with Guinea’s Boké Prefecture. With approximately $407,000 in USAID/OFDA assistance, the International Organization for Migration (IOM) is strengthening border surveillance and other health capacities in Guinea-Bissau. In addition, USAID/OFDA recently committed nearly $386,000 to support the non-governmental organization (NGO) iMMAP conduct EVD-related information management and humanitarian coordination activities in five West African countries, including Guinea-Bissau.

Liberia

On June 30 and July 1, the GoL Incident Management System (IMS) confirmed two additional EVD-positive cases in Margibi epidemiologically linked to the confirmed EVD case reported on June 29. The two patients are receiving care at the GoL-managed ELWA 3 EVD treatment unit (ETU) in nearby Montserrado County. Investigations are ongoing regarding the source of infection, as well as extensive contact tracing. According to the GoL IMS, case investigators in Liberia are currently monitoring more than 100 contacts. While this number fluctuates due to ongoing risk assessments and suspected case analyses, CDC field epidemiologists remain actively engaged in case investigation and contact tracing. The GoL reports that, as of July 6, the number of new confirmed cases remained at three—including the two active cases and the recently deceased individual.

According to the GoL IMS, nine households are under voluntary precautionary observation, with EVD response actors providing food and other emergency relief supplies. In addition, the USG Disaster Assistance Response Team (DART), CDC, WHO, USAID/OFDA partners, and other EVD response actors are supporting the GoL and the Margibi County Health Team (CHT) to coordinate efforts and ensure comprehensive outreach coverage. The GoL is also scaling up border monitoring and screening activities at air, coastal, and overland points of entry, as well as increasing surveillance at health facilities and engagement with border communities.

Social mobilization actors are strengthening efforts in Margibi, including through ongoing community leader engagement, increased coordination with contact tracers, and enhanced public messaging. With support from EVD response actors, including USAID/OFDA partners the UN Children’s Fund (UNICEF), the International Medical Corps (IMC), and Save the Children, the Margibi CHT is also conducting social mobilization and case management activities in the county’s most-affected communities, particularly in Nedowein and nearby Mambah-Ka District.

DART staff visited the USG-supported Monrovia Medical Unit (MMU) site on June 29 to monitor the decommissioning process, currently in its sixth week. Compared to other ETUs, the decommissioning of the MMU—which previously treated EVD-positive health care workers—is more labor intensive, requiring more than two months to fully decontaminate and decommission the site, which includes the deconstruction of infrastructure and requires staff to wear personal protective equipment. The process is expected to conclude in late July.

In late June, DART members visited Harper town, Maryland County, to visit USAID/OFDA-supported activities implemented by the NGO Partners in Health (PiH). During the visit, the DART members accompanied PiH staff to several health facilities and discussed the NGO’s ongoing community health worker activities and psychosocial support approach. As of June 25, PiH had trained more than 400 health facility workers in infection prevention and control and EVD prevention and treatment training. The 400 trainees include ETU employees, as well as hospital and health care staff working in four southern Liberian counties—Grand Gedeh, Grand Kru, Maryland, and River Cess.

Sierra Leone

Between June 29 and July 5, the GoSL Ministry of Health and Sanitation reported nine new confirmed EVD cases in Sierra Leone. Kambia District reported four cases, Port Loko District had two cases, and three cases came from Western Area Urban District. Of the nine EVD cases, four were from known contacts, three came from a known epidemiological link, and two cases came from an unknown contact and remain under investigation. One of the recent Kambia cases was an ETU health care worker; the source of infection was unconfirmed as of July 6.

During the week of June 30, the National Ebola Response Center (NERC) agreed to consolidate gains made through Operation Northern Push by extending surge activities for an additional 90 days after the operation’s former July 7 end date. Operation Northern Push is currently underway in Kambia and Port Loko, where new EVD cases increased between early and mid-June. Activities aim to strengthen EVD surveillance and comprehensive contact tracing, improve quarantine conditions, and expand cross-border coordination between Kambia and Guinea’s Forécariah. Since June 16, the NERC reported enhanced community engagement, increased numbers of surveillance officers, and improved adherence to quarantine efforts.

On July 4, the DART joined U.S. Ambassador to Sierra Leone John Hoover and representatives from CDC, the NERC, the UK Department for International Development (DFID), UNICEF, UNMEER, WHO, and Welthungerhilfe (WHH) on a visit to a voluntary quarantine facility at Western Area’s Hastings ETU and met with the District Ebola Response Center. At the facility, the delegation spoke to a number of people, including nurses recently exposed to an EVDpositive patient at a health clinic in the capital city of Freetown’s Magazine Wharf community—a highly congested, EVDaffected community formerly reticent to response activities. Individuals at the voluntary facility receive food and other support materials, including cooking equipment. As of the week of June 29, the Western Area facility was hosting 109 guests, and district-level actors report that 69 households, or 156 people, were under quarantine in Magazine Wharf as of July 4. The DART noted that, despite the challenging environment, social mobilizers and psychosocial support teams are conducting a well-organized and community-driven response in Magazine Wharf. The NERC plans to continue weekly outreach field trips rotating between the surge response in the three hotspot districts in the coming months.

UNMEER personnel officially completed their assignments in Sierra Leone on June 30; several core staff will remain in country through the end of July to fully close out the UN mission and facilitate the donation of remaining resources, according to the UN. Despite the phase out of UNMEER operations, UN agencies and associated organizations— including WHO, UNICEF, the UN World Food Program (WFP), the UN Population Fund (UNFPA), the UN Development Program (UNDP), IOM, and the World Bank—continue conducting EVD response activities in Sierra Leone. Among other activities in support of Operation Northern Push, UNDP provided 13 quality assurance monitors; WFP contributed fresh food and non-perishable rations for pre-quarantine, quarantine, and post-quarantine packages; IOM stocked 2,500 and 700 interim care kits in Kambia and Port Loko, respectively; and UNICEF supplied 2,000 family protection kits and 100 family tracing and reunification kits.

USAID/FFP partners continue providing livelihoods and food assistance to vulnerable communities in Sierra Leone. USAID/FFP partner Save the Children, along with the National Commission for Social Action and SPLASH Mobile Money, has identified approximately 6,400 households in Kailahun District to receive unconditional cash transfers of approximately $30 per household per month for a seven-month duration, which is scheduled to begin during the week of July 13.

Guinea

From June 29–July 1, the GoG reported ten new confirmed EVD cases—six in Boké, three in Forécariah, and one in Conakry Prefecture. Among the Boké cases, four came from Tamaranssy village, one from Kasongony village, and one—a community death and unknown contact—from Kassopo village. An investigation remains ongoing to determine the source of transmission and identify and register all subsequent contacts resulting from the community death.

The three confirmed cases in Forécariah came from Benty sub-prefecture’s Kigbaly village, where contact tracers subsequently identified 11 new contacts on June 30, the GoG reports. Benty remains the hottest zone in Forécariah due to multiple active chains of transmission and ongoing community reticence. During the past 21 days, prefectural authorities have reported five cases in Benty, compared to 11 cases reported across the entire prefecture.

The GoG has announced plans to expand its 21-day active EVD case finding and social mobilization campaign to Kigbaly on July 10 to stop EVD transmission in Benty and prevent suspected cases from traveling to other areas of Guinea. The campaign—which currently targets four villages in Boké, Dubréka, and Forécariah prefectures—includes a 21-day quarantine of EVD-affected communities during which response actors are conducting enhanced surveillance, health and sanitation activities, ensure safe and dignified burials, and promote community engagement in the EVD response through various social mobilization activities. WFP, along with the GoG, is providing participating households with daily food assistance, including fish, meat, cooking oil, and rice, for the duration of the campaign; the GoG is also providing cash support to beneficiary households.

From July 1–2, DART staff conducted a two-day visit to Boké and Dubréka to assess ongoing response activities and meet with response actors, including USAID/OFDA partner the International Federation of Red Cross and Red Crescent Societies (IFRC), to discuss current challenges. IFRC currently has 10 safe burial teams across three Boké subprefectures; the four teams in Kamsar sub-prefecture respond to an average of seven reported deaths per day. IFRC staff expressed concerns that recent threats of violence and community resistance to safe and dignified burials continues to impede response efforts in Boké. However, IFRC noted that the overall level of community resistance in active prefectures is declining due, in part, to increased efforts to raise awareness regarding burial procedures.

On July 5, Médecins Sans Frontières (MSF) opened the new Nongo ETU in Conakry; the site will supplant the nearby MSF-supported Donka ETU. In recent days, MSF transferred five remaining patients—four suspected and one confirmed—from the Donka facility to the new ETU. Beginning on July 5, the French Center for Treatment of Health Care Personnel (CTS), also located in Conakry, no longer accepted new patients; the CTS plans to transfer two remaining patients to the Nongo site where MSF is preparing a treatment area specifically for health care workers.

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