September 11, 2015

HIGHLIGHTS

Ebola Response

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  • Liberia declared free of EVD transmission; enters 90-day period of heightened surveillance
  • Weekly caseload remains low across the region; WHO notes potential for short-term increases in EVD case incidence
  • EVD vaccine made available to eligible contacts of confirmed EVD cases in Guinea and Sierra Leone

KEY DEVELOPMENTS

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  • On September 3, the UN World Health Organization (WHO) declared Liberia free of Ebola Virus Disease (EVD) transmission for the second time, 42 days after the last case from the Margibi County cluster was released from treatment following two EVD-negative tests. The Government of Liberia (GoL) Ministry of Health (MoH) and response partners, including USAID/OFDA, continue efforts to improve Liberia’s EVD surveillance and response systems as the country focuses on integrating public health disease response into Liberia’s routine health care system.
  • After more than 20 days with no new EVD cases, the Government of Sierra Leone (GoSL) Ministry of Health and Sanitation (MoHS) confirmed an EVD-positive case in Tonko Limba Chiefdom, Kambia District. The individual, a woman of approximately 60 years, became symptomatic as early as August 23 and died on August 28; a post-mortem swab the following day confirmed that she was EVD-positive. As of September 10, National Ebola Response Center (NERC) reports indicated that the August 29 index case had resulted in five subsequent EVD cases in Kambia.

REGIONAL

During the week of August 31–September 6, WHO reported two new confirmed EVD cases in the West African region, including one in Guinea and one in Sierra Leone. Both cases were high-risk contacts of EVD cases confirmed during the previous two weeks. As of September 9, WHO reported that three chains of transmission remained active in the region—two in Guinea’s Conakry and Dubréka prefectures and one in Kambia.

As of September 6, EVD response actors had identified approximately 1,300 contacts in Guinea and Sierra Leone, reflecting a significant increase from an estimated 450 contacts under observation as of August 30. The increase is due in large part to the EVD-positive community death identified in Kambia on August 29, which generated nearly 1,000 contacts, including approximately 40 high-risk contacts, according to WHO.

The WHO-led EVD ring vaccination trial was recently extended to include primary and secondary contacts in Sierra Leone, WHO reports. As of August 31, the GoG and WHO had vaccinated an estimated 4,880 contacts across Guinea, according to the UN.

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Liberia

On September 3, WHO re-declared Liberia free of EVD transmission, marking the start of a 90-day period of heightened surveillance in the country. EVD response actors, including USAID/OFDA partners, are working to ensure continued post-mortem swabs and increased laboratory capacity during this 90-day period.

During a press conference on the WHO declaration, the MoH highlighted the need for Liberia to recognize EVD as an endemic disease and continue prevention, surveillance, and response preparedness efforts following the completion of a 90-day heightened surveillance period. The GoL MoH also announced that 28 public health care facilities are scheduled to receive infrastructure upgrades in the coming months—including permanent triage and isolation structures constructed by the UN Office for Project Services, scheduled for completion by April 2016.

From August 25─28, 60 national public health practitioners received training on Liberia’s integrated disease surveillance and response system, as well as community-event based surveillance, a strategy that engages communities to identify and report suspected EVD cases to rapidly stop new EVD transmission chains. With USAID/OFDA funding, WHO provided both financial and technical assistance for the training, which included representatives from at least six USAID/OFDA partner organizations, as well as the GoL MoH, non-governmental organizations, and UN agencies.

On September 4, response partners—including the USG Disaster Assistance Response Team (DART), CDC, the International Federation of Red Cross and Red Crescent Societies (IFRC), the UN Development Program, the UN Population Fund (UNFPA), the UN Children’s Fund (UNICEF), the UN World Food Program (WFP), and WHO—met to discuss Liberia’s continued implementation of the WHO Phase 3 strategy. Liberia’s current focus is on the second objective of Phase 3: to identify and manage residual risks resulting from the EVD outbreak. The objective’s three pillars include adapting the alert management system to improve compliance and thereby strengthen surveillance, sustaining rapid response capacity, and providing survivor engagement and support.

USAID/OFDA partner PAE formally concluded EVD response operations in Liberia on August 31, following the decommissioning of all PAE-supported EVD treatment units (ETUs), asset disposition, and staff demobilization. Since October 2014, USAID/OFDA funding supported PAE to conduct clinical and non-clinical management of 10 ETUs throughout the country.

On August 26, USAID/OFDA partner the International Organization for Migration (IOM) handed the Tubmanburg ETU in Liberia’s Bomi County over to the Bomi County Health Team (CHT), which plans to use the decontaminated ETU structure as a local training center. IOM subsequently transferred all ETU assets—including generators, water pumps, and tents procured by the DoD—to the CHT. As of August 31, IOM had also completed handover of the decommissioned Buchanan ETU and DoD- and IOM-procured assets to the CHT in Grand Bassa County.

Per GoL MoH guidelines, Liberia’s four remaining USAID/OFDA-supported ETUs—including the IOM-operated Sinje ETU in Grand Cape Mount County—will remain open until on or about September 30, after which they will be decommissioned. USAID/OFDA partners continue to work with MoH officials, CHTs, and other health actors to ensure that each county has the capacity to safely triage, isolate, and refer suspected EVD cases in the absence of an ETU. To date, the MoH has identified four primary hospitals for future EVD referrals in Bomi, Bong, Lofa, and River Gee counties. The MoH plans to identify a fifth EVD referral hospital in Nimba County in the coming weeks.

According to the USAID-funded Famine Early Warning Systems Network (FEWS NET), at least 20 percent of the population across the three EVD-affected countries are expected to face Stressed—IPC Phase 2—levels of food insecurity through September 2015 due to a prolonged lean season caused by below-average food availability and household purchasing power.9

In late August, USAID/FFP supported Save the Children (SC) with nearly $4.6 million to provide cash transfers to an estimated 25,000 EVD-affected individuals in Liberia’s Bong and Margibi counties during the 2015 and 2016 lean seasons. USAID/FFP funding will also support livelihood recovery for 4,000 farming households through the provision of agricultural inputs in February and March 2016, prior to the planting season.

Sierra Leone

The MoHS reported one new EVD case during the week ending September 6. The new case was the first to emerge in connection to the post-mortem EVD confirmation in Kambia District on August 29. The individual was under quarantine in Sella village, Tonko Limba chiefdom, when she became symptomatic on September 3. Health care workers transferred the patient to the USAID/OFDA-supported International Medical Corps (IMC) ETU in Kambia town, Kambia, where lab results confirmed that the patient was EVD positive on September 4. From September 8–10, the NERC reported four additional EVD cases in Kambia, bringing the total number of cases in the current cluster to six.

As of September 7, the Kambia District Ebola Response Center (DERC) had quarantined approximately 850 people— including 44 high-risk contacts—in connection to the August 29 index case. UNICEF and WFP are providing food and water to quarantined households, while the DERC is implementing an agricultural livelihood support project to mitigate the quarantine’s impact on the harvest season.

The GoSL MoHS and GoSL Ministry of Social Welfare, Gender, and Children’s Affairs (MSWGCA)—with support from survivor advocacy groups, UNICEF, and WHO—have developed a strategy to provide Sierra Leone’s more than 4,000 EVD survivors with specialized clinical care, nutrition, social protection, and psychosocial services, as well as water, sanitation, and hygiene support. The strategy aims to deliver a standardized package of services to every survivor, beginning from the confirmation of diagnosis and continuing through convalescence. Under the framework, the MoHS and MSWGCA are responsible for training health care and psychosocial support personnel to provide specialized care to EVD survivors.

Poor households in Sierra Leone’s Bo, Kambia, Port Loko, Moyamba, Kailahun, and Kenema districts are expected to experience food consumption gaps—IPC Phase 3—through the 2015 lean season due to significant disruptions in agricultural production and market activities, according to FEWS NET.

USAID/FFP recently allocated approximately $2.5 million to Catholic Relief Services (CRS) to provide more than 26,600 EVD-affected individuals in Kenema with targeted cash transfers. The project aims to reduce acute food insecurity and increase household purchasing power during the 2015 and 2016 lean seasons.

Guinea

The Government of Guinea (GoG) confirmed one new EVD case during the week ending September 6. The case—a 13-year-old child—was identified on September 1 in Ratoma sub-prefecture, Conakry Prefecture. Despite being a registered contact, the child had not received an EVD vaccine due to WHO protocols prohibiting the vaccination of children younger than 18 years of age. In early September, WHO leadership revised the vaccine’s age restriction to include primary and secondary contacts of confirmed EVD cases ages six years and older.

On September 4, following several days of intensified surveillance efforts by WHO and other response staff in Forécariah Prefecture, all 95 remaining contacts of the August 14 case from Doto village in Moussayah sub-prefecture—the most recent confirmed EVD case in the prefecture—graduated from monitoring. The August 14 case convalesced and was discharged as an EVD survivor from the USAID/OFDA-supported Forécariah ETU, managed by the French Red Cross (FRC), on September 1, according to the GoG. An additional 59 contacts in Conakry’s Matam sub-prefecture graduated from monitoring on September 3. As of September 8, Ratoma and neighboring Dubréka-Centre sub-prefecture, Dubréka, were Guinea’s only areas with known EVD transmission within the past 21 days.

A high-level WHO delegation—including Assistant Director-General Dr. Bruce Aylward and Africa Region Health Security and Emergencies Director Dr. Ibrahima-Socé Fall—met with the National Ebola Coordination Cell on September 4, congratulating the GoG on the accomplishments of Guinea’s EVD response thus far. Citing reticence and violent attacks on aid workers, among other response challenges, in Forécariah in recent months, Dr. Aylward highlighted the continued risk of transmission by survivors and cross-border population movement. WHO representatives also underscored the importance of strengthening community-based surveillance and engagement in Guinea, as missing and unknown contacts could also generate additional clusters of cases.

Through nearly $5.5 million in USAID/OFDA funding, IOM is conducting surveillance activities along Guinea’s borders with neighboring countries, including Forécariah’s border with Sierra Leone’s Kambia District. IOM monitoring, sanitation, and community engagement activities at three key crossing points reached nearly 37,600 individuals between July 23 and August 27.  USAID/OFDA recently provided approximately $750,000 to the Women and Health Alliance (WAHA) in Guinea to train health facility staff in infection prevention and control and triage protocols, while strengthening sustainable triage systems. WAHA will also support referrals of suspected and confirmed EVD cases to health care facilities.  In addition, USAID/OFDA supported the Danish Refugee Council with $750,000 to reinforce EVD prevention measures, vigilance, and community-based early warning systems. With USAID/OFDA funding, DRC will also distribute hygiene promotion kits, among other non-food items, and rehabilitate water infrastructure to ensure improved sanitation and access to safe drinking water.

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