MSF’s West Africa Ebola response started in March 2014 and counts activities in Guinea, Liberia, Mali, and Sierra Leone. MSF currently employs 306 international and around 3,078 locally hired staff in the region. The organization operates seven Ebola case management centers (CMCs), providing approximately 600 beds in isolation, and two transit centers. Since the beginning of the outbreak, MSF has admitted more than 7,000 patients, among whom around 4,400 were confirmed as having Ebola. Nearly 1,900 patients have survived. More than 1,305 tonnes of supplies have been shipped to the affected countries since March. 

Facts

Ebola first appeared in 1976 in simultaneous outbreaks in Nzara, Sudan, and in Yambuku, DRC
The latter was in a village situated near the Ebola River, from which the disease takes its name
Fruit bats are considered to be the natural host of the Ebola virus
The case-fatality rate varies from 25 to 90 percent, depending on the strain

If contracted, Ebola is one of the world’s most deadly diseases. It is a highly infectious virus that can kill up to 90 percent of the people who catch it, causing terror among infected communities.

Doctors Without Borders/Médecins Sans Frontières (MSF) has treated hundreds of people with the disease and helped to contain numerous life-threatening epidemics.  

Latest News from the West Africa Outbreak

Ebola: Latest MSF Updates

 

WHO: Roadmap Situation Report (as of December 10, 2014)

 

Cases

Deaths

Guinea

2,292

1,428

Liberia

7,719

3,177

Nigeria

20

8

Sierra Leone

7,897

1,768

Senegal

1

0

Mali 8 6

Total

17,937

6,387

Data are based on official information reported by Ministries of Health. These numbers are subject to change due to ongoing reclassification, retrospective investigation, and availability of laboratory results. The figures are underestimated.

MSF Case Numbers

 

Date of info

Admissions since start of activities*

Confirmed

Recovered

GUINEA

 

Conakry CMC

11 Dec

1,234

474

221

Guéckédou CMC

11 Dec

1,550

1,021

421

Telimele CMC

Closed

35

21

16

SIERRA LEONE

 

Bo CMC

11 Dec

433

403

212

Kailahun CMC

11 Dec

1,206

858

458

Magburaka CMC

16 Dec

2

2

 -

Kingtown CMC

11 Dec

12

5

 -

LIBERIA

 

Monrovia (ELWA 3) CMC

09 Dec

1,753

1,194

472

Foya CMC

closed

695

384

154

Quewein CMC

11 Dec

10

7

 -

TOTAL

 

6,930

4,369

1,954

* Admissions include all suspected, probable and confirmed cases. Anyone who is admitted is lab tested which can take 1-2 days for results to come back. If they are negative, they are discharged. So the total admissions includes people who are currently waiting for lab confirmation and people who never had Ebola but had symptoms and were therefore admitted to the suspected ward.

MSF Staff on the Ground (as of November 17, 2014)

  • Guinea: 83 international, approximately 800 national
  • Liberia: 90 international, around 1,350 national
  • Sierra Leone: 113 international, around 1,100 national
  • Mali: 20 international, 28 national
  • Total: 306 international, around 3,078 national

Since the Ebola outbreak in West Africa was officially declared on March 22, 2014, in Guinea, it has claimed 6,387 lives in the region. The outbreak is the largest ever, and is currently affecting four countries in West Africa: Guinea, Liberia, Sierra Leone, and Mali. Outbreaks in Nigeria and Senegal have been declared over. A separate outbreak in Democratic Republic of Congo has also ended.

Three months after MSF called for states with biological disaster response capacity to urgently dispatch human and material resources to West Africa, all three of the worst-hit countries have received some assistance from the international community. But foreign governments have focused primarily on financing or building Ebola case management structures, leaving staffing them up to national authorities, local health care staff, and NGOs.

Across the region, there are still not adequate facilities for isolating and diagnosing patients where they are needed. Other elements that are essential to an Ebola response—such as awareness-raising and community acceptance, safe burials, contact tracing, alert and surveillance, and access to health care for non-Ebola patients—are still lacking in parts of West Africa.

The clinical trials for three different treatments led by MSF and three research institutions should start soon at MSF sites in West Africa. The French National Institute of Health and Medical Research (INSERM) will lead a trial for antiviral drug favipiravir at MSF’s facility in Guéckédou, Guinea. The inclusion of patients at this site has started this week. The Antwerp Institute of Tropical Medicine (ITM) will lead a trial of convalescent plasma therapy at MSF’s Donka Ebola center in Conakry, Guinea; and the University of Oxford will lead, on behalf of the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), a Wellcome Trust-funded trial of the antiviral drug brincidofovir at ELWA 3 in Monrovia. Both the trials for Donka and Monrovia are still under discussion.

The United Nations Mission for Ebola Emergency Response (UNMEER) is based in Ghana to pursue five strategic priorities: stop the spread of the disease, treat the infected, ensure essential services, preserve stability, and prevent the spread of the disease to countries currently unaffected.

MSF has been responding to the outbreak since March, and currently has more than 3,400 staff working in Guinea, Liberia, Sierra Leone, and Mali. Since the response began, 27 MSF staff members have fallen ill with Ebola, 14 of whom have recovered and 13 have died. The vast majority of these infections were found to have occurred in the community.

 

Sierra Leone

Update: December 18, 2014

General

President Koroma launched the "Western area surge" on December 16, an intensified effort to mobilize communities to identify potential Ebola cases and link them with care. The surge focuses on door-to-door social mobilization as well as engagement with community leaders, including government, religious, and tribal groups, as well as youth leaders and women.

The NERC (National Ebola Response Committee), a presidential task force on Ebola, has initiated a coordination center to improve communication and collaboration of country-wide and district-level responses.

New Ebola Management Centers (EMCs) have been opening and increasing bed capacity to meet the anticipated demand for space as a result of the Western area surge. MSF opened a new EMC in Freetown on December 9 and another in Magbaruka on Dec 15.

A wide range of needs are being seen in different areas of the country. While bed capacity was identified as a critical issue in the Western Area, some treatment centers in the rest of Sierra Leone are seeing empty beds, despite having around 40 new positive cases per day nationwide. Moreover, MSF is concerned that access and the coordination of care remains a challenge, as patients are being turned away from holding centers or unable to reach or receive a response from the 117 alert operator, when we know there is bed capacity in the EMCs.

For months, MSF teams in Bo and Kailahun have offered knowledge-transfer opportunities through “shadowing” and other engagements. MSF has recently launched a new project to offer more specific, structured, and targeted training opportunities for other organizations needing support in operating case management centers (CMCs) safely.

UNICEF’s Community Care Center (CCC) model was officially launched Dec 16, and is being rolled out across the country. It provides isolation units in patients’ communities.

Kailahun

The MSF EMC continues to see a decrease in the number of patients, with only three patients currently in isolation (two suspected and one confirmed). It had been expected that Kailahun could receive more patients from Kono District (a hotspot) but road conditions make other EMCs more accessible—including Kenema and Bo, which currently have capacity to assist.

Bo 

The MSF EMC in Bo has seen a slow decrease of cases, with an average of 46 patients in the ETC and no new admissions for two consecutive days (December 14 and 15). MSF has started to systematically visit quarantined houses in Bo and in hotspots in the rest of the district, and is working to increase the coordination of the response to alerts.

Magburaka

The EMC opened on December 15. The first two patients were admitted on the opening day. During the first stage, the center will start with 20 to 30 beds, until eventually scaling up as the needs arise. The Winnipeg Lab is installed in Magburaka, with a turnaround time on lab samples of 4 hours.

Freetown/Antimalarial Distribution

In Freetown, MSF completed the first round of house-to-house distributions of antimalarial medication. This initiative reached over 1.5 million people. The second round is scheduled to begin in mid-January.

Freetown/Prince of Wales Secondary School

The new EMC, which has been set up at the centrally located Prince of Wales secondary school, was able to treat its first patients on December 9, just two weeks after the start of construction. It has a current capacity of 44 beds, more than 50 percent of which are already filled. The plan is to gradually expand to 100 beds in the next 10 days. The center has a mobile lab on the premises, which currently tests 30 samples per day and can scale to 50 samples tested per day. Outreach activities are also being set up. 

Liberia

Update: December 18, 2014

 

Monrovia - Elwa 3

The number of patients in ELWA 3 has remained stable over the past few weeks, with around 20 new admissions every week. As a result, we are working to downsize ELWA 3 to a 60 bed center. Of course, should there again be a sharp increase in cases, MSF will be ready to scale up in order to accommodate them. We are also focusing on increasing the standard of care to patients, bringing in a laboratory technician to supervise the construction of a new laboratory within the ELWA 3 compound to help facilitate this.

Monrovia/Outreach

Ambulance service have been set up with a dedicated hotline that the community can call if they have suspected Ebola cases. The first teams are operational and refer Ebola patients from Gardnersville, New Georgia, Barnesville, and Paynesville in Monrovia to EMCs.

 

Monrovia / Support to non-Ebola health facilities

An MSF team is supporting five health centers in Monrovia with expertise in infection prevention and control; a team is also supporting the James Davis Junior Memorial Hospital (JDJ Hospital) in Monrovia, providing expertise in pediatrics, infection control, and triage. Rehabilitation of the premises has started to set up stringent infection control measures.

 

Monrovia/Transit Unit (Redemption Hospital)

Since the opening of the Ebola Transit Unit at the Redemption hospital site in New Kru Town on November 19, 2014, MSF has triaged more than 35 patients and admitted 16 to its Transit Unit, seven of whom tested positive. Patients who are admitted and test positive for Ebola and those who are clinically unstable upon arrival are transferred to ELWA 3 immediately. Patients are followed up with by the staff of the Redemption Unit throughout their time in treatment. Their families are offered psychosocial support, including transport to visit patients at ELWA 3, which can be up to an hour journey in traffic. Those who recover continue to receive support from MSF in the weeks following discharge.

In addition to running the 10-bed transit unit, MSF also supports the triage at Redemption Hospital's OPD. This is an extremely important step in the rebuilding of non-Ebola health services in Monrovia, as Redemption Hospital has been unable to run its normal operations since it was used as a holding center for Ebola patients in August.

Monrovia/ Health Promotion activities

The outbreak is at a critical stage in Monrovia, with cases remaining stable and vigilance across the city decreasing. As such, health promotion efforts are being streamlined and focused on preventing new infections. Health promotion teams are out in the community engaging in dialogue with community members about Ebola as well as running “training for trainers” for community-based organizations and other actors, with the aim of continuing to spread correct messaging on Ebola through communities across Monrovia.

Monrovia/Treatment and Prevention of Malaria

The first round of malaria drug distribution was completed on November 21. In total, more than 500,000 people have received their drugs in four neighborhoods. The second and last round of the distribution is ongoing and due to be completed on December 19. A distribution of mosquito nets will take place in early January 2015.

Rapid Response Teams/River Cess

There have been no new cases of Ebola in MSF's River Cess intervention for more than the 21 day incubation period and, as such, MSF has handed over the seven triage centres set up at local health centers, as well as health promotion activities in the area. Health staff in the area have been trained by MSF to recognize the symptoms of Ebola and to react accordingly. The project was successfully handed over to Partners in Health this week.

Rapid Response Teams/Grand Bassa

On November 29, MSF was informed of a single confirmed case and several suspicious deaths in Quewein village, in a remote area of Grand Bassa. Our team reached the area on December 2 and began home care for suspected and probable patients, while the set-up of a 12-bed EMC was finalized. In the following days, 31 suspected patients who were well enough to walk the 1.5 hours to waiting ambulances were transferred to ETCs in neighboring counties.

Of those not well enough to walk out, 18 were tested (14 were confirmed). On December 7, all confirmed patients were transferred from home care to the Quewein ETC. The team has ensured the safe burial of eight people from both the ETU and the community. As December 17, there are currently two suspected patients undergoing treatment at the center. There are currently three international staff as well as 15 national staff on the ground in Quewein. Since the team arrived they have referred 39 patients and treated 10 on-site.

Foya

After not having had any Ebola patients since October 30, and with new actors arriving in the area to provide support, MSF’s Ebola Management Center in Foya, Lofa County, was closed on December 10.  In the lead-up to handing the structure back to the NGO Samaritan's Purse, MSF invested strongly in health promotion activities and in the training of health staff in the districts of Foya, Kolahun, and Vahun. This will ensure a robust response should cases reappear in the area.

Between August 2 and December 10, 695 patients were admitted to the center, 384 of whom were confirmed Ebola cases. One-hundred fifty-four recovered from the virus and were discharged home.

Guinea

Update: December 18, 2014

The overall situation in Guinea remains concerning. Patient numbers remain high and the number of new cases continues to rise.

Conakry 

Donka Ebola Management Center in Conakry has reached its full capacity. Admissions have therefore temporarily stopped. New patients are being transferred by WHO to the Forecariah transit center 50 kilometers southeast of Conakry. This is the second time the Donka Ebola Management Center has reached full capacity. MSF is currently looking for an appropriate site to set up a bigger Ebola Management Center to serve the Conakry area.

Macenta

The technical support that MSF was offering to the local authorities in Kérouané and to the French Red Cross (FRC) in Macenta has ended. The MSF team left Macenta on December 10 after handing operations over to FRC.

Guéckédou

The number of admissions remained stable and on the low side, with a bed occupancy rate between 24 percent and 33 percent. The number of recovered patients is high (29 this week) and in the last four weeks there have been more recoveries than deaths.

The preparation for the INSERM study (FAVIPIRAVIR) is well underway. Trials will start the week of December 15.

Kankan

A new 20-bed CMC is being built in Kankan, and infection control has started in the Kankan General Hospital. The outbreak seems to have changed dynamic and is moving from Guinée Forestière to Haute Guinée.

Nigeria

Update: October 23, 2014

WHO declared October 20 as the official end of the epidemic after 42 days without a case. The MSF intervention has been closed.

Senegal

Update: October 23, 2014

WHO declared October 17 as the official end of the epidemic after 42 days without a case. The MSF intervention has been closed. MSF’s West African Unit (Dakar) will keep in contact with the government for follow-up as part of their routine activities.

Democratic Republic of Congo (DRC)

Update: November 20, 2014

The outbreak in DRC’s Equateur province, which was unrelated to the one in West Africa, was declared over this week. Around 60 MSF staff worked on this outbreak and two case management centers were established. The MSF teams have activated an exit plan.

Uganda

Update: November 20, 2014

On September 29, a case of Marburg fever was declared in Uganda. MSF has helped reinforce local capacities for treating confirmed cases and for infection control. No new cases of the disease have been declared since. 

Mali

Update: November 20, 2014

Mali confirmed its first case of Ebola on October 23. So far there have been seven reported deaths in the country (including the first case): five confirmed with Ebola and two suspected cases. To date, 360 contacts have been identified and nearly all have been placed under surveillance.

In Bamako, MSF is running a CMC in collaboration with CNAM, Mali’s national disease center. The only confirmed Ebola patient admitted to this facility recently died. The case was detected on November 11 and the patient was immediately admitted to the facility. There is one more suspected case currently at the CMC.

MSF has reinforced its team and expanded its activities to help stop the disease spreading further. MSF is training Malian staff from CNAM to manage Ebola cases, and is overseeing the organization of an ambulance system and safe burials.

No specific treatment or vaccine is yet available for Ebola.

Symptoms of Ebola

Early on, symptoms are nonspecific, making it difficult to diagnose.

The disease is often characterised by the sudden onset of fever, feeling weak, muscle pain, headaches, and a sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function, and, in some cases, internal and external bleeding.

Symptoms can appear from two to 21 days after exposure. Some patients may go on to experience rashes, red eyes, hiccups, chest pains, difficulty breathing, and swallowing.

Diagnosing Ebola

Diagnosing Ebola is difficult because the early symptoms, such as red eyes and rashes, are common.

Ebola infections can only be diagnosed definitively in the laboratory by five different tests.

Such tests are an extreme biohazard risk and should be conducted under maximum biological containment conditions. A number of human-to-human transmissions have occurred due to a lack of protective clothing. 

“Health workers are particularly susceptible to catching it so, along with treating patients, one of our main priorities is training health staff to reduce the risk of them catching the disease while caring for patients,” said Henry Gray, MSF’s emergency coordinator, during an outbreak of Ebola in Uganda in 2012.

“We have to put in place extremely rigorous safety procedures to ensure that no health workers are exposed to the virus—through contaminated material from patients or medical waste infected with Ebola.”

Treating Ebola

No specific treatment or vaccine is yet available for Ebola.

Standard treatment for Ebola is limited to supportive therapy. This consists of hydrating the patient, maintaining their oxygen status and blood pressure, and treating him or her for any complicating infections.

Despite the difficulty of diagnosing Ebola in its early stages, those who display its symptoms should be isolated and public health professionals notified. Supportive therapy can continue with proper protective clothing until samples from the patient are tested to confirm infection.

MSF contained an outbreak of Ebola in Uganda in 2012 by placing a control area around the treatment center.

An Ebola outbreak is officially considered at an end once 42 days have elapsed without any new confirmed cases.

Risk of Ebola Spreading

The risk of Ebola spreading to the US is minimal, but to minimize it even further we need more resources to bring the outbreak under control in West Africa. 

Before this outbreak, MSF has treated hundreds of people affected by Ebola in Uganda, Republic of Congo, the Democratic Republic of Congo (DRC), Sudan, Gabon, and Guinea. In 2007, MSF entirely contained an epidemic of Ebola in Uganda.

"I was collecting blood samples from patients. We did not have enough protective equipment to use [and] I developed the same symptoms,” says Kiiza Isaac, a nurse from Uganda.

On November 19, 2007, I received laboratory confirmation—I had contracted Ebola.

"MSF came to Bundibugyo and they ran a treatment center. Many patients were cared for. Thank God, I survived. After my recovery, I joined MSF."

It is estimated there have been over 1,800 cases of Ebola, with nearly 1,300 deaths.

The Ebola virus was first associated with an outbreak of 318 cases of a hemorrhagic disease in Zaire (now the Democratic Republic of Congo) in 1976. Of the 318 cases, 280 died—and died quickly. That same year, 284 people in Sudan also became infected with the virus, killing 156.

The Ebola virus is made up of five species: Bundibugyo, Ivory Coast, Reston, Sudan, and Zaire, named after their places of origin. Four of these five have caused disease in humans. While the Reston virus can infect humans, no illnesses or deaths have been reported.

MSF has treated hundreds of people affected by Ebola in UgandaRepublic of Congo, the Democratic Republic of Congo (DRC), Sudan, Gabon and Guinea. In 2007, MSF entirely contained an epidemic of Ebola in Uganda.

 

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