West Africa Ebola Outbreak Fact Sheet #37

June 30, 2015

HIGHLIGHTS

• The Government of Liberia (GoL) reports first new confirmed EVD case in Liberia since March 22.
• Overall EVD transmission continues to decrease in Sierra Leone since early June; renewed efforts to reach zero cases in Western Area Urban District begin.
• The Government of Guinea (GoG) launches a 21-day EVD case finding and social mobilization campaign across three prefectures with active transmission

KEY DEVELOPMENTS

• On June 29, the GoL reported the identification of a new EVD case in Nedowian village, Margibi County, Liberia’s first new case since March 22. The GoL, technical experts from CDC, the USG Disaster Assistance Response Team (DART), and other EVD response actors are investigating the case, identifying known contacts, and working with local officials in the affected county. To date, the source of transmission is unknown.
• WHO reports that between June 10 and 24, the area of active transmission in Guinea’s four EVD-affected prefectures—Boké, Conakry, Dubréka, and Forécariah—has changed and, in some cases, expanded. For instance, in Boké Prefecture, EVD cases are increasingly found among more densely populated urban areas. The new case in the capital city of Conakry is not linked to a known source of transmission.
• The two cases reported in Sierra Leone’s capital city of Freetown are the first confirmed cases in Western Area Urban in more than two weeks, according to WHO.

REGIONAL

WHO reported 20 confirmed cases of EVD in West Africa between June 15–21, including 12 cases in Guinea and eight cases in Sierra Leone, with new cases found across four Guinean prefectures and three districts in Sierra Leone; three health care workers—two in Guinea and one in Sierra Leone—are among the infected indivduals.

Between June 24–25, Acting Special Representative of the UN Secretary General (SRSG) and Head of the UN Mission for Ebola Emergency Response Peter Graaff visited Guinea-Bissau to assess the country’s level of EVD preparedness, including an evaluation of prevention and surveillance measures at a facility bordering Guinea’s Boké Prefecture. SRSG Graaff praised cross-border cooperation activities between Guinea and Guinea-Bissau and encouraged the Government of Guinea-Bissau to continue implementation of UN-supported preparedness and response measures.

The recent cluster of EVD cases in Boké—including nine confirmed cases since early May—has prompted EVD response organizations to focus increasingly on strengthening border surveillance and response preparations in neighboring Guinea-Bissau. During the week of June 8, USG Disaster Assistance Response Team (DART) staff traveled to the border town of Foulamôre to discuss EVD response preparations with staff from the Red Cross Society of Guinea-Bissau (RCGB) and the International Federation of Red Cross and Red Crescent Societies (IFRC), as well as representatives from a border community.

IFRC is preparing for potential cases in Guinea-Bissau through case management, social mobilization, and surveillance preparations. IFRC and RCGB are implementing a cross-border contact tracing alert system and have established two safe burial teams in bordering regions—one each in Gabú and Tombali. RCGB social mobilization teams are engaging with local leaders, religious authorities, and youth groups to ensure community awareness and support for EVD preparations in Guinea-Bissau’s border regions. As of June 9, RCGB had 100 volunteers engaging communities in Gabú and Tombali, with several hundred more expected to join in the coming weeks, according to IFRC.

The Government of Portugal has placed a diagnostic laboratory in the capital city of Bissau and is training local staff to perform diagnostic testing. Médecins Sans Frontières (MSF) has established a six-bed EVD isolation and treatment site at the Simao Mendes National Hospital in Bissau. With multiple partners preparing for potential cases, the Government of Guinea-Bissau has started convening coordination meetings to manage response efforts and has proposed protocols for 11 essential response efforts, including safe burials, case management, and generating contact lists.

Liberia

The Government of Liberia (GoL) Incident Management System (IMS) remains focused on maintaining vigilant surveillance and infection prevention and control (IPC) capacity to prevent, identify, and respond to a potential reintroduction of EVD. On June 7, the GoL reported zero suspected cases and 18 specimens tested—including 14 oral swabs and four whole blood samples.

On June 11, representatives from the DART—along with the GoL General Service Agency—visited the recently closed, USG-supported EVD treatment unit (ETU) site in Grand Kru County’s Barclayville town to facilitate the inventory and reallocation of remaining supplies prior to handing the facility to the GoL Ministry of Health (MoH). The DART continues to work with USG partners and the relevant GoL officials to decommission all but five of the USG-supported ETUs in Liberia. The five remaining ETUs, along with one non-USG-supported ETU in Montserrado County, are scheduled to remain open in the coming weeks.

On June 8, DART members participated in the weekly post-EVD outbreak transition meeting for Montserrado County— where Liberia’s last confirmed EVD case was detected; the county’s urban environment and high population density pose unique challenges to EVD prevention, containment, and response efforts. The GoL MoH and supporting response actors—including USAID/OFDA partners Action Contre la Faim (ACF), the International Rescue Committee (IRC), MENTOR Initiative, and WHO, as well as CDC and other organizations—continue to conduct disease surveillance countrywide, with an emphasis on Montserrado and the five Liberian counties that border Guinea and Sierra Leone.

GoL IMS personnel and supporting EVD response organizations—including USAID/OFDA partner Global Communities—are working to complete a safe and sustainable burial transition plan that will enable the GoL, funeral home staff, health care workers, and community members to carry out safe management of deceased individuals. Global Communities is currently operating 54 safe burial teams in all of Liberia’s 15 counties, and continues to collaborate with GoL officials and organizations to finalize a sustainable strategy for maintaining safe dead body management. To date, Global Communities has supported funeral home assessments in all 15 counties; Global Communities and WHO have trained staff on safe burial and sample collection methods at 18 Liberian funeral homes.

During the week of June 1, USAID/OFDA partner John Snow, Inc. (JSI) continued to support transition activities in Liberia by conducting county-level supportive supervision at more than 30 health facilities across Bomi, Gbarpolu, Grand Kru, Montserrado, and River Cess counties and reaching 86 health facilities in Bomi, Bong, Lofa, Margibi, River Cess, River Gee, and Sinoe counties with IPC supply distributions. Liberia’s remaining eight counties that have not begun distributions are engaged in preparation activities. The key challenge to JSI’s efforts continues to be Liberia’s ongoing May-to-November rainy season, which has worsened transportation networks, affecting all field activities.

As of May 31, USAID/OFDA partner Mercy Corps had reached 3,000 villages—comprising approximately 2.2 million people—through its Ebola Community Action Platform (ECAP) network in Liberia, which is designed to strengthen community EVD awareness and encourage behaviors that reduce EVD transmission through community-led social mobilization activities. The ECAP network consists of 76 NGOs, including 72 Liberian NGOs, that have collectively trained more than 800 mobilizers, who in turn trained more than 14,700 additional communicators.

Sierra Leone

From June 1–14, the GoSL Ministry of Health and Sanitation (MoHS) reported 29 new confirmed EVD cases in Sierra Leone. 18 of the cases occurred in Port Loko District, and 11 cases occurred in Kambia District. Western Urban District reported no new EVD cases for the second week in a row. According to the National Ebola Response Center (NERC), the source is unknown for one of the EVD cases in Kambia; response actors identified the remaining EVD cases from death swabs, quarantined homes, contacts lists, and two were previously overlooked contacts.

According to EVD response actors in Kambia, people continue hiding sick family members, conducting unsafe burials, holding weekly market days and trading after the 6:00 p.m. curfew, and traveling to Guinea’s Forécariah Prefecture. In response, USAID/OFDA-supported NGO Christian Aid held a community dialogue forum in Kambia’s Magbema Chiefdom in early June through a local partner. The DART, local leaders, and other response stakeholders attended the forum, which sought to facilitate community awareness of response efforts and reinforce knowledge of EVD-related bylaws. Additional USAID/OFDA-supported fora are planned in Kambia.

On the evening of June 11, the President of Sierra Leone, Ernest Bai Koroma, publically announced Operation Northern Push, a major GoSL effort to eradicate EVD in the country’s northern districts. The 21-day operation, which launched on June 16, focuses on ‘getting to zero’ through a combined EVD event- and chiefdom-level “surge” in Kambia and Port Loko. President Koroma related that the operation will involve leadership from local communities and requested that paramount chiefs, traditional healers, religious leaders, women, and youth take ownership of combatting EVD with support from the District Ebola Response Centers (DERCs) and the NERC.

According to the NERC, a curfew in the affected chiefdoms began on June 15, with no night transport allowed between 6:00 p.m. and 6:00 a.m. GoSL military personnel, alongside district police, will patrol targeted areas of Kambia and Port Loko. The number of checkpoints, with strengthened health screening posts, will increase on all main roads. The NERC also announced efforts to incentivize people to remain in quarantine by providing free medical care, improving sanitation conditions, and engaging the local community in common activities to support quarantined households. Other details include enhancing the number of surveillance activities, encouraging community observers to report suspected EVD cases, ensuring zero tolerance on secret burials and non-adherence to other EVD by-laws, and embedding traditional healers and religious leaders in the response.

DART and CDC representatives visited Port Loko on June 13 and met with USAID/OFDA partner the International Medical Corps (IMC) to observe psychosocial activities. Each day, IMC psychosocial teams visit quarantined households in Port Loko’s Kaffu Bullom Chiefdom to monitor the physical and mental wellbeing of those quarantined and provide survivor follow-up. IMC supplies provides emergency relief commodities to the quarantined households—including buckets, soap, food through the UN World Food Program (WFP), and schoolbooks through the UN Children’s Fund (UNICEF)—and, following discharge from IMC’s USAID/OFDA-supported Lunsar ETU, relief items for EVD survivors such as mattresses, food, cooking oil, clothing, mosquito nets, and condoms.

Following recent concerns that the onset of rainy season throughout West Africa could impede EVD response efforts, WFP reports that it has undertaken sufficient preparations to reinforce storage facilities and ensure the continuation of services—including pre-positioning and distributing food and relief commodities, maintaining a logistics network, and transporting humanitarian personnel and equipment—during the rainy season in Sierra Leone. To date, USAID/OFDA has provided approximately $20 million to WFP in support of humanitarian coordination and information management and logistics support and relief commodities efforts, including preparations for and activities during the rainy season in EVD-affected countries of West Africa.

Guinea

During the week ending June 7, WHO reported 16 confirmed EVD cases in Guinea; eight of those cases occurred in Forécariah, with Kindia, Conakry, Dubréka and Boké prefectures reporting three, two, two, and one new case, respectively. Five of the 16 new confirmed cases—including all three from Kindia—are from unknown sources of transmission. Until these recent cases, authorities had not reported a new case in Conakry or Kindia for more than 40 days, WHO reports. As of June 10, contact tracers were monitoring nearly 1,700 contacts in eight Guinean prefectures.

With these new cases, the GoG reported that six prefectures—Boké, Conakry, Dubréka, Fria, Forécariah, and Kindia— had active EVD transmission as of June 12. By comparison, during the first week of May, only two prefectures, Dubréka and Forécariah, recorded confirmed EVD cases.

On June 7, members of the DART traveled to Tanéné sub-prefecture—the area of Dubréka with active EVD transmission—for the official launch of the prefectural case finding and EVD messaging campaign. Modelled on the recent campaign in Forécariah, the campaign targets nearly 2,200 households—or approximately 11,000 individuals—in five areas of Tanéné with door-to-door EVD messaging and active case finding, as well as WFP food distributions and radio broadcasts on campaign activities conducted by USAID/OFDA partner Internews. Following the first three days of the campaign, case finders identified five suspected cases, while regular surveillance activities in Dubréka identified two suspected cases. Of these seven suspected cases, one has tested positive for EVD—the case was connected to a known line of transmission.

Local NGO AGIL is supporting WFP food distributions which were scheduled to commence on June 12—as in Forécariah, families are receiving food rations to dissuade additional movements. WFP and AGIL staff will accompany the 27 campaign teams to create an accurate list of beneficiaries for food assistance—in Forécariah, WFP staff were not part of the door-to-door campaign, and the number of households claiming a food ration was higher than planned. WFP hopes to preempt these discrepancies by joining door-to-door efforts.

IFRC recently reported that areas near Dubréka and Kindia are not adequately serviced by an EVD diagnostic laboratory, despite Dubréka and Kindia hosting active chains of transmission. Without a laboratory, IFRC noted that teams transporting specimens requiring diagnostic testing often travel long distances to reach laboratories in the capital city of Conakry, taking several hours round trip. To alleviate testing inefficiency for suspected cases or body swabs taken from Dubréka and Kindia, the GoG adopted a proposal by the safe and dignified burial group to install a mobile laboratory— provided by the Government of Japan—in Tanéné. The laboratory was scheduled to begin testing on June 8.

The GoG is also preparing to open a UNICEF-constructed transit center at the Kassopo centre de santé in Port Kamsar town of Boké in the coming days. UNICEF upgraded the site, providing space for six beds to hold suspected cases. In Kassopo, IMC will manage the operations at a recently constructed triage unit equipped to refer patients exhibiting symptoms consistent with EVD to the transit site to received basic care and have blood drawn for a diagnostic test, performed at an onsite laboratory managed by staff from the Government of Canada.

On June 8, USAID/OFDA partner Jhpiego began a five-day IPC training for 25 members of staff from health facilities in Boké, including from the Kassopo center de santé. The training aimed to improve staff understanding of IPC protocols in health care settings to reduce the risk of infection; course materials focused on EVD but also emphasized best practices for reducing the risk of contracting other communicable diseases while providing care. Prior to June, health staff in Boké had not received IPC training.

FOOD SECURITY AND LIVELIHOODS

USAID/FFP has supported WFP to provide food assistance to more than 3 million people in Guinea, Liberia, and Sierra Leone to date. In Guinea, WFP distributed food assistance to approximately 35,000 people during the GoG’s recent Forécariah campaign. With USAID/FFP support, WFP is also supporting the food needs of quarantined households in Boké and Dubréka prefectures. Through the GoG’s ongoing Dubréka campaign, for example, WFP is targeting more than 2,000 households in Tanéné sub-prefecture with approximately 180 metric tons (MT) of food assistance. To promote household access to nutritious food during the lean season, USAID/FFP also supported Catholic Relief Services (CRS) to provide food vouchers to approximately 2,000 Ebola-affected households in Guinea’s Macenta and Nzérékoré prefectures.

In Liberia, USAID/FFP partner Mercy Corps is providing targeted cash transfers to approximately 150,000 Ebolaaffected people across three of Liberia’s most affected counties. With USAID/FFP support, Mercy Corps, ACDI/VOCA and Project Concern International (PCI) have provided agricultural input vouchers to assist farmers during the planting season. Through these activities, USAID/FFP is increasing household purchasing power and access to food while stimulating local markets affected by the EVD outbreak.

As part of the President’s address regarding Operation Northern Push on June 11, the GoSL also announced the relaxation of curfews in non-EVD affected districts to support economic recovery and allow for increased business activities. President Koroma reminded businesses to remain committed to EVD prevention protocols, including temperature screening of employees and customers, hand washing before entering premises, and prevention of overcrowding during business hours. All other restrictions will remain in force until the country reaches zero-plus-42 days.

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