YALE- TULANE ESF-8 SPECIAL REPORT

WEST AFRICA – EBOLA 2014

CONFIRMED PROBABLE SUSPECTED TOTALS

CASES3075 1432 828 5335

DEATH1,583 713 326 2622

BACKGROUND

CURRENT SITUATION

19 SEPTEMBER 2014

BIOSECURITY MEASURES

LIBERIA• MINISTRY OF HEALTH AND SOCIA

L WELFARE NIGERIA • NIGERIA MINISTRY OF HEALTH• NIGERIA EMERGENCY MANAGEM

ENT AGENCY• EBOLA ALERT

SIERRA LEONE• MOHS• MINISTRY OF HEALTH AND SANITA

TION

INTERNATIONAL ORGANIZATIONS• RELIEF WEB• HUMANITARIAN RESPONSE • UNICEF • UN NEWS CENTER

WHO• WORLD HEALTH ORGANIZATION -

AFRICA• WHO AFRP EPR OUTBREAK NEWS• DISEASE OUTBREAK NEWS• GLOBAL ALERT RESPONSE -

EBOLA• WHO – EBOLA• IFRC NGO• MSF• ACT ALLIANCE• CATHOLIC RELIEF• SAMARITAN'S PURSE

RESPONSE ACTIVITIES

GUINEA | LIBERIA| SIERRA LEONE

US GOVERNMENT• US EMBASSY MONROVIA – LI

BERIA• US EMBASSY – CONAKRY, GUI

NEA.

• US EMBASSY – SIERRA LEONE• US EMBASSY – NIGERIA• CDC

EBOLA HEMORRHAGIC FEVER• CDC

– OUTBREAK OF EBOLA IN WEST AFRICA

• USAID

EU• ECDC• NaTHNac

PORTALS, BLOGS, AND RESOURCES• CIDRAP• PROMED MAIL• EBOLA ALERTS ON

--HEALTHMAP• OPENSTREETMAP WEST AFRI

CA EBOLA RESPONSE• MEDBOX EBOLA TOOLBOX• VIROLOGY DOWN UNDER BL

OG• H5N1• DISASTER INFORMATION RES

EARCH CENTER• INTERNATIONAL SOS• MAPACTION

NEW SOURCES• ALERTNET• NY TIMES• WASHINGTON POST

EBOLA VIRUS DISEASE, WEST AFRICA – UPDATE 18SEPTEMBER 2014

IMPACT ON HCW

GUINEA

LIBERIA

SIERRA LEON

CDC REFERENCE MATERIALS

QUALITY OF SERVICES

VACCINE DEVELOPMENT

BACKGROUND

SITUATION: EBOLA OUTBREAK - WEST AFRICA. • An uncontrolled outbreak of Ebola virus is currently underway in several countries

in West Africa (Guinea, Liberia, and Sierra Leone, with limited cases reported in Nigeria, and a single case reported in Senegal).

• This is the largest Ebola outbreak ever reported, both in terms of case numbers and geographical spread. It's also the first time the disease has affected large cities. Capital cities of these nations are affected. (Note that the Ebola cases in the Democratic Republic of Congo, as of 26 August, appear unrelated to the outbreak in Western Africa.)

• The disease is spreading person to person, causing significant international concern and disrupting both the health and economy of these countries as well as neighboring nations.

• In late July, the World Health Organization (WHO) declared the outbreak a Grade 3 emergency, its highest level of any emergency response. In early August, they declared it a Public Health Emergency of International Concern, meaning it is a serious public health event that endangers international public health

DEVELOPMENT OF THE OUTBREAK:• GUINEA: On 22 March 2014, the Guinea Ministry of Health notified WHO about a

rapidly evolving outbreak of EVD. Retrospective epidemiological investigations indicate that the first case of EVD probably occurred as early as December 2013 when a two-year-old girl from Guéckédou prefecture in the forested region of south-eastern Guinea died from symptoms compatible with EVD. Researchers confirmed that the virus is a member of the Zaire species, which kills most of its victims. Strains of that virus have caused outbreaks previously in Gabon and the Democratic Republic of Congo.

SOURCE: THE NEW ENGLAND JOURNAL OF MEDICINE. CDC WHO KEY POINTS – EBOLA VIRUS DISEASE, WEST AFRICA ECDC, INTERNATIONAL SOS

• SIERRA LEONE: The outbreak progressed rapidly in Sierra Leone. The first cases were reported on 25 May in the Kailahun District, near the border with Guéckédou in Guinea. By 20 June, there were 158 suspected cases, mainly in Kailahun and the adjacent district of Kenema, but also in the Kambia,Port Loko and Western districts in the north west of the country. By 17 July, the total number of suspected cases in the country stood at 442, and had overtaken those in Guinea and Liberia. By 20 July, additional cases had been reported in the Bo District the first case in Freetown, Sierra Leone's capital.

• NIGERIA: At the end of July 2014, a symptomatic case travelled by air to Lagos, Nigeria where he infected a number of healthcare workers and airport contacts before his condition was recognized to be EVD. This cluster in Nigeria, initiated by air travel of an infectious person, has now resulted in tertiary cases in Nigeria and recently a new cluster in Port Harcourt, Rivers State with three confirmed cases. Therefore, Rivers State is now considered as an affected area.

• SENEGAL: On 29 August, the Ministry of Health in Senegal reported a confirmed case of EVD in a 21-year-old male native of Guinea. He arrived in Dakar, by road, on 20 August and was hospitalized on 26 August after having initially been treated for malaria. On 27 August 2014, the Ministry of Health was informed that the patient was a contact of a known Ebola patient in Guinea and the patient was immediately isolated

SUBSEQUENT SPREAD• LIBERIA: In Liberia, the disease was reported in Lofa and Nimba counties in late

March and by mid-April, the Ministry of Health and Social Welfare had recorded possible cases in Margibi and Montserrado counties.

SOURCE: WHO – 18 SEP 2014

COMBINED EPIDEMIOLOGICAL CURVES – WEST AFRICA

The total number of probable, confirmed and suspected cases in the current outbreak of Ebola virus disease (Ebola) in West Africa was 5,335, with 2,622 deaths, as at the end of 14 September 2014.

WEST AFRICA

LOCATION OF CASES THROUGHOUT THE COUNTRIES WITH MOST INTENSE TRANSMISSION

• The map shows the location of cases throughout the countries with widespread and intense transmission.

• The cumulative number of cases to date in each area is shown (grey circles), together with the number of cases that have occurred within the 21 days (red circles) up to 14 September.

• Nine districts in which previous cases were confirmed have reported no cases during the 21 days prior to the end of 14 September (six districts in Guinea, one in Sierra Leone, and two in Liberia).

• Two previously uninfected areas reported initial cases during the seven days prior to the end of 14 September.

• In Guinea, there has been one suspected case and one confirmed case in the newly affected Dalaba area.

• In Liberia, four probable and two suspected cases have now been reported in the newly affected Maryland area, which borders Côte d’Ivoire.

SOURCE: WHO – 18 SEP 2014

NOTE: This is the largest ever documented outbreak of EVD with a number of reported cases and deaths that exceeds the case and death number of all historical outbreaks. It is also the largest outbreak in terms of geographical spread. THE OUTBREAK HAS NOT YET REACHED ITS PEAK AND IT IS CURRENTLY IN A PHASE OF RAPID SPREAD. Community resistance, inadequate treatment facilities and insufficient human resources in affected areas are among the challenges currently faced by the countries in responding to the EVD outbreak.

SITUATION

DISTRIBUTION OF REPORTED CASES OF EVD BY WEEK IN GUINEA, SIERRA LEONE, LIBERIA, NIGERIA AND SENEGAL WEEK 48/2013 TO 36/2014 (AS OF 6 SEPTEMBER 2014) SOURCE: ECDC

• The Ebola virus disease (EVD) outbreak continues to accelerate, with almost 40% of the total cases occurring in the past 21 days.

• The current EVD outbreak is unprecedented in scale and geographical reach: o The present West Africa outbreak has a higher caseload than all other

previous Ebola crises combined.

o An estimated 22.34 million people are living in areas where active EVD transmission has been reported, with 4.29 million people living in areas where twenty or more fatalities have been reported.

o The large number of cases in high-population density settings and simultaneously in remote, hard-to-access villages makes the outbreak particularly difficult to contain.

• According to WHO data, more than 240 health care workers in Guinea, Liberia, Nigeria and Sierra Leone have developed the disease with more than 120 succumbing to the epidemic.

• Because of their role as caregivers, women are experiencing the brunt of the disease, making up 75% of all cases. Women’s economic roles also place them at risk – they tend to work in the health care sector as nurses and midwives or as facility cleaners or border traders.

CASES, DEATHS AND CASE-FATALITY RATIOS IN THE EVD-AFFECTED COUNTRIES IN WEST AFRICA, AS OF 7 SEPTEMBER 2014

A woman ill with Ebola. 75% of all cases are women,

OCHA – 16 SEP

SITUATION

GROWING TENSION IN AFFECTED REGIONS. Tension and frustration among the population have repeatedly led to difficulties in accessing and treating affected populations.

• In Monrovia, the capital of Liberia, rioters attacked an Ebola treatment center ‘freeing’ patients and looting Ebola infected goods (i.e. mattress, sheets) on BBC - 17 AUG.

• A military quarantine of some 70,000people living in the West Point slum in Monrovia was lifted on 30 August following ten days of confinement of the population. (OCHA - 9 SEP)

• In the capital of Guinea’s Forest Region, Nzerekore demonstrators clashed with security forces and attacked the Regional Hospital, reportedly after the local market was sprayed with Ebola disinfectant.

• Seven people were killed, 21 injures, during rioting in Guinea as members of a mission seeking to educate the population about the Ebola virus were attacked by angry crowds in the village of Wome. The delegation was seeking to raise awareness about the deadly viral disease, and encountered a hostile reaction of citizens who continue to believe that Ebola does not exist, or that it was created to eliminate them (Bloomberg - 18 SEP) ( LA Times)

• States of emergency have been declared in Guinea, Liberia, Nigeria, and Sierra Leone, with many affected counties under quarantine, banning any movement. (OCHA - 9 SEP)

• Sierra Leonean authorities are planning a nationwide quarantine from 19-21 September confining people to their homes and subjecting them to door-to-door medical screenings. (CNN -8 SEP)

• A national curfew is imposed in Liberia, where troops this month were given the authority to shoot upon sight anyone found crossing into their borders from Sierra Leone. OCHA - 9 SEP)

Protesters hurl rocks at retreating soldiers and policemen amid rioting in West Point.

A Liberian soldier is deployed to restrict movement of Liberians traveling from Bomi Country to the capital Monrovia as a measure to try to curb the spread of Ebola Photo Ahmed Jallanzo.

SITUATION

MULTI-SECTORAL IMPACT OF THE EVD OUTBREAK

• The outbreak is proving to have a wider security, economic and livelihood impact on all affected countries and on the West African region as a whole.

• Restrictions on movement out of, into and within affected countries have resulted in a shortage of availability of goods and services.

• Medical goods needed to respond to the outbreak and goods to meet basic needs (i.e. food) are in shorter supply due to transport limitations.

• Agricultural activities have been abandoned due to movement restrictions, and prices of basic foodstuffs have already markedly increased.

• Aid workers face serious challenges entering the Ebola affected countries due to limited flight availability. Those do manage to enter are not guaranteed a way of exit, including in the event of a medical emergency. This situation has hampered the recruitment of much-needed personnel.

• The EVD outbreak has disrupted the availability of non-Ebola health services, most worryingly the treatment of endemic TB and malaria, and the provision of obstetric care for pregnant women. In addition, all schools are closed in Liberia and Sierra Leone and Guinea has postponed the re-opening of schools.

• The outbreak is also negatively impacting the national economies, affecting agriculture, trade, the financial sector, small businesses and employment, and weakening the fiscal position of impacted governments through higher expenditures and reduction of tax revenues.

SOUCE: OCHA – 16 SEP

The FAO said it had been encouraging group farming, which yields more produce than individual subsistence farming. But with the Ebola-related ban on large gatherings, farmers have been afraid to work in groups (USAID photo)

A number of airlines have stopped flying into affected countries

SITUATION

IMAPCT ON CHILDREN

• There are 2.5 million children under the age of five living in areas affected by the Ebola virus. Children face direct risks of exposure to the virus, as well as secondary risks as a result of loss of infected caregivers and family members, or inability to return to their quarantined places of origin.

• As basic service delivery becomes increasingly strained as a result of the outbreak, children’s access to health care, education and protection may be limited, further increasing their vulnerability and risk. Children who have lost one or both of their parents to Ebola face the risk of growing up without proper care or having to fend for themselves.

• In Ebola affected areas, especially Sierra Leone and Liberia where the outbreak is nationwide, the collapse of health care systems is challenging the provision of maternal and new-born care and the management of acute malnutrition.

• The disruption of health services means that many children are not receiving life-saving vaccinations, and may be left untreated for preventable but potentially fatal common childhood illnesses, such as malaria, pneumonia and diarrhea.

• The Ebola outbreak is likely to have negative consequences on children’s access to education, on the availability of teachers, and on the quality of teaching and learning as well as on the safety of school premises.

SOUCE: OCHA – 16 SEP

A medical worker wearing a protective suit carries bags followed by Ebola infected children in the high-risk area of the Elwa hospital run by Medecins Sans Frontieres Photograph: Dominique Faget/AFP/Getty

QUALITY OF CORE SERVICES SUB NATIONAL COORDINATION

http://reliefweb.int/sites/reliefweb.int/files/resources/2014-09-15_Ebola_SNC.pdf

QUALITY OF CORE SERVICES SAFE BURIAL

http://reliefweb.int/sites/reliefweb.int/files/resources/2014-09-15_Ebola_SB.pdf

QUALITY OF CORE SERVICES REFERRAL CENTERS

http://reliefweb.int/sites/reliefweb.int/files/resources/2014-09-15_Ebola_RC.pdf

QUALITY OF CORE SERVICES LABORATORIES

http://reliefweb.int/sites/reliefweb.int/files/resources/2014-09-15_Ebola_Lab.pdf

http://reliefweb.int/sites/reliefweb.int/files/resources/2014-09-15_Ebola_CT.pdf

QUALITY OF CORE SERVICES CONTACT TRACING

SITUATION GUINEA

WHO – 18 SEP

BACKGROUND• Affected areas include Conakry, Coyah, Dalaba, Dubreka, Forecariah,

Gueckedou, Kerouane, Macenta, Nzerekore, Pita, Yomou. (International SOS – 16 SEP)

• As of 10th September, new confirmed cases have been reported in Conakry, Guékedou, Macenta, Siguri, Forécariah and Kérouane. (WHO – 12 SEP)

• The confirmed totals for each prefecture are: Conakry (117 cases, 47 deaths), Guekedou (232 cases, 182 deaths), Macenta (232 cases, 134 deaths), Dubreka (21 cases, 4 deaths), Pita (6 cases, 2 deaths), Nzerekore (14 cases, 7 deaths), Yomou (11 cases, 5 deaths), Forecariah (7 cases, 4 deaths), Kerouane (17 cases, 1 deaths), Coyah (6 cases, 2 deaths). (International SOS – 12 SEP)

GOVERNMENT OF GUINEA• The Government of Guinea (GoG) declared a public health emergency on

August 14 and announced the implementation of preventive measures, including travel restrictions and a ban on transporting human remains between towns, according to international media. Guinean President Alpha Condé also stated that health authorities would hospitalize anyone suspected of EVD infection pending laboratory test results.

• The GoG has implemented strict border controls, with health care workers checking individuals—and isolating any suspected EVD cases—at points along Guinea’s borders with Liberia and Sierra Leone, international media report. (USAID – 20 AUG)

UNOCHA – 15 SEPT

GUINEACONFIRMED PROBABLE SUSPECT TOTALS

Cases 750 162 30 942Deaths 435 161 5 601

CASE FATALITY RATE: 63.8%

SITUATION GUINEA

CASE MANAGEMENT AND INFECTION PREVENTION AND CONTROL• The number of newly reported cases in week 37 has not increased (there

has been a slight drop compared with the previous week. This is largely attributable to a fall in the number of cases reported from Macenta, which borders Gueckedou, the origin of the outbreak. Transmission in the capital

• Conakry is sustained. There is no indication of a sustained reduction in case incidence in Guinea. (WHO – 18 SEP)

• WHO reports that approximately 33 percent of the 936 suspected, probable, and confirmed EVD cases in Guinea were identified in the past 21 days. Of the 595 suspected EVD-related deaths in Guinea, WHO reports that 429 have been confirmed as EVD cases as of September 13 )(USAID – 17 SEP).

• Guinea-Bissau launched a nationwide hygiene drive, cleaning and

disinfection of public places the last Saturday of every month, according to the office of Prime Minister Domingos Simoes Pereira (30 AUG-Agence France-Presse)

FOOD: Guinea: WFP began food distributions because of Ebola four months ago and has reached around 40,000 people (in Biffa, Fria, Télémélé, N’Zerekore, Macenta and Guekedo). Preparations are being made to gradually increase distributions to 464,000 people over a period of three months. (WFP 3 SEP)

RIOTS/ DEMONSTRATIONS• In Nzérékoré, Guinea’s second largest city, on 28 AUG, riots occurred

The cause was a rumor that officers reportedly went into the local market to spray against Ebola.

• People panicked, looted, and attacked the Regional Hospital of Nzérékoré. Groups of youths armed with stones, sticks and other sharp objects chanted “Ebola, it's wrong, there is no Ebola.”

• Regional and prefectural authorities, elders, religious leaders and local representatives of the UN system, including UNICEF, are conducting advocacy to find lasting solutions to this situation. (29 AUG UNICEF BBC

RUMORS AND CHALLENGES• In reluctant villages in Guékédou it was notable to see the fear caused

by the bottles of chlorine among villagers who consider the chlorine to be poison used to introduce the virus or disease. (29 AUG UNICEF)

• The reluctance of people makes it very difficult to undertake interpersonal communication and sensitize community leaders. Community sensitizers often face danger and their activities in the field are routinely suspended. Local media is an essential compliment in these cases, but their lack of coverage limits their actions (29 AUG UNICEF)

RISK COMMUNICATIONS• Community sensitization activities continue in Conakry, Nzérékoré

Macenta Yomou, Siguiri and Kouroussa continue.

• 220 new religious leaders were trained and gave sermons in 220 places of worship in Conakry and Nzérékoré; 11,050 households we re sensitized through door to door visits and public events. This included the distribution of 28.066 pieces of soap, chlorine 15.084 bottles, and thousands of flyers. (UNICEF 29 AUG)

SITUATIONLIBERIA

LIBERIA CONFIRMED PROBABLE SUSPECT TOTALS

Cases 812 1233 675 2710Deaths 631 518 310 1459

WHO – 18 SEP

GOVERNMENT OF LIBERIA• Vice President Mr. Joseph Boakai officially launched the “Wash Away Ebola”

strategy, which was developed by the Ministry of Public Works together with UNICEF, and which will guide nationwide Water, Sanitation and Hygiene (WASH) efforts geared at stopping the spread of Ebola. (UNICEF – 10 SEP)

• The GoL recently approved an additional ETU at the Samuel K. Doe (SKD) Stadium in Monrovia, which humanitarian actors report may be able to accommodate up to 600 beds. The GoL approved the use of a large structure behind SKD Stadium as a humanitarian warehouse. (USAID – 17 SEP)

• Additionally, the GoL approved the construction of up to eight additional ETUs outside of Montserrado County by the Armed Forces of Liberia (AFL). AFL personnel are working with CDC, USAID, DoD, Médecins Sans Frontières (MSF), and WHO to determine ETU locations and provide design specifications. (USAID – 17 SEP)

MINISTRY OF HEALTH AND SOCIAL WELFARE• The Ministry of Health and Social Welfare has established hotlines that the

public can call to get basic Ebola information: 1333, 4455, 0886229641, 0886397381, and 0776547437. (International SOS – 16 SEPT)

• 15 SEP: In its latest situation report the Ministry of Health and Social Welfare reports new suspected and probable cases in Bomi, Bong, Lofa, Margibi, Montserrado and Nimba counties. On 11 September, there were 59 new admissions and 230 patients receiving treatment. (International SOS – 16 SEP)

CASE FATALITY RATE: 53.8%

Residents look on as the body of a man suspected of dying from Ebola lies in a busy street, after it was reportedly dragged there to draw attention of burial teams following days of failed attempts by his family to have his body picked up, in Monrovia, Liberia, Sept. 15, 2014. (TIME)

• 12 SEPT The Ministry of Health and Social Welfare in its latest Situation Report as of 10 September confirms additional cases, deaths and contacts. At least 539 suspected, 1080 probable and 796 confirmed cases were reported. Most cases were detected in Lofa and Monstserrado counties. In Bong county, the new Ebola Treatment Unit has been handed over to health authorities. (International SOS – 16 SEP)

• The Ministry of Health and Social Welfare has set up epidemiological surveillance for the outbreak and plans to strengthen this further with support from Centre for Disease Control-World Health Organization. One of the major gaps in the current response is contact tracing within all locations.

• The Ministry of Health and Social Welfare has also reported a lack of personal protective equipment at primary health care levels and referral pathways as well as ambulances for the transportation of suspected cases to isolation centers. (IFRC SEP)

SITUATIONLIBERIA

SOURCE: UNOCHA - 15 SEPT

• 12 SEPT: Media sources report that fake death certificates mentioning non-Ebola causes of death in Ebola victims are being issued in Liberia. Such certificates allow family members to carry out traditional burials of the dead bodies. Health authorities have started inspecting medical facilities to investigate this as traditional burial practices will further spread the disease. (International SOS – 16 SEP)

CASE MANAGEMENT AND INFECTION PREVENTION AND CONTROL

• Liberia accounts for more than half of all the ebola cases in the region

• Based on the data, the epicenter of the outbreak has shifted from Foya, Lofa County, where the rate of reported cases appears to be lessening, to Monrovia, Montserrado County, where the rate of reported cases is rapidly rising. (UNICEF – 10 SEP)

• Training for the County Health Teams in infection control has commenced. This is the first step toward reopening health facilities nationwide. (UNICEF – 10 SEP)

• Together with the Ministry of Health and Social Welfare (MoHSW), WHO and other key partners, UNICEF conducted a refresher Training of Trainers (ToT) for 42 Master Trainers. These trainers will support UNICEF-funded trainings, including trainings of over 2,000 general Community Health Volunteers (gCHVs) in all 15 counties for their door to door messaging. (UNICEF – 10 SEP)

SITUATIONLIBERIA

SOURCE: INTERNATIONAL SOS – 16 SEP

HOSPITAL RESPONSE AND ISOLATION/TREATMENT CENTERS• As at 5 September, the country has 314 treatment beds, and WHO

estimates many more are required (additional 760 beds required in Monrovia).

• Foya, Lofa county: Borma Hospital Ebola Treatment Unit (ETU) is being run by Medecins Sans Frontieres (MSF) as at 15 August. It has a capacity of 40 beds, with expansion to 80 beds underway. No date for completion has been announced. A "mid-level isolation unit" has been established in Telewowan Hospital, Voinjama, managed by MSF. The centre will expand to 40 beds although no estimated date for completion has been set.

• Monrovia: ELWA hospital ETU is being run by MSF. The new 120-bed facility opened on 17 August. There are plans to expand to 300 beds by 2nd September. The facility in JFK Hospital is functioning as a full ETU. WHO advised on 5 September an additional 40 beds had been opened in Monrovia. There is a Holding Unit at Redemption Hospital.

• Montserrado: West Point holding unit has been established.

• Nimba: Renovation of the holding facilties at G. W. Harley and Ganta Hospitals is underway as at 20 August.

• Bong: The new 50 bed facility has been handed over to the County Authority and is awaiting admissions, as at 10 September.

• Bomi: Bomi County Health Team (CHT) opened three, two-room quarantine units with a 12-bed capacity for Ebola patients. There is a holding centre in Tubmanburg.

Health workers in protective suits carried the body of an Ebola victim in Liberia on 12 SEP

BACKGROUND:• An outbreak of Ebola has been ongoing in Sierra Leone since May 2014.• Affected districts in Sierra Leone include Bo, Bombali, Bonthe, Kailahun,

Kambia, Kenema, Kono, Moyamba, Port Loko, Pujehun, Tonkolili, and Western Area, including the capital of Freetown.

• On 13 August, U.S. Chargé d’Affaires Kathleen FitzGibbon declared a disaster due to the effects of the EVD outbreak in Sierra Leone. DART staff in Freetown are coordinating with government officials, U.N. agencies, and other stakeholders to assess the situation and identify gaps where USG assistance will be most effective.

GOVERNMENT OF SIERRA LEONE • On 29 August, Government of Sierra Leone (GoSL) President Ernest Bai

Koroma dismissed GoSL’s Minister of Health Miatta Kargbo, citing her ineffective management of the ongoing EVD outbreak, according to international media.

• Parliament in Sierra Leone has passed a law that imposes jail time (up to two years) for concealing Ebola-infected patients. Legislation also passed that imposes up to 6-month jail sentence to individuals entering or leaving Ebola affected areas who are not authorized (30 AUG-ACAPS)

• From September 19 to 21, the government has a "House to House Ebola Talk" planned, to identify cases of Ebola in the community and educate the general public. During this time, everyone is asked to remain in their residence, and some businesses are expected to be closed.

• Recent actions include new protocols for arrivals and departures at the Lungi International Airport, restrictions on public and other mass gatherings, quarantine measures for Ebola affected communities until cleared by a medical team, authorized police and military personnel to enforce these measures, and required local governments to establish laws to support Ebola prevention .

SIERRA LEONE CONFIRMED PROBABLE SUSPECTED TOTALS

Cases 1,513 37 123 1,673Deaths 517 34 11 562

SOURCE: OCHA 15 SEPT 2014

SITUATIONSIERRA LEONE

SOURCE: CDC- 13 AUG 14 International SOS 16 SEPT 2014 CDC 11 SEPT 2014

EBOLA VIRUS DISEASE-SITUATION REPORT--UPDATE 18 SEPTEMBER 2014 CASE FATALITY RATE: 33.5%

ISOLATION / TREATMENT CENTERS• Kenema: The Red Cross isolation facility in Kenema Government

Hospital was relocated outside of the Kenema township, a few miles from Hanga. The facility has 60 beds and was operational as of September 12. Admissions initially staggered to keep healthcare workers safe.

• Kailahun: There is an 80-bed facility, operated by MSF. The villages of Koindu and Buedu have "referral units", where patients who have symptoms of Ebola are isolated and evaluated. If they are determined to have Ebola they are then transferred to the isolation facility.

• Freetown: An isolation unit has been established at Connaught Hospital, with assistance from a medical team from King's Health Partners, UK.

• Bo: MSF is constructing a 35-bed isolation centre which is expected to be functional by 28 August. A transit centre in Gondama is run by MSF. Construction has begun on an isolation ward at Bo government hospital.

• Port Loko: On September 12, officials announced a holding center would be established at the St John of God Hospital and should be “operational anytime”. The hospital reopened September 13 after a 21-day closure.

• Western Area: A holding facility is being established in Lakka, and a facility is being constructed in Kerry Town. Maculy Street Hospital will be renovated to serve as an isolation unit due to the high demand for additional beds

• Bomball: ADDAX is assisting in the construction of a holding center. Expected completion by the first week of October.

• Ministry of Energy committed to providing electricity to EVD lab in Lakka and Solar Street lights to Kerry Town treatment center

SITUATIONSIERRA LEONE

• Difficult to transport commodities in and out of the country due to airline suspensions and poor road conditions worsened by the rainy season.

• Diminished food availiability and income earning opportunities is another concern USAID 10 SEPT 2014.

LABORATORY CAPACITY• Additional laboratory support is needed in addition to the Kenema laboratory

(supported by Metabiota and the US Department of Defense Critical Reagent Team) to cope with the increasing disease burden. (WHO 29 AUG)

• A mobile laboratory from South Africa has been deployed to Freetown, where Ebola treatment centers are being constructed to care for patients locally and in better conditions, rather than referring them to Kenema. (WHO 29 AUG)

CASE MANAGEMENT AND INFECTION PREVENTION AND CONTROL

• The incidence of cases in Sierra Leone has been relatively flat, although with increases in the past week. Problems in scaling up response measures persist, notably in two districts, Kenema and Kailahun. Numbers of cases increased in the capital, Freetown (WHO 29 AUG) . On September 11, Kenemaand Kallahun centers reached maximum capacity. International SOS 16 SEPT 2014

MOST URGENT HUMANITARIAN NEEDS In order to be more effective in the Ebola response there is a continued urgent need for the following:

• Additional Health Workers (doctors & nurses), • Additional Transport – Ambulances (4x4), Pick-ups (4x4),

motorcycles• Medical supplies (including personal protective equipment), • Continued Nation-wide community outreach/social mobilization

programs, • Scaling-up of quality Contact Tracing• Support to survivors & affected communities (including Family

Tracing & Reunification and PsychoSocial Support).

INTERNATIONAL RESPONSE UPDATES• Sept 12: Cuba announces team of 165 healthcare workers to arrive in

October and stay 6 months.• Sept 9: Britain announces new treatment center new Freetown• Sept 16: China to dispatch mobile lab team of 59 to Chines Sierra

Leone friendship hospital

Source: International SOS 16 SEPT 2014 WHO 16 SEPT 2014 GoSL 12 SEPT 2014

RESPONSE ACTIVITIES

“ In the hardest hit countries, an exponentially rising caseload threatens to push governments to the brink of state failure. WHO has successfully managed many big outbreaks in recent years. But this Ebola event is different. Very different This is likely the greatest peacetime challenge that the United Nations and its agencies have ever faced.

None of us experienced in containing outbreaks has ever seen, in our lifetimes, an emergency on this scale, with this degree of suffering, and with this magnitude of cascading consequences.

This is not just an outbreak. This is not just a public health crisis. This is a social crisis, a humanitarian crisis, crisis, an economic crisis, and a threat to national security well beyond the outbreak zones.

In some areas, hunger, hunger has become an even greater concern than the virus.

For example, the fertile fields of Lofa County, once Liberia’s breadbasket, are now fallow. In that county alone, nearly 170 farmers and their family members have died from Ebola.

Dr Margaret ChanDirector-General of the World Health OrganizationAddress to emergency session of the UN Security CouncilPeace and security in Africa (Ebola) New York, USA 18 September 2014

CURRENT RESPONSE STATUSBEDS• There are still critical shortages of Ebola treatment center beds in Guinea, Liberia,

and Sierra Leone, the three countries that have intense and widespread transmission.

• In the past week, an additional 40 beds have been established by Médecins Sans Frontières (MSF) in Monrovia; a further 40 beds will soon be available in Bong, Liberia.

• Another 170 beds are expected to be available soon in Sierra Leone.

• Based on current capacity and needs, an additional 980 Ebola treatment center beds are required, with 760 of these in Monrovia alone. Although plans are in place to build such facilities, there is a critical shortage of clinical teams available to manage them.

LABORATORY CAPACITY • Laboratory capacity is gradually expanding; however, there are still critical needs in a

number of locations. • Increased laboratory capacity is essential for proper screening and triage of patients.

CONTACT TRACING AND SAFE BURIALS• Contact tracing and safe burials continue to be of concern in light of increasing cases

and deaths. Of particular concern is the safety of community burials and mass cremation. MSF is putting in place increased capacity for cremation services in Monrovia.

SOCIAL MOBILIZATION• Responsible agencies are rapidly improving the coordination and scale of social

mobilization efforts in affected countries. • National Social Mobilization Task Forces have been established, additional human

resources are being identified and deployed. • Additional work is needed to ensure the quality of social mobilization national and

sub-national plans and efforts at district level are coordinated with the overall response.

MOBILIZATION• The US, UK, China, Cuba and other countries are using a variety of assets, including

military assetsSOURCE : WHO – 18 SEP

RESPONSE ACTIVITIESUNITED NATIONS

18 September 2014 – The Security Council, in its first emergency meeting on a public health crisis, declared the Ebola outbreak in West Africa a threat to peace and security.

Secretary-General Ban Ki-moon announced that the United Nations will deploy a new emergency health mission to combat one of most horrific diseases on the planet that has shattered the lives of millions.

The international mission, to be known as the United Nations Mission for Ebola Emergency Response, or UNMEER, will have five priorities: stopping the outbreak, treating the infected, ensuring essential services, preserving stability and preventing further outbreaks.

Under the leadership of a Special Representative of the Secretary-General, the Mission will bring together the full range of UN actors and expertise in support of national effort.

The mission’s effectiveness will depend crucially on support from the international community. (UN NEWS CENTER – 18 SEP)

History was made on Thursday as the Security Council unanimously adopted a resolution, sponsored by 131 countries – reportedly more than any other sponsors of a resolution to date – the resolution calls countries to provide health personnel and supplies, and declared that the outbreak was a threat to international peace and security.

U.N. Secretary-General Ban Ki-moon speaks during a U.N. Security Council meeting about the Ebola epidemic in West Africa at U.N. headquarters in New York City on Sept. 18, 2014 (TIME)

RESPONSE ACTIVITIESWORLD HEALTH ORGANIZATION

WHO is initiating the disbursement of the African Development Bank grant provided for the EVD outbreak response. The first tranche, totaling US$ 37.5 million, will mainly support laboratories, procurement of personal protective equipment, medical waste management, IT software for emergency alert and response, health information management systems, training and deployment of health personnel, rehabilitation and isolation units.

WHO has disbursed a total of US$ 756 130 from the accounts of the African Public Health Emergency Fund (APHEF) to support Democratic Republic of the Congo, Guinea, Liberia and Sierra Leone in their fight against Ebola.. (WHO – 12 SEP)

Increases in demand for Ebola Treatment Centre (ETC) beds and referral unit places are continuing to outstrip capacity in Guinea, Liberia, and Sierra Leone. WHO continues to mobilize partners in response to these needs. (WHO - 12 SEP)

• SURVEILLANCE: WHO, the Global Alert and Response Network (GOARN), and its partners are providing guidance and support and have deployed teams of experts to West African countries, including epidemiologists to work with the countries in surveillance and monitoring of the outbreak and laboratory experts to support mobile field laboratories for early confirmation of Ebola cases.

• DEPLOYED ASSETS: WHO has deployed clinical management experts to help health-care facilities treat affected patients, infection and prevention control experts to help the countries stop community and health-care facility transmission of the virus, and logisticians to dispatch needed equipment and materials.

• EXPERIMENTAL MEDICINES AND VACCINESo WHO has advised that the use of experimental medicines and

vaccines under the exceptional circumstances of this outbreak is ethically acceptable. However, existing supplies of all experimental medicines are either extremely limited or exhausted.

o WHO welcomes the decision by the Canadian government to donate several hundred doses of an experimental vaccine to support the outbreak response. A fully tested and licensed vaccine is not expected before 2015.

Image Source: WHO – 17 SEP

RESPONSE ACTIVITIES

WFP’s response is targeting up to 1.3 million people in Guinea, Liberia and Sierra Leone. WFP is deploying 50 additional staff across the three affected countries, while the United Nations Humanitarian Air Service, managed by WFP, has deployed a 19-seat airplane and a helicopter to allow vital access for humanitarian personnel and the cargo delivery to the three affected countries. (WHO - 12 SEP)

The U.N. World Food Program (WFP) reports that food prices have risen along the borders of Guinea and Senegal since the start of the EVD outbreak. In particular, palm oil prices have increased by 40 percent and coffee prices have increased by 50 percent since mid-August. WFP also notes that traders have reported a 50 percent drop in market activities (USAID - 17 SEP)

To date, in the three most affected countries of Liberia, Guinea and Sierra Leone: 3,000 mt of food delivered for 147,500 people since April 2014;290 responders transported by UNHAS, with 2 planes and 1 helicopter in operation; and 400 m3 of medical cargo transported.

• Guinea: WFP in Guinea aims to deliver food and nutrition packages to 464,000 people over a period of three months . In cooperation with FAO, the Ministry of Agriculture, and the Ministry of Livestock, WFP is preparing a rapid assessment on the impact of the outbreak on food security.

• Liberia: WFP in Liberia is scaling up operations in response to the Ebola outbreak. WFP will provide food to 449,000 people in areas of widespread and intense transmission. All the 15 counties are targeted, with seven initially prioritized (Lofa, Monteserrado, Nimba, Margibi, Bomi, Bong, and Grant Bassa Counties).

• Sierra Leone: WFP’s immediate priorities are the provision of food to: ebola treatment centers; the most vulnerable areas of Freetown; and the priority epicentre areas of Kenema and Kailaian. WFP is currently targeting 400,000 people in Sierra Leone. WFP is preparing to distribute 5,000 food parcels as take-home rations for people suspected of having ebola who have to stay at home for 21 days. (WFP – 15 SEP)

WORLD FOOD PROGRAM

Food distribution in Monrovia, Liberia (WFP)

The U.N. World Food Program (WFP) reports that food prices have risen along the borders of Guinea and Senegal since the start of the EVD outbreak. In particular, palm oil prices have increased by 40 percent and coffee prices have increased by 50 percent since mid-August. WFP also notes that traders have reported a 50 percent drop in market activities.

The Famine Early Warning Systems Network (FEWS NET) predicts that between September 2014 and March 2015, Stressed—IPC 2—food insecurity or higher is expected for at least 20 percent of the population in EVD-affected areas of Sierra Leone and Liberia.

A smaller proportion of the population is expected to face illness and market disruptions in Guinea, where Minimal—IPC 1—acute food insecurity is expected.

FEWS NET predicts that food insecurity will likely particularly affect households with ill family members and the urban poor.

RESPONSE ACTIVITIESUNITED NATIONS CHILDREN'S FUND

UNICEF:

• UNICEF is appealing for US$200 million to respond to the Ebola outbreak in West Africa. Of the $200 million, nearly $65 million will go to UNICEF’s programs in Liberia, around $61 million to Sierra Leone and more than $55 million to Guinea. An additional $10 million will help neighboring countries be prepared for a potential spread of the disease within their borders. The remaining $9 million are required for regional coordination efforts. (UNICEF – 16 SEP)

• UNICEF has delivered 402 metric tons of essential medicine and protective equipment to the three major Ebola-affected countries in 32 shipments since early August. Of the total, 70.6 MT were flown in to Guinea, 213.8 MT to Liberia and 117.7 MT to Sierra Leone. (UNICEF – 5 SEP)

• In Liberia, Vice President Mr. Joseph Boakai officially launched the “Wash Away Ebola” strategy, which was developed by the Ministry of Public Works together with UNICEF, and which will guide nationwide Water, Sanitation and Hygiene (WASH) efforts geared at stopping the spread of Ebola.

• In Liberia, together with the Ministry of Health and Social Welfare (MoHSW), WHO and other key partners, UNICEF conducted a refresher Training of Trainers (ToT). These trainers will support UNICEF-funded trainings, including trainings of over 2,000 general Community Health Volunteers in all 15 counties for their door to door messaging. (UNICEF – 10 SEP)

• On September 17, USAID/OFDA contributed $2.2 million to UNICEF to procure and distribute 50,000 household protection kits in Liberia. In response to the current shortage of EVD treatment facilities in Liberia,

• UNICEF plans to distribute household protection kits to people who exhibit EVD symptoms but do not have access to ETU care.

• UNICEF is training ETU staff, contact tracers, and case investigation teams to distribute the kits and train recipients to properly use them to minimize the risks of EVD transmission for home-based patients. Each household protection kits contains a bucket, a sprayer, garbage bags, gloves, protective gowns, surgical makes, soap, and chlorine.

RESPONSE ACTIVITIESUS GOVERNMENT

DECLARATIONS: • On August 4, the U.S. Ambassador to Liberia declared a disaster due to the

effects of the Ebola outbreak. In response, USAID has activated a Disaster Assistance Response Team (DART).

• On August 13, U.S. Chargé d’Affaires Kathleen FitzGibbon declared a disaster due to the effects of the EVD outbreak in Sierra Leone.

• On August 15. U.S. Chargé d’Affaires Ervin Massinga declared a disaster due to the magnitude of the EVD outbreak in Guinea

• The U.S. Government (USG) has launched a whole-of-government response to the EVD outbreak in West Africa, including increased involvement from the U.S. military.

• On September 16, President Obama announced that an estimated 3,000 U.S. troops plan to deploy to provide logistics support, construct EVD treatment units (ETUs), and train health care workers. Additionally, the U.S. Public Health Service Commissioned Corps plans to deploy health care workers to West Africa. (USAID -17 SEP)

• The Ebola epidemic in West Africa and the humanitarian crisis there is a top national security priority for the United States. In order to contain and combat it, the US is partnering with the United Nations and other international partners to help the Governments of Guinea, Liberia, Sierra Leone, Nigeria, and Senegal respond just as the US fortify its defenses at home. (WHITE HOUSE - 16 SEP)

• The US Strategy is predicated on four goals:

o Controlling the epidemic at its source in West Africa;o Mitigating second-order impacts, including blunting the economic, social, and

political tolls in the region;o Engaging and coordinating with a broader global audience; and,o Fortifying global health security infrastructure in the region and beyond.

Liberian Red Cross distributes food provided by USAID to Monrovia's West Point neighborhood. (Liberian Red Ross)

• The President also announced the launch of our Community Care Campaign, which will ensure that every family and every community gets the support they need to protect themselves from this deadly virus.

• Partnering with the affected countries, the U.N. Children’s Fund (UNICEF), the Paul G. Allen Family Foundation, and organizations on the ground, USAID will initially target 400,000 of the highest risk households in Liberia with vital training and important tools—soap, chlorine, and protective equipment.

• Working alongside the Paul G. Allen Foundation, the US will airlift 50,000 USAID-funded home healthcare kits this week to be delivered to some of the most isolated and vulnerable communities in Liberia.

TESTIMONY OF ASSISTANT ADMINISTRATOR FOR DEMOCRACY, CONFLICT AND HUMANITARIAN ASSISTANCE NANCY LINDBORG BEFORE THE HOUSE SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH, GLOBAL HUMAN RIGHTS AND INTERNATIONAL ORGANIZATIONS

USG PROGRAMS FOR EBOLA OUTBREAK IN WEST AFRICA

USAID 17 SEPT 2014

RESPONSE ACTIVITIESUS AGENCY FOR INTERNATIONAL DEVELOPMENT

USAID DART • The USAID-led Disaster Assistance Response Team (DART)—comprising

disaster response and public health experts from USAID/OFDA, CDC, the US Forest Service, and the U.S. Department of Defense (DoD)—continues to operate in Monrovia, Liberia. USAID/OFDA and CDC have deployed additional DART staff to Conakry, Guinea, and Freetown, Sierra Leone, to support the U.S. Government (USG) regional EVD response.

• The DART team’s medical component, led by CDC, is supporting Ebola treatment units that help isolate and treat those affected by the disease, helping minimize the further spread of Ebola. CDC specialists across the region are assisting with contact tracing, database management, and health education. These experts are also providing technical guidance to the national public health agencies in the region to help prevent, detect, and stop the spread of the virus.

• The Department of Defense is working to upgrade laboratory testing facilities to help quickly detect the disease.

• Days after the DART deployed to the region in early August, the US began airlifting urgent medical supplies and emergency equipment to West Africa. This includes 10,000 sets of personal protective equipment to safeguard health workers—with an additional 130,000 being delivered in the coming weeks. Two portable water storage tanks and two water treatment systems; 40 tons of chlorine; 250 rolls of plastic sheeting to help bolster infrastructure at the Ebola treatment units; 5,000 body bags to increase support for the safe and dignified removal and transport of the bodies of Ebola victims; and 500 infrared thermometers to boost Ebola screening efforts.

• To ensure these critical supplies are reaching the affected countries, USAID is supporting the UN Humanitarian Air Service, which is operating flights in and out of Guinea, Liberia, and Sierra Leone, ensuring that personnel and medical equipment are getting to areas of need despite commercial flight limitations.

TESTIMONY OF ASSISTANT ADMINISTRATOR FOR DEMOCRACY, CONFLICT AND HUMANITARIAN ASSISTANCE NANCY LINDBORG BEFORE THE HOUSE SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH, GLOBAL HUMAN RIGHTS AND INTERNATIONAL ORGANIZATIONS

A team of U.S. experts from CDC, the U.S. Army Medical Research Institutes for Infectious Diseases (AMRIID), and the U.S. National Institutes of Health has almost doubled LIBR’s Ebola specimen testing capacity by training local staff and bringing in more equipment. Photo credit: Carol Han, USAID/OFDA

RESPONSE ACTIVITIESUS CENTER FOR DISEASE CONRTOL

CDC’s response to Ebola is the largest international outbreak response in CDC’s history. As of 16 SEP 2014, CDC has more than 100 disease detectives on the ground in West Africa, supported by hundreds of public health emergency response experts stateside. CDC teams are deployed from the CDC 24/7 Emergency Operations Center (EOC), activated at Level 1, its highest level, because of the significance of this outbreak. Each team is flexibly composed to match talents and expertise with critical needs in country:

• CDC’s disease detectives find emerging cases to identify contacts and stop further transmission with isolation and improved infection control practices

• CDC’s lab scientists diagnose Ebola cases and crack Ebola virus DNA codes to map outbreak connections

• Outbreak control specialists find patterns of spread and population vulnerabilities so scarce resources can be deployed more efficiently

• CDC’s Ebola outbreak veterans lead with expert guidance to national and international counterparts and new recruits in the Ebola fight

• Health risk communication specialists fight rumors, stigmatization and unsafe practices in real time

• Emergency operations teams bring incident management expertise to organize complex efforts.

ESTABLISHING EMERGENCY OPERATIONS CENTERS (EOCS). CDC supports countries establish national and sub-national EOCs. All 3 West African countries at the center of the epidemic now have an Incident Manager, reporting to the President of the country, to lead efforts.

STRENGTHENING SURVEILLANCE AND EPIDEMIOLOGY. CDC helps countries track the epidemic, including using real-time data to improve real-time response (e.g., identifying the epicenter and tracking the response).

IMPROVING CASE FINDING AND CONTACT TRACING. CDC strengthens efforts in West Africa to investigate cases and track their contacts. CDC helps interview people who may have been in contact with Ebola patients to see if they have symptoms and monitor them for 21 days. A single missed contact can start another chain of transmission.

SUPPORTING LABORATORY NETWORKS. CDC is operating and supporting labs in the region to improve diagnosis. CDC is also testing samples from people with suspected Ebola from around the world, and, with Department of Defense support, helped 12 labs around the US gain the capacity to test for Ebola within hours.

STRENGTHENING HEALTH CARE SYSTEMS. CDC leads infection control training for health care workers and safe patient triage throughout the health care system, communities, and households.

IMPROVING HEALTH COMMUNICATION. CDC health communicators and public health advisors in Sierra Leone, Guinea, and Liberia are working with country embassies, UNICEF, WHO, MSF, other NGOs and Ministries of Health to improve health information.

COORDINATING WITH PARTNERS AND FACILITATING INVOLVEMENT BY PUBLIC HEALTH ORGANIZATIONS AROUND THE WORLD. CDC is working closely with USAID’s Office of Foreign Disaster Assistance, to support the deployment of a Disaster Assistance Response Team. CDC is also facilitating assistance by critical organizations such as the African Union, which will mobilize at least 150 staff (including doctors, nurses, epidemiologists and health educators) to support the response. CDC also works closely with non-governmental organizations on many aspects of the response.

ADVISING TRAVELERS ON HOW TO PROTECT THEIR HEALTH AND PREVENTING SICK TRAVELERS FROM GETTING ON PLANES. CDC works with airlines, airports, and Ministries of Health to provide technical assistance for exit screening and travel restrictions in affected areas to prevent sick travelers from getting on planes. CDC also works with airlines to address crew and airline staff concerns while ensuring that humanitarian and public health organizations can still travel to affected countries.

SOURCE: CDC EBOLA SURGE – 16 SEP

RESPONSE ACTIVITIESFOOD AND DRUG ADMINSTRATION

FDA has a critical role in helping to facilitate the development, manufacturing, and availability of investigational products for use against Ebola virus disease.

FDA is actively working to facilitate development of treatments and vaccines with the potential to help mitigate this epidemic. They are providing scientific and regulatory advice to U.S. government agencies that support medical product development, including the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH), the Biomedical Advanced Research and Development Authority (BARDA), and the U.S. Department of Defense (DoD), to help speed development and production programs.

September 4, 2014 – The largest, most severe and most complex outbreak of Ebola virus disease in history is highlighting the absence of authorized medicines to treat or prevent this terrible disease affecting people in a number of countries in West Africa. In the face of this outbreak, medicines regulators worldwide have committed to enhanced cooperation with the World Health Organization (WHO) and between regulatory agencies to encourage submission of regulatory dossiers and evaluation of the submitted information on potential new medicines. The aim is to accelerate access to investigational treatments for patients most in need during the current outbreak. The enhanced cooperation also aims to ensure that in the future, public health authorities in countries affected by Ebola have safe and efficacious medicines at their disposal, and so strengthen their ability to respond effectively to outbreaks and to save lives. This pledge was made by members of an interim International Coalition of Medicines Regulatory Authorities (ICMRA). Read the full statement

August 25, 2014 – FDA and the World Health Organization Department of Essential Medicines and Health Products (WHO EMP) have signed an agreement (PDF, 550 KB) to help facilitate communications between FDA and WHO EMP regarding an actual or potential public health crisis or public health emergency of international concern, such as the Ebola outbreak in West Africa. The agreement allows sharing of information that is non-public but important to address public health emergencies between the organizations. More information about FDA’s international arrangements

August 22, 2014 – FDA Voice blog post: FDA works to mitigate the West Africa Ebola outbreak - The world is witnessing the devastating effects of the Ebola virus outbreak in West Africa, the worst Ebola outbreak in recorded history. We at FDA are dedicated to helping end this outbreak as quickly as possible, and to help prevent future outbreaks like this. Read more

August 20, 2014 – Responding to Ebola: The View From the FDA - As part of FDA's expert commentary and interview series, Medscape spoke with FDA Acting Deputy Chief Scientist and Assistant Commissioner for Counterterrorism Policy Luciana Borio, MD, about the issue of compassionate use and FDA efforts to respond to the Ebola outbreak.

August 14, 2014 – FDA statement: FDA is advising consumers to be aware of products sold online claiming to prevent or treat the Ebola virus. Since the outbreak of the Ebola virus in West Africa, the FDA has seen and received consumer complaints about a variety of products claiming to either prevent the Ebola virus or treat the infection. Español - La FDA advierte a los consumidores contra productos para el tratamiento del ébola fraudulentosFrançais - La FDA met en garde les consommateurs contre les produits frauduleux de traitement contre l’Ebola

August 5, 2014 – FDA authorized the use of a diagnostic test developed by the U.S. Department of Defense (DoD) to detect the Ebola Zaire virus in laboratories designated by the DoD to help facilitate effective response to the ongoing Ebola outbreak in West Africa. The test is designed for use in individuals, including DoD personnel and responders, who may be at risk of infection as a result of the outbreak. Specifically, the test is intended for use in individuals with signs and symptoms of infection with Ebola Zaire virus, who are at risk for exposure to the virus or who may have been exposed to the virus. (See also: August 12, 2014 Federal Register notice from HHS: Declaration Regarding Emergency Use of In Vitro Diagnostics for Detection of Ebola Virus and September 17, 2014 Federal Register notice: Authorization of Emergency Use of an In Vitro Diagnostic Device for Detection of Ebola Zaire Virus)

RESPONSE ACTIVITIESUS DEPARTMENT OF DEFENSE – OPERATION UNITED ASSITANCE

DOD• U.S. Army Medical Research Institute of Infectious Diseases, or

USAMRIID, is in Liberia as part of a larger U.S. interagency response to the world’s worst outbreak of the Ebola virus which continues to spread in West Africa

• USAMRIID has established diagnostic laboratories in Liberia and Sierra Leone, two of three countries where the outbreak has been spreading in recent months. (DOD 4 AUG)

• DoD has provided more than 10,000 Ebola test kits to the Liberian Institute of Biological Research and the Kenema Government Hospital in Sierra Leone. They have also provided personal protective equipment, have trained local professionals, and plan to send a field-deployable hospital to Liberia.

• Requested $500 million in FY 2014 Overseas Contingency Operations funds, a portion of which will be used for military air transport of DoD and non-DoD isolation units, personnel, supplies PPE, logistics and engineering support, and experts in sanitation and mortuary affairs. (WHITE HOUSE - 16 SEP)

U.S. AFRICA COMMAND – OPERATION UNITED ASSITANCE• U.S. Africa Command will set up a Joint Force Command headquartered in Monrovia, Liberia, to provide regional command and control support to U.S. military

activities and facilitate coordination with U.S. government and international relief efforts. Major General Darryl A. Williams , Commander, U.S. Army Africa, will lead this effort, which will involve an estimated 3,000 U.S. forces.

• U.S. Africa Command will establish a regional intermediate staging base (ISB) to facilitate and expedite the transportation of equipment, supplies and personnel. Of the U.S. forces taking part in this response, many will be stationed at the ISB

• Command engineers will build additional Ebola Treatment Units in affected areas, and the U.S. Government will help recruit and organize medical personnel to staff them.

• Additionally, the Command will establish a site to train up to 500 health care providers per week, enabling healthcare workers to safely provide direct medical care to patients.

• The United States Public Health Service Commissioned Corps is preparing to deploy 65 Commissioned Corps officers to Liberia to manage and staff a previously announced DoD hospital to care for healthcare workers who become ill. The deployment roster will consist of administrators, clinicians, and support staff.

SOURCE: WHITE HOUSE - 16 SEP

Major General Darryl A. Williams and members of his staffed arrived in Liberia on Tuesday, 16 SEP to begin the process of building a Combined Joint Task Force (CJTF) to combat Ebola and coordinating efforts in the region

RESPONSE ACTIVITIES EUROPEAN UNION

EUROPEAN COMMISSION HUMANITARIAN AID (ECHO): • In a statement on 17 September, the EU Commissioner for International

Cooperation, Humanitarian Aid and Crisis Response emphasized that, beyond funding, “what is needed now is personnel, equipment, and transport.” To that end, the EU has deployed three mobile laboratories to help with testing and identifying the virus, and ECHO has put a health expert in each of the three most-affected countries, as well as the United Nations Disaster Assessment and Coordination (UNDAC), and the European Response Coordination Center (ERCC) in Brussels is coordinating intra-EU meetings in response to the crisis.

• The EU Commissioner also emphasized the importance of being able to transport supplies, equipment and humanitarian personnel into and out of the region, and is working to develop a European coordination system for medical evacuation of humanitarian workers. (ECHO – 17 SEP)

• The European Mobile Laboratory (EMlab) project has deployed a third mobile laboratory to Liberia. The laboratory is being set up and should be providing diagnostic services soon. Supply chain is being set up to ensure replenishment for supplies at laboratories in Guinea, Nigeria and Liberia. (EMLab – 10 SEP) EMLab deployed its ninth medical team to Guéckédou, Guinea, made up of colleagues from Public Health England, the Robert Koch Institute in Germany and the Heinrich Pette Institute in Germany. (EMLab – 10 SEP)

FRANCE:• France is mobilizing approximately 20 reserve personnel from its Health

Emergency Preparedness and Response Agency who will work on a rotating basis over the next three months in Guinea. (France – 4 SEP)

• France will set up a military hospital in Guinea to fight the Ebola outbreak. (ReliefWeb – 18 SEP)

ITALY:• The National Institute for Infectious Disease “Lazzaro Spollanzani” and the

Italian Ministry of Foreign Affairs and Cooperation are dispatching a mobile laboratory team of four to the MSF Ebola Treatment Center in Foya, Lofa County, Liberia. (Liberia MOFA – 8 SEP)

UNITED KINGDOM:• The UK’S Foreign Secretary announced a commitment to provide an

additional 700 treatment beds in Sierra Leone, more than 200 of which are already in the pipeline, with 500 to be delivered in the coming months. UK Armed Forces will provide logistical support in planning, delivering and constructing sites for the additional sites. The UK will work with partners to provide trained staff to operate the treatment centers. (UK – 17 SEP)

• The UK’s Department for International Development (DFID) and Ministry of Defense, in partnership with Save the Children, will be establishing a medical treatment center for Ebola victims in Sierra Leone. The facility will have a 50-bed medical unit to treat victims of Ebola, as well as an additional 12-bed treatment center for local and international medical workers, and should be operational within the next eight weeks. (UK – 11 SEP)

• The UK government has called on medical, logistics and WASH practitioners to sign up for the UK International Emergency Medical Register. (UK – 8 SEP)

• In addition to its call for global research on improved management of Ebola outbreaks, the UK, working with Wellcome Trust and Medical Research Council, has co-funded clinical trials of vaccines and has approved GlaxoSmithKline to manufacture additional doses of the vaccine so that, if the trials are successful, the the stocks can be made available for emergency vaccination of at risk communities. (UK – 11 SEP)

GERMANY:• Germany’s Bernard Nocht Institute for Tropical Medicine (BNI) has

been working on Ebola diagnosis in Guinea since the start of the crisis, with support from the German Federal Foreign Office. (Germany – 17 SEP)

• German medical and pharmaceutical company, B. Braun Melsungen AG, donated 50,000 pieces of gloves to the Liberian government. (Liberia MOFA – 11 SEP)

RESPONSE ACTIVITIES OTHER COUNTRIES

CUBACuba confirmed the sending of 165 health workers to Sierra Leone to help fight the Ebola outbreak during a United Nations Security Council emergency meeting on Thursday. The Cuban health workers going to Sierra Leone are part of the International Henry Reeve Contingent, a special medical force created in Cuba in 2005 in order to fight health and humanitarian emergencies all over the world.

JAPAN:• Japan sent $288,000 worth of equipment to Liberia, including 100 tents, 500

sleeping pads, 500 blankets, 25 generators, 30 water storage tanks and 500 water containers. The supplies will support medical facilities in Montserrado, Bong and Lofa counties. (Liberia MOFA – 2 SEP)

CHINA:• China chartered two planes to deliver a China Center for Disease Control and

Prevention laboratory team and a mobile laboratory to Sierra Leone. The team includes 29 medical experts from the China CDC and 30 doctors and nurses from the Military Hospital of China. The team will run a holding center at the Sierra Leone – China Friendship Hospital for six months. This is China’s third delivery of emergency medical materials, and its third team of medical experts to Sierra Leone. (China – 18 SEP)

GHANA:• Ghana has begun airlifting approximately 100 tons of humanitarian food

supplies to Guinea, Liberia and Sierra Leone, including rice, oil and milk to help feed people in Ebola treatment centers. (Ghana – 15 SEP) The Ghanaian government has also agreed to Accra being used as a logistical hub in the region for the UN and other international organizations. (Ghana – 29 AUG)

MALAYSIA:• The government of Malaysia has coordinated with private sector companies

to contribute 20.9 million medical rubber gloves in eleven containers to West African Countries. Guinea, Liberia and Sierra Leone will each receive three containers, and DRC and Nigeria will each receive one container. (Malaysia – 15 SEP)

AFRICAN UNION:• The African Union Support to Ebola in West Africa (ASEOWA) is sending a team

of 30 volunteer health workers and specialists to work in Liberia after undergoing pre-deployment briefings in Addis Ababa. The epidemiologists, clinicians, public health specialists and communications personnel come from Uganda, Rwanda, DRC, Nigeria and Ethiopia. A second group of volunteers is expected to be deployed to Sierra Leone soon. (AU – 15 SEP)

ECONOMIC COMMUNITY OF WEST AFRICAN STATES (ECOWAS):• The ECOWAS Committee of Chiefs of Defense Staff (CCDS) has pledged the

support of the militaries of various member states in response to the Ebola outbreak in the region. (ECOWAS – 14 SEP)

SWITZERLAND:• Swiss Humanitarian Aid sent 14 tons of medical supplies to Monrovia, Liberia

at the beginning of September, including 31,000 bottles of hand disinfectant, 300,000 protective gloves, 100,000 masks, 200 body bags, 6,840 intravenous drips and 3,000 rehydration solutions. (Switzerland – 12 SEP)

• The Swiss Agency for Development and Cooperation (SDC) and the University Hospitals of Geneva sent a joint needs assessment team to West Africa, and the results of the mission are currently being analyzed. (Switzerland – 12 SEP)

• Clinical trials of two experimental Ebola vaccines are expected to begin in Switzerland, according to the Tropical and Public Health Institute. 100 people are set to take part in the tests. (ReliefWeb – 19 SEP)

CANADA:• Canada has committed to donating $2.5million worth of personal protective

equipment to WHO from its National Emergency Strategic Stockpile (NESS) and Health Canada’s First Nation and Inuit Health Branch (FNIHB). Canada is also operating a mobile laboratory unit in Sierra Leone. (Canada – 15 SEP)

HEALTHCARE WORKERS

• Infections among healthcare workers continue to be a concern. As of 12 September 2014, 301 healthcare workers have developed the disease, almost half of whom have died. (OCHA - 16 SEPT)

• There remains a big concern regarding the lack of specialized staff, including doctors and nurses throughout the affected areas.

HOW CAN HEALTHCARE WORKERS DECREASE THE CHANCE OF INFECTION?

• Wear the right personal protective equipment, including but not limited to masks, gloves, gowns, and eye protection, when entering patient care areas.

• Use proper infection prevention and control measures including:

• Follow cleaning and disinfection recommendations of reusable medical equipment, proper disposal of needles and other disposable equipment, and proper disposal of patient excretions.

• Wash your hands often, using soap and water (or alcohol-based hand sanitizers when soap and water are not available) to remove potentially infectious materials from your skin and help prevent disease transmission.

• Do not reuse gloves; instead dispose of them according to recommended infection control precautions. After disposing of the gloves, wash your hands.

• Learn the signs and symptoms of Ebola and develop a triage system so Ebola patients can be identified and properly handled.

• Avoid direct, unprotected contact with the bodies of people who have died from Ebola

• Several infectious diseases endemic in the region, like malaria, typhoid fever, and Lassa fever, mimic the initial symptoms of Ebola virus disease. It is important to be aware of the similarities and differences they present.

• As part of a comprehensive and coordinated response, the CDC is developing an introductory training course for licensed clinicians intending to work in an Ebola Treatment Unit (ETU) in Africa. This will be a 3-day course held weekly beginning in October in the United States. (CDC - 11 SEPT)

• The high proportion of medical staff that has become infected can be attributed to factors such as shortages of personal protective equipment and/or improper use of protective equipment, insufficient numbers of medical staff to handle patients, and exhaustion of current medical staff.

• An estimated 2% of the entire Liberian healthcare workforce has been infected. This is primarily due to the lack of access to Ebola Treatment Units (ETUs). (OCHA - 16 SEPT)

• Due to the lack of ETUs, infected individuals are seeking care from under-resourced private health care facilities, creating increased risk of infection for health care workers in those facilities.

• The CDC is educating U.S. health care providers to consider Ebola if symptoms are present within 3 weeks of a traveler returning from West Africa. The CDC is also issuing infection control guidance for hospitals to prevent further spread to health care workers and communities

• Instances of civil unrest and violence against aid workers have been reported in West Africa as a result of the outbreak. The public health systems in the affected countries are being severely strained as the outbreak grows.

HEALTHCARE WORKERS

UPDATES ON HCW CONDITIONS

Both foreign and local health care workers have been affected as this continues to be a global fight. MSF has 1,800 HCWs working on Ebola in Guinea, Sierra Leone, Liberia and Nigeria. Of those, 184 are foreign volunteers. WHO has both foreign and local people on the ground and the U.S. CDC has more than 100 disease detectives on the ground.

GUINEA

• The bodies of eight officials and journalists who went to a remote village in Guinea to dispel rumors about the deadly Ebola outbreak gripping the region were discovered after a rock-hurling mob attacked the delegation, claiming that it had come to spread the illness. (NYT- 18 SEP)

• Nurses told the press they lacked basic medical equipment to treat patients. Cases are being reported in new districts towards Guinea Bissau that are exacerbating already stressed resources. (ReliefWeb - 17 SEP)

LIBERIA

• The ELWA3 Ebola treatment centre in Monrovia will not be accepting any new patients until investigations are complete into how a French nurse volunteering with MSF became infected. (INTERNATIONALSOS - 17 SEP)

• As the Ebola death toll mounts, burial teams are having to contend with physical risk and trauma as they take charge of safely burying the dead. Due to increasing violence and risk of physical harm, police now escort burial teams. (ReliefWeb - 12 SEPT)

SIERRA LEONE--The International Federation of Red Cross and Red Crescent Societies (IFRC) has opened a treatment center in Kenema. (INTERNATIONALSOS - 16 SEPT)

A health worker brings a woman suspected of having contracted the Ebola virus to an ambulance in Monrovia, Liberia, on September 15, 2014. Photo Credit: James Giahyue Reuters

A team of specialized officers from the U.S. Public Health Service Commissioned Corps is being prepared to deploy to manage and staff a previously announced U.S. Department of Defense hospital in Liberia to care for health care workers who become ill from Ebola. This includes 65 Commissioned Corps officers, with diverse clinical and public health backgrounds. (HHS - 16 SEPT)

HEALTHCARE WORKERS

The above table indicates the total number of probable, confirmed, and suspected cases in healthcare workers in Guinea, Liberia, and Sierra Leone as of 14 September 2014

(WHO Ebola Roadmap Report 6 – 18 SEP)

DEATHS and NEW INFECTIONS AMONG HCWs

• A French MSF staff member in Liberia has tested positive for Ebola. The MSF staff member was on assignment in Monrovia and was placed in isolation on 16 September. It is unclear at this time how she contracted the disease. According to MSF protocol, she will be transferred to a treatment center in France. (ReliefWeb - 17 SEPT)

• The CDC returned a staff member from West Africa by charter flight after the employee had low-risk contact with an international health worker who recently tested positive for Ebola. The CDC staff member is not sick and does not currently show symptoms of Ebola. (CDC - 17 SEPT)

• A medical team from International SOS evacuated two Dutch doctors with possible exposure to the Ebola virus from Sierra Leone on 14 September. They were not exhibiting any symptoms at the time of removal. (INTERNATIONALSOS - 15 SEPT)

BIOSECURITY MEASURES

• Human-to-human transmission of the Ebola virus is associated with direct or indirect contact with blood and body fluids.

• Close physical contact with Ebola patients should be avoided. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home.

• Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.

• People who have died from Ebola should be promptly and safely buried. World Health Organization

• Health-care workers caring for patients with suspected or confirmed Ebola virus should apply, in addition to standard precautions, other infection control measures to avoid any exposure to the patient’s blood and body fluids and direct unprotected contact with the possibly contaminated environment.

• When in close contact (within 1 meter) of patients, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).

• Ebola viruses are considered Risk Group 4 Pathogens by WHO, requiring Biosafety Level 4 equipment in laboratories. World Health Organization

The World Health Organization has released an Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola.

If carefully implemented, infection prevention and control (IPC) measures will reduce or stop the spread of the virus and protect health-care workers (HCWs) and others.

VACCINE DEVELOPMENTS

Testing in humans for a vaccine against Ebola has begun in the UK. In an unprecedented move, the untested vaccine has already gone into mass production. Some 10,000 doses are being manufactured by the British drug company GlaxoSmithKline, funded by the Wellcome Trust and the UK government, which are also supporting the Oxford trial. (17 SEP)

The candidate vaccine is against the Zaire species of Ebola - the one circulating in West Africa - and uses a single Ebola virus protein to generate an immune response. As it does not contain infectious virus material, it cannot cause a person who is vaccinated to become infected with Ebola. Pre-clinical research by the NIH and Okairos, a biotechnology company acquired last year by GSK, has indicated that it provides promising protection in non-human primates exposed to Ebola, without significant adverse effects.

PHASE I:• Phase I of the clinical trial will take place in the U.S. at the NIH Clinical Center in

Bethesda, Maryland, and will involve 20 healthy human adults. Researchers will be assessing the safety of the vaccine and watching participants' immune responses for side effects. No one will be infected with Ebola. The vaccine reportedly uses a single Ebola virus protein to generate an immune response.

• The vaccine also will be tested in the United Kingdom, Gambia and Mali, and officials in Nigeria are discussing conducting another trial with the Centers for Disease Control and Prevention. Professor Adrian Hill, director of the Jenner Institute at the University of Oxford is leading the parallel tests .

PHASE 2: The second phase of the clinical trial for the vaccine likely will involve a larger group and serve to confirm formulations and doses, as well as identify the need for boosters and the best intervals between each dose.

PHASE 3: A third phase could evaluate the protection given to several thousand volunteers who are at risk from the disease.

A $4.6 million grant from the Wellcome Trust, the Medical Research Council and the UK Department for International Development is funding the trial overseas

There are currently no FDA approved vaccines for Ebola. The NIH's National Institute of Allergy and Infectious Diseases is working on developing an Ebola vaccine. NIH recently announced they are expediting their work, and has launched PHASE 1 clinical trials . The early-stage trial will begin initial human testing of a vaccine co-developed by NIAID and GlaxoSmithKline (GSK) and will evaluate the experimental vaccine’s safety and ability to generate an immune system response in healthy adults. The study is the first of several Phase 1 clinical trials that will examine the investigational NIAID/GSK Ebola vaccine and an experimental Ebola vaccine developed by the Public Health Agency of Canada and licensed to NewLink Genetics Corp. The study is the first of several Phase 1 clinical trials that will examine the investigational NIAID/GSK Ebola vaccine and an experimental Ebola vaccine developed by the Public Health Agency of Canada and licensed to NewLink Genetics Corp. (CDC)

SOURCE: WELLCOME TRUST WASHINGTON POST USA NEWS AND WORLD REPORT

The first British volunteer is Ruth Atkins, 48, a communications and engagement manager in the NHS from Marcham in Oxfordshire and a former nurse. She heard on the radio as she was driving home from work that volunteers were needed for a vaccine trial run by Oxford University researchers. She is the first of 60 healthy volunteers receive the vaccine.

• Advice for Humanitarian Aid Organizations (On Traveler's Health website) - September 16, 2014

• Health Care Facility Preparedness Checklist for Ebola Virus Disease (EVD)[PDF - 2 pages] - September 12, 2014

• Health Care Provider Preparedness Checklist for Ebola Virus Disease[PDF - 2 pages] - September 12, 2014

• CDC Safety Training Course for Healthcare Workers Going to West Africa in Response to the 2014 Ebola Outbreak - September 11, 2014

• How U.S. Clinical Laboratories Can Safely Manage Specimens from Persons Under Investigation for Ebola Virus Disease - September 11, 2014

• Guidance on Air Medical Transport for Patients with Ebola Virus Disease - Updated September 11, 2014

• Ebola Outbreak: Airport, Border, and Port of Entry Resources for Use by International Partners (on Traveler's Health Website) - Updated September 11, 2014

• Interim Guidance Regarding Compliance with Select Agent Regulations for Laboratories Handling Patient Specimens that are Known or Suspected to Contain Ebola Virus - September 8, 2014

• Updated: Interim Guidance about Ebola Virus Infection for Airline Flight Crews, Cleaning Personnel, and Cargo Personnel - September 5, 2014

• Ebola Outbreak: Communication Resources for Use by International Partners - Updated September 5, 2014

• Interim Guidance for Specimen Collection, Transport, Testing, and Submission for Persons Under Investigation for Ebola Virus Disease in the United States - Updated August 26, 2014

• Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Known or Suspected Ebola Virus Disease in the United States - August 26, 2014

• Guidance for Safe Handling of Human Remains of Ebola Patients in U. S. Hospitals and Mortuaries - August 25, 2014

• Advice for Humanitarian Aid Workers Traveling to Guinea, Liberia, Nigeria, or Sierra Leone during the Ebola Outbreak (on Traveler's Health website) -August 23, 2014

• Interim Guidance for Monitoring and Movement of Persons with Ebola Virus Disease Exposure - Updated August 22, 2014

KEY RESOURCE MATERIAL FROM CDC