January 21, 2015

HIGHLIGHTS

Ebola Response

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  • Malian authorities and WHO announce the end of the EVD outbreak in Mali following two 21-day cycles without anew confirmed case in the country.
  • USAID/OFDA partners commenced operations at the Voinjama town EVD treatment unit (ETU) in Liberia’s Lofa County on January 14.
  • The Government of Guinea (GoG) officially reopens public schools countrywide; preparations to reopen schools in Liberia and Sierra Leone remain underway.
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KEY DEVELOPMENTS

  • UN Special Envoy on Ebola David Nabarro reported on January 15 that in recent days, Liberia had reported the lowest number of new EVD cases since June, while Guinea and Sierra Leone both reported the lowest number of new cases since August. Despite the progress, Special Envoy Nabarro remarked that additional efforts are required to end the current outbreak, noting at least 50 areas where clusters of new cases persist.
  • The Government of Sierra Leone (GoSL) recently launched the second phase of Western Area surge operations, which primarily focuses on increasing community awareness of EVD and mobilizing communities to support response efforts. The second phase of Western Area surge operations is a core component of the National Ebola Response Center’s (NERC) strategy to meet the national goal of significantly reducing the EVD caseload by late February and reaching zero new confirmed EVD cases by May.
  • According to WHO, EVD cases continue to decline in Guinea, with 38 total laboratory-confirmed cases recorded for the period of January 5 to 11—a nearly 46 percent decrease from the previous week’s total of 70. Overall, most of Guinea’s prefectures showed fewer or no cases, although authorities noted increases in confirmed cases in the Coyah, Faranah, and Forecariah prefectures.

CURRENT SITUATION

UN Mission for Ebola Emergency Response (UNMEER) continues to emphasize regional coordination as part of the second phase of the UN mission’s EVD response. Regional priorities include the need to confront complacency as the number of EVD cases continues to decline and to strengthen cross-border surveillance. During a recent meeting with the USG Disaster Assistance Response Team (DART), UNMEER leadership also highlighted the importance of community leader engagement—particularly at the district level—in border regions of Guinea, Liberia, and Sierra Leone, as well as less-affected countries such as Cote d'Ivoire, Guinea-Bissau, Mali, and Senegal.

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Liberia

During the 21-day period ending January 18, the Government of Liberia (GoL) Ministry of Health (MoH) reported 25 confirmed EVD cases countrywide. 15 confirmed cases were located in Montserrado County, while all 25 cases were found in just three counties—Grand Cape Mount, Margibi, and Montserrado—with Grand Cape Mount reporting the second highest number of new confirmed cases with nine.

On January 14, the ETU in Lofa County’s Voinjama town opened with an initial 20 beds. Lofa is located near the Liberia–Guinea border—WHO reported new EVD cases in areas of Guinea adjoining Lofa as of mid-January. On the first day of operation, ETU staff accepted a suspect EVD case. The facility is the tenth operational USG-constructed ETU in Liberia; USAID/OFDA partner GOAL will provide clinical care for cases at the site.

CDC plans to support a new sub-county-level approach implemented by the Montserrado county-level incident management system (IMS) to decentralize and more closely coordinate response activities, dividing densely populated Montserrado—which includes the capital city of Monrovia—into four geographic sectors. Each sector will be led by an IMS-appointed coordinator and a partner organization. CDC will serve as the coordinating partner for Sector One—based out of John F. Kennedy Hospital in Monrovia—and USAID/OFDA partner the UN Children’s Fund (UNICEF) will provide operational and logistical support, including office space, supplies, and transportation. USAID/OFDA partners the International Rescue Committee (IRC) and Global Communities are also providing support in the other three Montserrado sectors by establishing and managing operational bases.

With USAID/OFDA support, Catholic Relief Services (CRS) is implementing facility rehabilitation projects to re-establish basic health care service at five clinics in Montserrado, including the construction of separate triage areas for patients with early and advanced EVD symptoms and an ambulance embarkation area. The CRS project indicates progress in providing infrastructure necessary for safe resumption of health services in some of Monrovia’s most EVD-affected and underserved communities.

On January 14, CDC infection prevention and control (IPC) staff conducted a “Keep Safe, Keep Serving” (KSKS) master trainer refresher session for more than 50 students. KSKS is a training course for health care providers designed to ensure job safety and minimize risk of EVD infection. CDC IPC staff also evaluated 50 public and private Montserrado health and vaccination clinics between January 14 and January 16, providing technical assistance and making recommendations for improvement where appropriate. Common recommendations included implementing triage outside of facilities, utilizing eye and face protection by vaccinators, labeling hand-washing stations with chlorine concentrations, and maintaining recommended personal protective equipment (PPE) supplies.

In recent days, more than 60 African Union (AU) epidemiologists observed contact tracers and case investigators conducting interviews and other activities in preparation for supporting EVD response efforts in Montserrado and other areas of Liberia, according to CDC. Approximately 340 AU personnel are supporting the EVD response in Liberia, with additional health care personnel planning to deploy from Nigeria in the coming weeks.

Sierra Leone

Between January 12 and 18, the GoSL reported a total of 117 new confirmed cases of EVD in Sierra Leone—representing a 36 percent decrease from the previous week. Despite the countrywide decline in cases, the GoSL NERC and response partners remain concerned regarding ongoing EVD transmission in some districts. Health officials reported an increase in the number of cases reported in Bombali District, a relatively stable caseload in Kono District, and a decrease in the number of new confirmed cases in Bo, Kambia, Moyamba, Tonkolili, Western Area Rural, and Western Area Urban districts. NERC staff and partners continue to focus on targeted, district-level responses led by the GoSL district Ebola response centers; for instance, WHO recently deployed 130 technical staff to support EVD response effort in districts with high transmission rates, including Bombali.

Reports from response actors, such as UNICEF, indicate that several factors—including concerns of stigma attached to EVD patients, fear of contracting EVD at treatment facilities and a lack of public information regarding patient experiences within treatment facilities—prevent potential cases from seeking care. As part of the second phase of Western Area surge operations, social mobilization activities will take place over a two-week period from January 19 to February 2, while community engagement, surveillance strengthening, and contact tracing activities began on January 19 and will remain ongoing.

USAID/OFDA partner the International Medical Corps (IMC)—currently operating an ETU in Port Loko District’s Lunsar town—recently established a health care worker training center in Lunsar. Scheduled to open during the week of January 19, the center encompasses two training halls, tents for mock ETU exercises, and sufficient room for 36 students to board. While the center was established to provide EVD-specific training, response actors—including GoSL Ministry of Health and Sanitation (MoHS) personnel—may consider expanding the center’s mandate to include general health care worker training for MoHS staff from throughout Sierra Leone.

A DoD-established laboratory in southern Sierra Leone’s Moyamba District began operations on January 13. Including the Moyamba laboratory and a CDC-supported laboratory in Bo, Sierra Leone currently has 13 operational laboratories providing critical EVD specimen and swab diagnostic testing.

The GoSL and response partners are increasing focus on non-EVD health care needs, including the post-recovery health care needs of EVD survivors and malaria prevention. On January 16, the MoHS and partners—including Médecins Sans Frontières and UNICEF—began a second-round, four-day malaria campaign that is expected to reach approximately 2.5 million people with interventions to prevent and treat malaria. The event follows a first-round malaria campaign in Sierra Leone that delivered 1.5 million antimalarial treatments to Western Area residents in December 2014.

Since opening in early January, the USAID/OFDA-funded, Medair-managed Kontorloh EVD triage and initial treatment facility in Western Area’s Kissy neighborhood had admitted 34 patients—including eight confirmed EVD cases—as of January 19. The facility offers initial care, IPC services, triage, and psychosocial support, typically discharging patients, providing referrals to non-EVD health care facilities, or working with the district Ebola response command center to transfer positive cases to a nearby ETU within 48 hours of laboratory results, according to the relief organization.

Guinea

Guinean schools officially reopened on January 19. In Conakry, the GoG Ministry of Education organized visits to schools throughout the capital’s five communes to observe the resumption of classes. The UN reports that UNICEF and response partners are working with the GoG to reduce EVD transmission risks, training an estimated 80,600 instructors on the implementation of safety measures—including daily temperature screening—and distributing more than 48,600 hand-washing kits and approximately 20,500 thermometers to an estimated 12,000 schools of all levels.

GoG Prime Minister Mohamed Said Fofana and high-level Government of France (GoF) officials inaugurated the French centre de traitement pour les soignants (CTS)—an EVD treatment center for health care providers—on January 19. The GoF Ministry of Defense is operating the 10-bed facility, which is located at the Gbessia military air base in Conakry. According to French officials, the CTS will provide treatment to both Guinean and international direct-care providers working at ETUs or other EVD treatment facilities who contract EVD. A laboratory to complement the CTS is expected to open in the coming week. USAID/OFDA partner the UN World Food Program (WFP) contributed an incinerator to the CTS in recent weeks, while the UN Humanitarian Air Service (UNHAS) is providing medical evacuation services, according to UNMEER.

The Guinean Minister of Health, the French ambassador to Guinea, the national EVD response coordinator, and other GoG officials attended the inauguration ceremony for the ETU in Beyla Prefecture on January 14. The GoF has provided €3 million, or nearly $3.5 million, to French-based non-governmental organization (NGO) Women and Health Alliance International to operate the ETU. The facility is opening with an initial 25 beds, although it has a maximum capacity of 50 beds. The ETU is accompanied by a mobile lab designed by French company K-Plan.

During the month of December, USAID/OFDA-funded NGO Plan International trained 90 youths—three groups of three people each in Conakry, Coyah, Dubreka, Forecariah, Gueckedou, Kissidougou, Macenta, N’Zerekore, Telimele, and Yomou prefectures—to conduct a door-to-door campaign on EVD prevention beginning later in January. Plan also continues to create and train comités de veille, or community watch committees, coordinating with other response actors, such as UNICEF, to reduce duplication of response efforts.

UNICEF recently reported that two community transit centers—one each in Kissidougou and the Guinea–Mali border town of Kouremale—are operational as of mid-January. UNICEF completed construction of both centers in December 2014, and the GoG Ministry of Health has provided staff to operate them.

In recent days, USAID/OFDA partner the International Organization for Migration (IOM) reported the delivery of a first batch of equipment and supplies to the prefectural emergency operations centers (PEOCs) in 14 prefectures: Beyla, Boffa, Coyah, Dabola, Dalaba, Forecariah, Gueckedou, Kankan, Kerouane, Kindia, Lola, Macenta, N’Zerekore, and Yomou. IOM—with USAID/OFDA funding—provided each office with a generator, office supplies, and hygiene supplies, such as chlorine. IOM is finalizing the procurement of technological supplies, such as laptops, printers, wireless internet routers, and cameras, for the 14 abovementioned PEOCs, as well as the PEOC in Conakry.

Mali

Government of Mali (GoM) authorities and WHO announced Mali’s EVD-free designation on January 18, marking the end of two 21-day incubation cycles with no new cases countrywide. According to WHO, health actors in Mali have identified a total of eight confirmed EVD cases—including six deaths.

While praising domestic and international response efforts to stop EVD transmission in Mali, GoM Minister of Health and Public Hygiene Ousmane Kone has underscored the continued risk of case importation from neighboring EVD-affected countries and urged local populations to continue adherence to basic prevention measures.

Some response actors, including anthropologists, media, and health experts, have expressed concern that the use of the phrase “Ebola Free” in the early part of a public message will detract from the rest of the message emphasizing that Malians must continue EVD prevention activities and behaviors as long as EVD cases remain present in West Africa.

LOGISTICS SUPPORT AND RELIEF COMMODITIES

WFP continues to enhance Guinea’s EVD response storage capacity in areas not covered by WFP forward logistics bases—such as Boke, Kankan, Labe, and Mamou prefectures. WFP plans to equip the additional storage locations with vehicles, personnel, and fuel to facilitate the distribution of PPE to nearby health facilities. WFP is currently managing three logistics facilities in Guinea, including one each in Conakry, Kissidougu, and Nzerekore prefectures.

Logistics actors continue to coordinate airlifts of response supplies and urgently needed equipment from UNMEER headquarters in Accra, Ghana, to—and between—the three most-affected countries. From January 14-20, response agencies recently transported more than 60 motorbikes to Guinea and Sierra Leone, 12 metric tons (MT) of food from Freetown to Monrovia, 3 MT of PPE and other medical supplies from Monrovia to Conakry, and 12 MT of operations equipment—such as generators and a forklift—from Accra to Freetown. In total, logistics actors facilitated the transport of approximately 730 cubic meters of medical and humanitarian cargo in support of EVD response efforts in Guinea, Liberia, and Sierra Leone.

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:

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