MSF’s West Africa Ebola response started in March 2014 and counts activities in Guinea, Liberia, and Sierra Leone. In response to a confirmed case in Mali, an MSF team arrived in the country this week to reinforce MSF’s regular mission and provide technical support to the Ministry of Health.

 

MSF currently employs 263 international and around 3,084 locally hired staff in the region. The organization operates six Ebola case management centers (CMCs), providing approximately 600 beds in isolation. Since the beginning of the outbreak, MSF has sent more than 700 international staff to the region and admitted more than 5,200 patients, among whom around 3,200 were confirmed as having Ebola. More than 1,200 patients have survived.

 

More than 1,019 tonnes of supplies have been shipped to the affected countries since March.

 

The provisional 2014 budget for MSF’s Ebola response in West Africa is €51 million. MSF will continue its operational response in 2015, and is currently estimating operational budgets beyond 2014. So far, MSF has approved institutional funding for a value of €20M and have raised some €28M in private funds.

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 November 7, 2014)

 

Cases

Deaths

Guinea

1,760

1,054

Liberia

6,619

2,766

Nigeria

20

8

Sierra Leone

4,862

1,130

Senegal

1

0

Total

13,263

4,959

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

6 November

907

320

172

Guéckédou

6 November

1,301

826

291

SIERRA LEONE

 

Kailahun

6 November

1,022

695

329

Bo 6 November 195 172 75

LIBERIA

 

Foya

5 November

701

389

152

Monrovia (ELWA 3)

2 November

1,565

1,101

398

TOTAL

 

5,691

3,503

1,417

* 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.

**Some numbers will have dropped since last week due to a revision of MSF databases; these numbers are most accurate reflection of current situation.

MSF Staff on the Ground (as of October 24, 2014)

  • Guinea: 71 international, approximately 360 national (+48 from Ministry of Health)
  • Liberia: 77 international, around 1,417 national
  • Sierra Leone: 103 international, around 1,300 national
  • Mali: 12 international
  • Total: 263 international, around 3,077 national

Supplies Sent to West Africa Since Beginning of Ebola Response: 1,107 tonnes of cargo

Since the Ebola outbreak in West Africa was officially declared on March 22 in Guinea, it has claimed 4,919 lives in the region. The outbreak is the largest ever, and is currently affecting four countries in West Africa: Mali, Guinea, Liberia, and Sierra Leone. On October 24, the first case of Ebola was confirmed in Mali, and that person has died. One person in the United States of America (USA) is currently being treated for Ebola, and one has died. One person in Spain and two people in the USA have recovered. Outbreaks in Nigeria and Senegal have been declared over.

On October 23, the first case of Ebola was confirmed in Mali. The WHO, CDC, and the Ministry of Health (MoH) in Mali are responding. An MSF team arrived in Mali this week to reinforce MSF’s regular mission in the country and provide technical support to the MoH.

There is an unrelated outbreak of Ebola in DRC. With no reported new cases since early October, the MSF teams in Lokolia and Boende have activated exit plans for the coming weeks. On September 29, a case of Marburg fever was declared in Uganda; however no new cases of the disease have been declared since.

Following announcements made in the last weeks, deployment of international aid is slowly taking place in the three main countries affected: Sierra Leone, Liberia, and Guinea. However, there is little indication that current efforts to increase capacity to isolate and take care of suspected and confirmed Ebola cases will address needs sufficiently.

The United Nations Mission for Ebola Emergency Response (UNMEER) has been set up and will be 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 teams in West Africa are still seeing critical gaps in all aspects of the response, including medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems, community education, and mobilization.

MSF has been responding to the outbreak since March, and currently has a total of 3,347 staff working in Guinea, Liberia, and Sierra Leone, treating a rapidly increasing number of patients. Since the response began, 23 MSF staff have been infected with Ebola, eight of whom have recovered. The vast majority of these infections were found to have occurred in the community.

 

Sierra Leone

Update: October 30, 2014

Every district in Sierra Leone is now affected by the epidemic. New hotspots for the disease include the capital, Freetown, and the areas of Port Loko, Bombali, and Moyamba. The government has put five of the worst-affected districts under quarantine, setting up checkpoints on roads to prevent people leaving the area—measures which affect between one and two million people.

The government’s response is hampered by a lack of resources and coordination at both national and district level. There is no strong surveillance system in place, while up to 85 percent of calls to the national telephone helpline get no response. Transit centers are full and management is really an issue, creating the risk of cross-contamination. As a result of overcrowding, delays in lab testing, and too few ambulances, staff in transit centers are obliged to send people untested to treatment centers, risking positive cases infecting those who are negative. As there are few treatment centers, and these are often far away, people often die on the long journey there. Dead bodies have the highest viral load possible, putting other travelers at risk.

With so many deaths from Ebola, we are seeing an increasing number of orphaned children in MSF centers, and a lack of caregivers.

The international response is beginning to get underway, but it is slow and uncoordinated. Governments (including the UK and China) and various NGOs have sent teams to construct new centers at different locations around the country, including Jiu, Port Loko, and Freetown. Getting these new centers up and running is a matter of urgency. The need for more resources on the ground continues. Community sensitization is an area of increasing concern.

MSF has been conducting training for organizations interested in joining the response. So far three international organizations have been trained in MSF centers in Bo and Kailahun, with more trainings planned in the coming weeks.

Kailahun

There has been an increase in patient numbers from the Kailahun district. The new hotspot is the Chiefdom of Yawei. The three transit centers that were previously receiving large numbers of cases from throughout the district are for the moment empty. However, patients are still arriving at our treatment center on a daily basis from parts of the district, and, worryingly, some are coming from Kailahun town itself, which is a new development. MSF is supporting a team of 800 health promoters who are tasked with passing Ebola awareness messages throughout the district of 429,000 inhabitants.

Our treatment center continues to receive patients from outside of Kailahun, as there are not enough treatment centers in the country. The patients are being transported from the heavily affected districts of Bombali and Tonkilili, traveling over eight hours by car, which is a serious medical concern as the conditions inside the ambulances can create cross-contamination and people are very sick. Sometimes people travel for hours with a dead body next to them.  

We are seeing an increase in the number of households and communities under quarantine in the Kailahun district, which is of some concern as it limits sick people’s access to medical care.

Social mobilization and sensitization activities have increased as the health promotion and medical teams reach out to public health units, community stakeholders, and the community at large to raise awareness. 

Bo

In Bo MSF’s new 35-bed Ebola management center, which opened on September 19, has now seen more than 35 people discharged since its opening. With the provision of trained staff, the CMC will be looking to scale up its bed capacity in the coming weeks. Capacity-building of national staff is ongoing. 

Liberia

Update: October 30, 2014

Monrovia

The number of patients in MSF’s ELWA 3 facility is dropping: as of October 28, there were around 80 patients in the 250-bed facility. MSF teams are looking into the reasons for this; a widespread aversion to the government’s mandatory cremation policy, poor ambulance and referral systems, changes in behavior, and other factors may play a role. MSF cannot rule out the possibility that patient numbers will go up again.  

Distributions of household protection kits is ongoing. As of October 28, 44,154 kits had been distributed in several areas of Monrovia. These kits are designed for use by the families and communities of symptomatic individuals who haven’t been able to make it to a CMC for lack of means of transport, or who have died at home. They are in no way meant as a substitute for the care provided in CMCs like ELWA 3.

Mass distributions of anti-malaria treatment began on October 25. The objective of these distributions is to reduce deaths and illness from malaria in the poorest and most densely populated areas of Monrovia, where access to health care is limited, and to reduce the risk of people becoming contaminated with Ebola in health facilities. MSF aims to reach 300,000 people—or around 50,000 households—with this distribution.

Foya

The number of admissions in Foya has been low for the past few weeks, with very few patients currently admitted. During the last 33 days, there has only been one confirmed case in the western districts of Foya, Kolahun, and Vahun, and this patient was infected outside of Lofa county. Most patients are coming from the east of the county, near the border of Guinea and increasingly further afield, from Zorzor, Saleya, and close to Bong county. MSF activities in Voinjama and Quardu Bondi are increasing accordingly.

The decrease in the number of cases in Foya has occurred as a result of a comprehensive package of medical care, outreach activities, health promotion, and contact tracing. There has been a strong acceptance of MSF within the community, and they have significantly changed their behaviours and daily routines to help stop the spread of the epidemic.

However, the lower number of cases, particularly in the west of the county, is leading to a concerning perception among the community that Ebola may soon be over. MSF is remaining vigilant, and is reinforcing health promotion messages and activities. In Foya, MSF has expanded health promotion activities to villages where outbreaks have not yet occurred. The organization is also training local groups to deliver health promotion messages in remote areas that MSF has not yet reached. In Voinjama the health promotion instructed health promotion trainers for 17 NGOs and local organizations to ensure that best practices are passed on.

MSF will soon open a transit center to accommodate patients identified late in the day. They will spend the night at the unit and be transferred the next morning to the center in Foya. Ebola triage stations in the outpatient department (OPD) and General Hospital of Voinjama are also being established.

MSF is now training key partners in the Foya CMC and in its outreach activities.

As local health centers begin to reopen, MSF is making donations of protective equipment and providing training to the staff working in these centers on how to use this equipment safely.

Guinea

Update: October 30, 2014

MSF welcomes the involvement of other actors in the response to Ebola in Guinea, but these positive steps won’t be sufficient to stop the epidemic. The response must be structured and coherent; however, it is still scattered and piecemeal. More health promotion activities and more support with contact tracing and safe burials, particularly in hotspots in the east of the country, are required. At the moment, only a few actors are providing the services required: for example, MSF is still the only organization operating CMCs.

There is an urgent need for more transit centers and CMCs to get up and running in the affected rural districts. New chains of transmissions have appeared in Kerouane and Nzerekore, but existing CMCs are difficult to access from these areas.

On October 24, an MSF international staff member who had been working in Guinea earlier this month tested positive for Ebola once he was back in the USA. The circumstances under which the staff member contracted Ebola have not yet been determined. A thorough investigation is underway by MSF.

Conakry

The situation in Conakry has slightly stabilized in the last week, but regular small troughs and peaks show that the epidemic is not under control. MSF is clearing a new site in Koloma for the construction of a new CMC. Once this has been constructed, the Donka CMC’s activities will move here. The Donka facility was built with the expectation of running for six months and the structure can no longer keep up with the development of the outbreak. 

With the logistical and technical support of MSF, the Ministry of Health (MoH) opened a transit centre in Forecariah (southeast of Conakry), which will transfer patients to MSF’s CMC in the city.

Macenta/Gueckedou

The team has seen a slight increase in confirmed patients in Guéckédou, with many coming from Kerouane, revealing new chains of transmission.

On two occasions, the transit center in Macenta narrowly avoided overflow by doubling the number of transfers to Guéckédou. MSF is speeding up construction of the new 30-bed CMC in Macenta to cope with increasing caseloads.

MSF and the French Red Cross (FRC) will start training FRC staff in November to eventually operate the Macenta CMC. The French Red Cross will take over in Macenta at the end of November.

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: October 30, 2014

The current outbreak in DRC’s Equateur province is unrelated to the one in West Africa. Around 60 MSF staff have been working on this outbreak and two case management centers have been established: one in Lokolia (24 beds) and one in Boende (10 beds). With no reported new cases since early October, the MSF teams in Lokolia and Boende have activated exit plans for the coming weeks. 

Uganda

Update: October 30, 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: October 30, 2014

On October 23, the first case of Ebola was confirmed in Mali. The WHO, CDC, and the Ministry of Health in Mali are responding. An MSF team arrived in Mali this week to reinforce MSF’s regular mission and provide technical support to the Ministry of Health. 

What causes Ebola?

Ebola can be caught from both humans and animals. It is transmitted through close contact with blood, secretions, or other bodily fluids.

Health care workers have frequently been infected while treating Ebola patients. This has occurred through close contact without the use of gloves, masks, or protective goggles.

In areas of Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope, and porcupines found dead or ill in the rainforest.

Burials where mourners have direct contact with the deceased can also transmit the virus, whereas transmission through infected semen can occur up to seven weeks after clinical recovery.

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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