West Africa - Ebola Outbreak - Fact Sheet #8 (FY 15)

November 19, 2014

HIGHLIGHTS

• The U.S. Government (USG) declared a disaster on November 17 and is assessing urgent needs in Mali following five EVD related deaths in the capital city of Bamako.
• As progress continues in curtailing the EVD outbreak in Liberia, the Government of Liberia (GoL) announced the end of the national state of emergency on November 13. The GoL underscored continued vigilance in EVD-affected areas.
• USAID/OFDA partner the International Organization for Migration (IOM) opened an EVD Treatment Unit (ETU) in Liberia’s Bomi County on November 18.

KEY DEVELOPMENTS

• On November 17, U.S. Chargé d’Affaires, a.i., Andrew Young declared a disaster due to the humanitarian consequences of an EVD outbreak in Mali, which has resulted in six confirmed or probable EVD cases and five related deaths since late October. In response, the USG Disaster Assistance Response Team (DART) is deploying personnel to Bamako in addition to CDC personnel who were working in Mali prior to the disaster declaration to help prepare the Government of Mali (GoM) for potential EVD cases. USG support may include infection prevention and control (IPC) activities, safe burial teams, case management and infection control training, the distribution of infection control commodities, and support to the GoM’s newly established Ebola Emergency Operations Center (EOC).
• EVD transmission rates remain elevated in Sierra Leone, and relief agencies report that health care needs in Western Area and Port Loko districts are exceeding the capacity of EVD treatment facilities. The U.N. notes a critical need for continued surveillance to ensure that personnel can identify and respond to new EVD outbreaks.
• Between November 5 and 19, the USG provided nearly $185 million in additional funding to support the humanitarian response to the EVD outbreak in West Africa, including emergency medical services, community education and outreach, food, and water, sanitation, and hygiene (WASH) interventions, as well as logistical support and relief commodities.

CURRENT SITUATION

With support from the USG, relief agencies continue to expand EVD response activities across affected countries in West Africa. As of November 19, WHO reported that the outbreak had resulted in more than 15,100 suspected or confirmed EVD cases and approximately 5,400 related deaths, including the death of nearly 600 health care workers. IPC quality assurance checks are underway at ETUs in Guinea, Liberia, and Sierra Leone to ensure the safety of health care personnel, while relief organizations are working to provide sufficient supplies of personal protective equipment (PPE) to all ETUs.

Guinea

CDC is working closely with the Government of Guinea (GoG) National Ebola Coordination Cell to implement a four-pronged IPC strategy in Guinea. The strategy includes training health care workers on IPC principles; equipping medical facilities with PPE, chlorine, and other supplies; providing quality assurance via follow-up training; and monitoring and evaluating overall IPC implementation. CDC plans to prioritize IPC training in Kérouané, N’Zérékoré, and Macenta prefectures. CDC is also working with USAID/OFDA partner Catholic Relief Services (CRS) and other relief organizations to develop standardized checklists to measure IPC guideline implementation.

In early November, the GoG established a countrywide EVD hotline in Guinea to respond to EVD-related questions and enable people to report suspected EVD cases. Three major cellular data companies are routing calls into the hotline, and the GoG expects that companies plan to increase the number of hours per day that calls feed into the hotline. CDC is providing extensive technical assistance to GoG staff in the national EOC to develop the hotline and inform the guidance provided to callers.

With nearly $1.5 million in FY 2015, USAID/OFDA partner Save the Children/U.S. (SC/US) is supporting contact tracing and surveillance systems in EVD-affected communities in Guinea, as well as areas bordering Côte d’Ivoire, Liberia, and Sierra Leone.

Liberia

In a national address on November 13, President of Liberia Ellen Johnson Sirleaf cited progress in containing the EVD outbreak in Liberia and announced that the GoL would not seek an extension of the 90-day state of emergency declared in early August. Although markets are re-opening, even in border areas, President Johnson Sirleaf emphasized the continued need for interventions and response activities—particularly in rural areas experiencing new EVD cases—and the GoL will maintain a countrywide curfew that restricts movement between midnight and 6:00 a.m.

During the week of November 9, local officials from the GoL Ministry of Health and Social Welfare (MoHSW) and CDC field staff reported an EVD hotspot in River Cess County’s Keya town. Between November 11 and 13, CDC, WHO, and the county-level health team assessed the outbreak, identifying at least 25 suspected, probable, and confirmed cases. The team reported social mobilization challenges and other needs—including basic food and supply shortages due to self-quarantine and critical shortages of PPE for non-EVD health clinics. CDC will support the response in this area by providing technical assistance for contact tracing and case identification efforts.

In response, USAID/OFDA partner Global Communities (GC) is assisting local health officials improve EVD and safe burial awareness, bolster contact tracing activities, and provide basic health care and supplies to individuals in Keya. In early November, GC positioned two safe burial teams and conducted seven safe burials in River Cess, continuing efforts to improve the management of EVD-associated deaths countrywide. USAID/FFP partner the U.N. World Food Program (WFP) mobilized food deliveries to the area, while CDC and the MoHSW are addressing other urgent needs.

On November 14, health officials reported 28 new EVD cases in health care workers across Liberia since mid-October. The MoHSW has noted the need to investigate infections among health care workers, as it is currently unknown where the infections are occurring—in the community, at health facilities, or during private consultations.

To help prevent health care workers from becoming infected with EVD while working in ETUs, the DoD is providing ETU staff training in Monrovia and at the county level. As of November 15, the DoD training center in Monrovia had provided training related to PPE, triaging, and managing complicated cases and dead bodies for more than 200 people, including nearly 150 ETU staff.

Three Liberian health care workers are currently admitted at the recently opened Monrovia Medical Unit, according to the U.S. Public Health Service (USPHS) team that is managing and operating the 25-bed facility.

On November 18, USAID/OFDA partner the IOM opened an ETU in Tubmanburg town, Bomi County, and is providing clinical services for admitted three patients. With USAID/OFDA support, IOPM is providing clinical and non-medical services for the DoD-constructed ETU.

In FY 2015, USAID/OFDA has provided $7.6 million to the American Refugee Committee (ARC) for the operation and management of a 50-bed ETU in River Gee County, Liberia. ARC will train clinical staff and support health care services, including patient intake and triage, EVD laboratory testing, and symptomatic monitoring and treatment. The ARC-managed ETU will also provide nutritional support and supplementation for patients in treatment.

With nearly $1.7 million in USAID/OFDA support, CARE is providing community-based EVD surveillance mechanisms and promoting social and behavior change through community mobilization efforts in Liberia. CARE is working to reach vulnerable populations with EVD prevention messages, expand social mobilization interventions, increase public EVD awareness through media campaigns, and reinforce training of key community mobilizers—including teachers and community leaders. Social mobilization activities are critical to educating communities about EVD and improving EVD prevention and response through outreach and media campaigns.

Mali

Health officials in Mali have identified six confirmed or probable EVD cases and five related deaths—linked to an individual who traveled from Guinea to Mali for treatment of suspected EVD symptoms and died in late October—in Mali since late October. As health officials try to control the outbreak, officials from WHO report that the number of contacts in need of monitoring had increased to more than 440 people as of November 17. Relief agencies are mobilizing response efforts quickly to support ETUs, health personnel, and contact tracing teams to contain the EVD outbreak in Mali.

In addition to deploying health and humanitarian personnel to Bamako through the DART, USAID/OFDA is rapidly assessing the most acute humanitarian needs in Mali. CDC is also supporting the response through technical assistance for risk communications, contact tracing, case identification, exit screening, EOC development and specimen transit. Additional USG support could potentially include IPC activities, safe burial teams, case management and infection control training, the distribution of infection control commodities, and support to the GoM’s newly established national EOC.

Sierra Leone

According to WHO, EVD transmission remains high in Sierra Leone, with more than 400 new confirmed EVD cases—including nearly 200 cases in Western Area—reported during the week of November 3. However, WHO reported decreased EVD transmission in Kailahun and Kenema districts—the previous epicenters of the EVD outbreak in Sierra Leone—reflects the breadth of response efforts in Eastern Province, including improved isolation of patients, comprehensive contact tracing, and robust IPC measures. Nevertheless, the U.N. notes a critical need for continued surveillance to ensure that health and response personnel can quickly identify new outbreaks, including in areas where data indicate low levels of EVD transmission.

Increased, suspected, probable, and confirmed EVD cases in Western Area continue to exceed available bed capacity, and approximately 50 people have remained in their communities due to lack of available beds at EVD holding centers, according to relief agencies. As of November 11, patients with EVD were occupying approximately 194 of 205 EVD treatment beds in Port Loko, while an estimated 89 additional people were awaiting clinical care. The Government of the U.K. Ministry of Defense is exploring options to establish emergency holding units in Port Loko schools as a temporary measure to address inadequate bed capacity. However, WHO continues to express concerns about safety standards and IPC procedures in holding centers.

From October 6–17, the Government of Sierra Leone Ministry of Health and Sanitation and partners assessed primary health units (PHUs) in Sierra Leone. The assessment examined all of the estimated 1,185 PHUs throughout the country, using direct observation, interviews, and analysis of PHU registers to determine the effect of the EVD outbreak on the overall health system. Most PHUs across the country are open and functional, according to the assessment findings. Northern Province’s Bombali District, Southern Province’s Bonthe District, and Western Area had the highest proportion of closed facilities, with authorities reporting lack of staff as the primary reason for the closures.

On November 14, the International Federation of Red Cross and Red Crescent Societies (IFRC) in Sierra Leone reported that 50 IFRC-supported safe burial teams will be operational in all 14 districts of Sierra Leone by November 30. During the same period, IFRC also plans to increase bed capacity—from 40 to 60 beds—at the USAID/OFDA-supported ETU in the eastern city of Kenema. USAID/OFDA support is enabling IFRC to implement social mobilization activities, support contact tracing teams, provide psychosocial support to EVD survivors and families, and conduct safe burials in Sierra Leone.

LOGISTICS AND RELIEF COMMODITIES

CDC is working with NGO eHealth and the GoL MoHSW to address urgent EVD-related transportation needs of county-level health departments countrywide. CDC recently procured five vehicles from local markets for conversion into ambulances, which will supplement more than 80 ambulances previously purchased by CDC and currently en route to Liberia.

FOOD SECURITY AND LIVELIHOODS

During the week of November 17, USAID/FFP provided an additional $14 million to support WFP’s Ebola Emergency Operation to people affected by the EVD outbreak in Guinea, Liberia, and Sierra Leone, including individuals receiving treatment in ETUs, EVD survivors who are discharged from treatment centers, the families of people infected with EVD, and communities with widespread transmission. USAID/FFP’s $14 million contribution will enable WFP to purchase approximately 8,400 metric tons (MT) of rice, pulses, and oil—sufficient to provide the equivalent of a one-month food ration for 509,000 people—in local and regional markets to sustain market functionality in the region.

USAID/FFP’s recent contribution also includes 1,910 MT of in-kind U.S. Corn Soy Blend Plus, a fortified food to help prevent nutritional deficiencies and provide EVD patients and survivors, as well as nursing mothers and children, with supplemental nutritional support. To date, USAID/FFP has provided $34.5 million to WFP.

WFP is providing logistical support to the U.N. Mission for Ebola Emergency Response to enhance the humanitarian community’s EVD response in Guinea, Liberia, and Sierra Leone, aiming to improve operational efficiency, and establish humanitarian access to deliver critical relief commodities.

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