MSF’s West Africa Ebola response started in March 2014 and includes activities in Guinea, Liberia, Mali, and Sierra Leone. MSF currently employs 302 international and around 4,000 national locally hired staff in the region. The organization operates eight Ebola case management centers (CMCs), providing approximately 650 beds in isolation, and one transit center. Since the beginning of the outbreak, MSF has admitted more than 8,100 patients, among whom around 4,960 were confirmed as having Ebola. More than 2,300 patients have survived. More than 1,400 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.  

Ebola: Latest MSF Updates

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WHO: Roadmap Situation Report (as of February 12, 2015)

 

Cases

Deaths

Guinea (2/7/2015)

3,042

1,990

Liberia (2/7/2015)

8,881

3,826

Sierra Leone (2/7/2015)

10,905

3,336

Total

22,828

9,152

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

02 Jan

1,499

613

303

Guéckédou CMC

05 Jan

1,641

1,081

455

Telimele CMC

Closed

35

21

16

SIERRA LEONE

 

Bo CMC

04 Jan

476

437

255

Kailahun CMC

03 Jan

1,215

857

466

Magburaka CMC

08 Jan

56

39

12

Freetown CMC

06 Jan

177

81

28

Kissy CMC 08 Jan 5 1 -

LIBERIA

 

Monrovia (ELWA 3) CMC

29 Dec

1,826

1,225

498

Foya CMC

Closed

695

384

154

Quewein CMC

Closed

17

16

8

TOTAL

 

7,642

4,755

2,195

* 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 February 12, 2015)

  • Guinea: 76 international, approximately 800 national
  • Liberia: 92 international, around 1,600 national
  • Sierra Leone: 157 international, around 1,750 national
  • Total: 325 international, around 4,150 national

Since the Ebola outbreak in West Africa was officially declared on March 22, 2014, in Guinea, it has claimed more than 8,600 lives in the region. The outbreak is the largest ever, and is currently affecting three countries in West Africa: Guinea, Liberia, and Sierra Leone. Outbreaks in Mali, Nigeria, and Senegal have been declared over. A separate outbreak in Democratic Republic of Congo (DRC) has also ended.

Following the downward trend of new cases reported in MSF Ebola management centers across the three affected countries during the first weeks of 2015, the number of new cases has seen a slight increase. Surveillance remains weak: the World Health Organization (WHO) reported that during the last week only about 15 percent of new cases in Guinea are from known Ebola contacts. And in Sierra Leone the available data is limited; according to WHO, only 21 percent of new cases were from known contacts. There is almost no information sharing for tracing Ebola contacts between the three most-affected countries. Since a single new case is enough to reignite an outbreak, the level of vigilance should remain high in order not to jeopardize the progress made in stemming the epidemic.  

 

Sierra Leone

Update: February 12, 2015

The number of admissions to the MSF ETCs remains low, with Kailahun and Bo having reached zero patients admitted to the EMC. However, in all districts outreach activities, surveillance, social mobilization, trainings, etc. remain a priority.

Kailahun

On 22 January, Kailahun district was declared Ebola-free after 42 consecutive days without an Ebola case. MSF and the Ministry of Health are looking together at Kailahun hospital to take over responsibility for future suspected cases, which would allow MSF to close its project in Kailahun. MSF is building an isolation unit in the grounds of the local hospital and training MoH staff. In the meantime, the EMC in Kailahun has been transformed into a transit center, and dismantling of parts of the facility have commenced. Outreach activities have ended in this district. 

Bo 

The MSF ETC in Bo saw a decrease of cases in late December following the opening of more treatment facilities in different regions of the country.  There are currently no patients in the ETC. The last confirmed patient was admitted on January 12, while the last discharge took place on January 26. MSF continues to provide mental health services in the ETC as well as strengthening health promotion activities, training community health workers, and visiting quarantined houses in the district, as well as supporting the local alerts team. With some capacity freed up due to the decline in patients in the ETC, the teams are expanding outreach and surveillance activities to all chiefdoms in Bo district. At the same time, decontamination of the two wards is underway.

Magburaka

After the last patient was discharged on February 9, one new positive case was admitted. The Winnipeg Laboratory, installed inside the EMC, is operating as a district lab, is working with three other holding centers and 11 community care centers in the area. It has a turnaround time on lab samples of four hours, which has helped reduce the number of patients in holding centers. Outreach activities are ongoing to all chiefdoms in Tonkolili district.

Kissy

On January 8, MSF opened an Ebola Treatment Center in Kissy, one of the current hotspots of the epidemic, in the outskirts of Freetown. On January 28, the maternity section of the center (METC) opened, providing obstetric services for Ebola-positive pregnant women.  So far, there have been 61 admissions to the center, of which nine are pregnant women, representing 15 percent of total admissions. Of the three confirmed METC patients, two confirmed pregnant women were discharged. One suspected patient is under care in the ETC. The last confirmed case was admitted on January 25 and discharged February 8. Out of the 17 confirmed patients, eight were discharged.

The first referral of a positive maternity patient from outside the Western Area was received last week. The patient was referred from an ETC operated by GOAL in the district of Port Loko, which has become the latest hotspot.   

Freetown/Antimalarial Distribution

MSF completed the second round of antimalarial distribution on January 16-19 for a target population of 1.8 million people. Social mobilization teams completed a house-to-house sensitization on the distribution of antimalarial drugs, with information on the purpose of the campaign and instructions on how to use these medications should be used for malaria prevention.  Following this sensitization, a four-day house-to-house distribution of antimalarials was undertaken, where recipients were encouraged to take the artesunate amodiaquine with directly observed therapy (DOT) to support adherence. Preliminary results indicate high levels of coverage and compliance, and MSF has undertaken a survey to assess outcomes.  The compliance survey for the second round is ready to start.

Freetown/Prince of Wales Secondary School

The ETC at Prince of Wales School has a 100-bed capacity, with 30 individual rooms for suspect cases to prevent cross-infection, as well as 70 treatment beds for confirmed patients and an intensive care ward with a Plexiglas corridor to enable more intensive monitoring. With declining transmission, the ETC reduced bed capacity to 20 confirmed and 10 suspect beds. The center has a mobile lab on premises that currently tests 30 samples per day, and can scale up to 50 samples tested per day. An Ebola community outreach strategy is underway, including support for epidemiological surveillance related activities, health promotion, and house disinfection. MSF is also conducting survivors’ follow ups to monitor mental health and medical consequences that they may face after they have recovered from the disease.

Liberia

Update: February 12, 2015

Liberia has seen a sharp decline in Ebola cases. Due to the overall improvement of the country’s situation, MSF has progressively reduced its Ebola related activities, and is working today in Monrovia in two facilities: the Redemption Hospital transit center and ELWA 3.  However, the counties reporting more contacts may potentially see an increase of cases. The main focus is now on surveillance, infection control and prevention, health promotion, and training activities. Support of non-Ebola health care remains a priority.

The National Institutes of Health and the Liberian government Ebola Vaccine trial (phase II) started on January 31 at Redemption Hospital in Monrovia, with priority being given to 600 health staff and population at risk. MSF is not involved in this trial.

In Monrovia, MSF is planning to open a 46 beds pediatric hospital, but its maximum total capacity is expected to increase up to 100 beds.

Monrovia: ELWA 3 ETC

During the past two weeks, there have been very few admissions in ELWA.  Currently this ETC hosts two patients. The downsizing of the center continues and its capacity is now 30. The survivors’ clinic opened the last week, offering psychosocial support, health screening ,and primary health care to Ebola survivors.

The trial of the experimental Ebola drug brincidofovir in Liberia has been halted due the significant drop in the number of new Ebola cases, coupled with the announcement made on January 30 by the drug’s manufacturer that it would no longer participate in the trial.

Monrovia: Distribution and Outreach

Forty health facilities are being supported and their staff trained on infections prevention and control. A team is also supporting the pediatric and maternal James Davis Junior Memorial (JDJ) Hospital in Monrovia. After MSF did the rehabilitation work to set up infection control and to upgrade the equipment of the triage, consultation rooms, and pediatrics ward, MSF staff started working inside the JDJ hospital to support Ministry of Health staff. The maternity ward opened on the February 9.

Monrovia: Redemption ETU, health promotion and training

Coordination on rapid and effective implementation of infection control trainings in health centers/clinics surrounding MSF Transit Unit is ongoing. Health promotion teams are conducting daily training sessions for CBOs and district task forces. MSF is also engaged in community dialogue.

MSF started a three-day pilot RITE (Rapid Isolation and Treatment of Ebola) training for County Health Teams staff.

Guinea

Update: February 12, 2015

Following the decrease of new Ebola cases during the first four weeks of 2015, numbers in Conakry rose again, from nine confirmed cases on January 30 to 18 confirmed cases as of February 10.  Moreover, with many of the country’s prefectures considered as “active,” the epidemic is still geographically spread out. New chains of transmission have been reported in areas previously considered as Ebola-free. MSF deployed rapid response teams that are able to quickly identify, investigate, and follow new cases and contacts, as well as quickly setting up isolation units within existing health structures. The number of unreported community death and unsafe burials remains concerning, especially in Conakry. Outreach activities, active surveillance, social mobilization, and training are ongoing in all projects. 

Conakry 

There has been an increase in cases with 17 patients at Donka CTE. MSF continues outreach and community sensitization activities in the city, but the level of acceptance remains low. The capacity of the non-MSF ETC at Coyah reached its limit with 23 patients during the weekend.  Patients from the areas surrounding Coyah were therefore referred to Donka.

Guéckédou

With one new recent admission, the number of patients in Guéckédou remains low. MSF launched a support intervention in the nearby town of Kissidougou, where sensitization activities, support to the surveillance team, and health structure evaluation are ongoing.

Preliminary results of the favipiravir trial led by INSERM have been announced. However, it is too soon to draw conclusion on the efficacy of the drug. Therefore the trial is still ongoing.

Rapid Response Teams – Faranah

The rapid response team is currently setting up a transit center in Faranah to facilitate the individuation and referral of new cases. The team is also involved in surveillance and support to local health structures, and is conducting community sensitization activities.

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.

 

Related News & Publications