MSF’s West Africa Ebola response started in March 2014 and counts activities in Guinea, Liberia, Mali, and Sierra Leone. MSF currently employs 302 international and around 3,600 national locally hired staff in the region. The organization operates eight Ebola case management centers (CMCs), providing approximately 650 beds in isolation, and two transit centers. Since the beginning of the outbreak, MSF has admitted more than 7,700 patients, among whom around 4,800 were confirmed as having Ebola. More than 2,200 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.  

Latest News from the West Africa Outbreak

Ebola: Latest MSF Updates

WHO: Roadmap Situation Report (as of January 4, 2015)

 

Cases

Deaths

Guinea

2,775

1,781

Liberia

8,157

3,496

Nigeria

20

8

Sierra Leone

9,780

2,943

Senegal

1

0

Mali 8 6

Total

20,741

8,234

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 January 9, 2015)

  • Guinea: 77 international, approximately 600 national
  • Liberia: 82 international, around 1,400 national
  • Sierra Leone: 142 international, around 1,600 national
  • Mali: 1 international
  • Total: 302 international, around 3,600 national

Since the Ebola outbreak in West Africa was officially declared on March 22, 2014, in Guinea, it has claimed more than 8,200 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 DRC has also ended.

In September 2014, 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.

Two of the three clinical trials for different treatments led by MSF and three research institutions have started, while the third should start soon at MSF sites in West Africa. The French National Institute of Health and Medical Research (INSERM) is leading a trial for antiviral drug favipiravir at MSF’s facility in Guéckédou, Guinea. The inclusion of patients at this site has started mid-December. The University of Oxford leads, 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. The inclusion of patients started on January, 1, 2015.

The Antwerp Institute of Tropical Medicine (ITM) will lead a trial of convalescent plasma therapy at MSF’s Donka Ebola center in Conakry, Guinea. This trial is expected to start in the coming weeks.

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 2014. On December 30, there was almost 3,800 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: January 13, 2015

General

Operation Western Area Surge was launched December 16, 2014, as an intensified effort to mobilize communities to identify potential Ebola cases and link them with care. The surge focused 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 outcomes of the Surge are currently unknown, though there has been a 10 percent increase in calls to the Ebola hotline and a slight increase in Ebola-positive cases in MSF’s Ebola Treatment Center in Freetown. These increases are substantially less than expected, indicating a potential shortfall in the social mobilization effort. 

On New Year’s Eve, President Koroma extended the surge for another two weeks and expressed hope that schools would reopen soon.

Kailahun

Teams continue to reinforce outreach activities, including monitoring of surveillance activities by other actors and assistance where needed. The MSF EMC in Kailahun has admitted no positive cases since December 11, 2014. Following the opening and increased capacity of treatment centers in other districts both by MSF (Bo, Magburaka, Freetown) and other actors (Kenema, Makeni), no patients from other districts have been admitted since November 30. A small but significant number of patients presenting with Ebola-like symptoms continues, but since December 11 all have tested negative for the disease. While Ebola is still present in other districts, the possibility will remain that travelers may present with Ebola in Kailahun. The bed capacity in the EMC was reduced to 20 beds, although it can still be upgraded to 100 beds again in the future if needed.

Bo 

The MSF EMC centre in Bo saw a decrease of cases in late December following the opening of more treatment facilities in different regions of the country, although the current situation in Kono led to a slight increase of patients last week. As of January 4, 2015, there are 20 patients in isolation—16 confirmed cases, one probable, and three suspects. MSF continues to provide mental health services in the EMC in addition to strengthening health promotion activities, focusing on hotspots, training community health workers, and visiting all quarantine houses, as well as supporting the organization and dispatch of the alerts team.

Magburaka

Fifteen confirmed patients and five suspected are currently present in the EMC. Last week, the first cured patient was discharged. Since then, four cured patients have been discharged in total. The Winnipeg Laboratory, installed inside the EMC, is operating as district lab, working with three other holding centers and 11 CCCs in the area. It has a turnaround time on lab samples of four hours, which helped reduced the number of patients in holding centers. The team is currently evaluating the possibility of starting outreach activities.

Kissy

This week MSF has opened an Ebola Treatment Center in Kissy, one of the current hotspots of the epidemic, on the outskirts of Freetown. The current capacity is 20 beds, but the center will expand to an 80-bed referral center for Ebola-positive pregnant women, with an isolation ward where they will be able to receive obstetric care.

Freetown/Antimalarial Distribution

MSF will begin the second round of antimalarial distribution on January 16-19 for a target population of 1,8 million people. Teams will run house-to-house distribution of antimalarial drugs, sensitization on how these medications should be used for malaria prevention, and directly observed therapy (DOT) to support adherence. A large campaign of social mobilization has been run (radio, TV, posters, banners, as well as meetings with community leaders and stakeholders).

Freetown/Prince of Wales Secondary School

The Ebola Treatment Center at Prince of Wales School has reached its full capacity of 100 beds, though the center was only one-third full last week. The center includes 30 individual rooms for suspect cases to prevent cross-infection, as well as 70 treatment beds, including an intensive care ward with a plexiglas corridor to enable more intensive monitoring. Delays between onset of symptoms and access to treatment remain the most significant factor related to mortality. Since the center opened on December 10, there have been 178 admissions, 82 Ebola-confirmed patients, 30 Ebola deaths, and 32 survivors.

The center has a mobile lab on the premises that currently tests 30 samples per day, and can scale to 50 samples per day.

Outreach activities have begun in the neighboring areas of Kroo Bay and Congotown. MSF is also supporting infection prevention and control (IPC) training for NGOs that are responding to Ebola cases alerts. MSF will add an additional car to this alert response, providing health promotion and additional IPC support.

Liberia

Update: January 13, 2015

 

Monrovia: Elwa 3

Following the decrease in the number of patients in Elwa 3 (currently three confirmed and four suspected), teams have downsized Elwa 3 from a 250-bed facility to a 60-bed facility. The teams have also built a laboratory to help better monitor patients; it is expect the lab will open in the coming week.

On January 9, a “stabilization center” for patients with acute illnesses who do not meet the Ebola case definition was open at Elwa 3. The idea is that patients will be stabilized (using universal precautions but not full PPE) before being transferred to an available hospital bed at another facility. This is to mitigate problems surrounding the transfer of untested non-cases to other hospitals, which usually face lengthy delays and have in some cases resulted in the death of the patient.

The trial of brincidofovir, led by an Oxford university team, started on January 1.

Monrovia/Outreach

Ambulance service has been set up with a dedicated hotline that the community can call if they have suspected Ebola cases. Teams 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.

Meanwhile, teams are working at the set-up of an MSF-run pediatric hospital in Monrovia.

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, MSF has triaged 100 patients and admitted 51 to its Transit Unit. 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 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 ten-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

Health promotion teams are out in the community engaging in dialogue with interested 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 two rounds of malaria drug distribution were completed on November 21 and December 19, respectively. In total, more than 500,000 people have received their drugs in four neighborhoods. A distribution of mosquito nets will take place early January.

Rapid Response Teams/River Cess

At the end of December, MSF handed over to Partners in Health the seven triage centers set up at local health centers, as well as health promotion activities in the area. Health staff in the area has been trained by MSF to recognize the symptoms of Ebola and to react accordingly.

Rapid Response Teams/Grand Bassa

The MSF intervention in Quewein, Grand Bassa County, started on December 2 and was handed over at the beginning of January to Concern Worldwide and local health authorities. MSF teams took in charge or organized the referral of about 50 patients in the area.

Rapid Response Teams/Grand Cape Mount

There are currently up to three trains of active transmission in Grand Cape Mount County, including one in an open cut mine. Following an evaluation, the team has decided to run mobile clinics in villages across the region to find active cases, train local health staff in proper triage and infection control procedures, and fill a gap in primary health care.

Foya

After not having had any Ebola patients since October 30, 2014, and with new actors arriving in the area to provide support, MSF’s Ebola Management Center in Foya, Lofa County, was handed over 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: January 13, 2015

The overall situation in Guinea remains concerning. While the total number of new cases has been relatively stable during the last three weeks, the epidemic continues to spread geographically, with new districts declaring cases for the first time.

Conakry and the surrounding areas account for approximately half of the cases in the country.

Conakry 

Donka Ebola Management Center in Conakry is admitting an average of five patients per day, mostly from Conakry.

Since last week, MSF teams are involved in contact-tracing activities. MSF is looking for an appropriate site to set up a bigger Ebola Management Center to serve the Conakry area.

Macenta

MSF completed the handover of the Macenta center to the French Red Cross in December. MSF teams left Macenta on December 10.

Guéckédou

The number of admissions remains stable on the low side. The number of admitted patients has also decreased in surrounding Ebola centers in the region.   

The INSERM study started 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. Outreach activities have also started in Kankan and its surroundings. 

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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