MSF’s West Africa Ebola response started in March 2014 and counts activities in Guinea, Liberia, Mali, and Sierra Leone. MSF currently employs 276 international and around 3,160 locally hired staff in the region. The organization operates six Ebola case management centers (CMCs), providing approximately 600 beds in isolation, and two transit centers. Since the beginning of the outbreak, MSF has sent more than 700 international staff to the region and admitted more than 6,000 patients, among whom around 3,800 were confirmed as having Ebola. Nearly 1,600 patients have survived. More than 1,200 tonnes of supplies have been shipped to the affected countries since March. The provisional budget for 2014 and 2015 for MSF's Ebola response in West Africa is €113M. So far MSF has raised €21M in institutional funds and €52M 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 19, 2014)

 

Cases

Deaths

Guinea

1,971

1,192

Liberia

7,069

2,964

Nigeria

20

8

Sierra Leone

6,073

1,250

Senegal

1

0

Mali 6 5

Total

15,145

5,420

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

16 November

980

342

179

Guéckédou

16 November

1,406

912

331

SIERRA LEONE

 

Kailahun

17 November

1,121

783

373

Bo 17 November 270 244 108

LIBERIA

 

Foya

17 November

695

384

152

Monrovia (ELWA 3)

17 November

1,650

1,148

456

TOTAL

 

6,122

3,813

1,599

* 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 the most accurate reflection of the current situation.

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

  • Guinea: 72 international, approximately 360 national (+48 from Ministry of Health)
  • Liberia: 108 international, around 1,300 national
  • Sierra Leone: 80 international, around 1,500 national
  • Mali: 16 international
  • Total: 276 international, around 3,160 national

Supplies Sent to West Africa Since Beginning of Ebola Response: 1,201 tonnes of cargo

Since the Ebola outbreak in West Africa was officially declared on March 22 in Guinea, it has claimed 5,420 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. One person in Spain and three people in the USA have recovered; one person in the USA has died. Outbreaks in Nigeria and Senegal have been declared over. A separate outbreak in DRC has also ended.

Following announcements made in the last weeks, deployment of international aid is slowly rolling out 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.

Last week, MSF and three research institutions announced that clinical trials for three different treatments would be carried out at MSF sites in West Africa. The French National Institute of Health and Medical Research médicale (INSERM) will lead a trial for antiviral drug favipiravir at MSF’s facility in Guéckédou, Guinea; the Antwerp Institute of Tropical Medicine (ITM) will lead a trial of convalescent whole blood and 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 a site yet to be determined.

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 more than 3,400 staff working in Guinea, Liberia, Sierra Leone, and Mali, treating an increasing number of patients. Since the response began, 24 MSF staff members have fallen ill with Ebola; 11 have recovered. The vast majority of these infections were found to have occurred in the community.

 

Sierra Leone

Update: November 20, 2014

The overall effort to combat Ebola in Sierra Leone is being outpaced. Despite efforts from authorities and support from international actors, including MSF, the situation is not under control.

The NERC (National Ebola Response Committee) has initiated new coordination centers to improve communication and collaboration of country-wide and district-level responses. Despite an increased number of coordination structures, a wealth of technical expertise, and substantial material support, the overall output of the response is struggling to face the needs. 

Governments (including the UK and China) and various NGOs have sent teams to construct new centers in different locations around the country, including Port Loko and Freetown. While many centers are scheduled to open soon, they will not be running at full capacity until well into 2015. Meanwhile, because of the overwhelming pressure, many localities, hospitals, transit centers, health units, and communities are initiating responses with varying degrees of support from international actors.

Bed capacity remains a critical issue. Moreover, MSF is concerned that transit facilities, holding facilities, functioning health care facilities, and ambulances can all act as points of transmission. 

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.

Kailahun

The MSF CMC continues to receive patients from outside of Kailahun as there are not enough CMCs in the country. Patients are transported from the heavily affected districts of Bombali and Tonkolili, traveling over eight hours by car. Conditions inside the ambulances can create cross-contamination as people are often very sick.

Social mobilization and sensitization activities have increased as the Health Promotion team and the medical team are reaching out to public health units, community stakeholders, and the community at large to raise awareness.

Bo

In Bo, the MSF CMC is gradually being scaled up to 64 beds. At the moment, its capacity is 60 beds. The CMC is receiving confirmed cases mostly from Moyamba, Port Loko, and Freetown, but has recently received patients from the Koinadugu district.                                                                                                                       

Freetown

In Freetown, MSF is planning two rounds of house-to-house distributions of antimalarial medication. This initiative aims to reach about 1.4 million people and will start December 5. The second round will be a month later.

A recent assessment by an MSF team in Freetown and the area identified beds for Ebola patients as the greatest need. Discussions with health authorities on a possible MSF intervention are in the advanced stages. A team of five is already on the ground and will be reinforced by another fifteen people by next week. 

Liberia

Update: November 20, 2014

Monrovia

The number of patients in ELWA 3 has been dropping: as of November 18, the total number of confirmed cases was only 18. There is a decrease in case numbers everywhere else in Monrovia and in some other parts of the country. This is a positive development, but the epidemic is still far from over and we need to remain vigilant. MSF continues to admit new patients: there were 42 admissions last week.

MSF is still concerned about the poor ambulance and referral systems, community surveillance, safe body management practices, and contact tracing. However an ambulance service has been set up with a dedicated hotline and the first team became operational this week.

Recruitment and training of home visitors is ongoing. 

Distribution of malaria treatment started in Monrovia on October 25 and was well-received by the population.  By the end of the first round, 100,000 households will have received medication. The second round of the distribution is due to start in late November.

On November 19, MSF opened a 10-bed triage point at Redemption hospital in New Kru Town, Monrovia. Patients going to the government-run hospital can now be screened for Ebola and referred if needed to a CMC. Redemption hospital is one of the few hospitals providing care free-of-charge in Monrovia. Until recently it has been unable to run its normal operations as it was being used as a holding center for Ebola patients.

Lofa

In Lofa county, the CMC in Foya has not recorded any admissions for the past 10 days and since October 30 there have been no confirmed Ebola cases. The teams are now reducing the capacity of the CMC from 25 to 10 beds and will close it by the end of the month. MSF continues health promotion work and outreach activities in the area. 

In Voinjama, the transit unit, outreach, and hygiene promotion activities and health worker training have been handed over to partners.

The comprehensive package of medical care, outreach activities, psychosocial support, health promotion, contact tracing, and other measures has led to a steep decrease in cases in Lofa. There has been a strong acceptance of MSF within the community, and people have significantly changed their behaviors and daily routines to help stop the epidemic.

The fight against Ebola is far from over and people must remain vigilant. Complacency is a real issue and cases are on the rise again in neighboring counties.

Cess River

A team has arrived in Cess River to respond to positive cases coming from this rural area. Activities have already started and include contact tracing with the Center for Disease Control (CDC), safe burials, distribution of protection kits, and preparation of a transit center. 

Guinea

Update: November 20, 2014

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

Conakry

Last week there was a small increase in cases. Because the Donka case management centre (CMC) requires refurbishment—it was meant as a temporary structure when it was built in March 2014, seven months ago—MSF has identified a site for a new structure and is currently engaging with community to ensure acceptance.

Macenta/Guéckédou

November 14 saw the official handover of the MSF-built CMC in Macenta to the French Red Cross, with high-level officials from both Guinea and France.

On two separate occasions in the last 14 days, the MSF transit facility in Macenta had to stop admissions because the clinic was full, and the safety of the staff would be compromised with more admissions.

The CMC in Guéckédou is currently full to capacity and the situation in surrounding prefectures, especially the eastern ones, is concerning. Patients often come from far away—sometimes traveling 12 hours in an ambulance—and they are often in a bad state when they arrive at the CMC.

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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