BACKGROUND

SITUATION

18 APRIL 2014

AS OF : 4:00 PM EST

RISK ASSESSMENTS

BIOSECURITY MEASURES

LIBERIA MINISTRY OF HEALTH AND SOCIAL WELFARE MINISTRY OF FOREIGN AFFAIRS INTERNATIONAL ORGANIZATIONS

RELIEF WEB HUMANITARIAN RESPONSE

UNICEF

UN NEWS CENTER WHO WORLD HEALTH ORGANIZATION - AFRICA DISEASE OUTBREAK NEWS GLOBAL ALERT RESPONSE - EBOLA WHO – EBOLA

INTERNATIONAL FEDERATION OF RED CROSS RED

CRESCENT

NGO MSF ACT ALLIANCE CATHOLIC RELIEF

US GOVERNMENT

CDC – OUTBREAK OF EBOLA IN GUINEA AND LIBERIA US EMBASSY MONROVIA – LIBERIA US EMBASSY – CONAKRY, GUINEA

PORTALS, BLOGS, AND RESOURCES

CIDRAP HEALTH MAP PROMED MAIL

NEW SOURCES

ALERTNET NY TIMES WASHINGTON POST

YALE- TULANE ESF-8 SPECIAL REPORT

GUINEA | LIBERIA EBOLA

RESPONSE ACTIVITIES

AS OF 18 APRIL 2014

LABORATORY CONFIRMATION

DEAD

224 197|27

135 122|13

CLINICAL DIAGNISIS

107 101|6

WHAT IS EBOLA?

Ebola Virus Disease (EVD) Outbreak, Guinea and Liberia 2014

Guinea | Liberia

BACKGROUND

GUINEA • On 24 March, Guinea’s Ministry of Health notified the WHO of a fast-

spreading outbreak of deadly Ebola virus disease in the country since early February. Thirteen of the cases tested positive for Ebola virus by PCR (six at the Centre International de Recherche en Infectiologie (CIRI) in Lyon, France, and seven at the Institut Pasteur Dakar, Senegal), confirming the first Ebola hemorrhagic fever outbreak in Guinea.

• On 28 March, Guinea's government confirmed for the first time four cases of the deadly Ebola virus in the capital city of Conakry. The spread of the disease from the southeastern forest districts of Macenta, Gueckedou, Nzerekore and Kissidougou to the capital, where some two million people live, marked a significant escalation in the spread of the disease. (ACAPS -Global Emergency Overview)

• By 5 April, the total number of suspected and confirmed cases amounted to 151, including 98 deaths. All age groups have been affected but most of the cases are adults aged 15–59 years.

DISTRIBUTION OF CASES BY AGE GROUP IN GUINEA - 7 APRIL

LIBERIA On 31 March, the Ministry of Health and Social Welfare (MoHSW) of Liberia reported confirmed cases of Ebola in Lofa District and 8 suspected cases, including 6 deaths, in individuals who had recently traveled to Guinea. On 1 April the U.S. Embassy in Monrovia was advised that a woman confirmed to have Ebola had traveled to the Firestone Plantation Camp in Monrovia. The woman subsequently died.

An outbreak of Ebola virus disease (EVD) with onset in early February 2014 continues to evolve in West Africa. This is the first such outbreak in the region. Two countries, Guinea and Liberia, have reported confirmed cases. The first cases were reported from the forested region of south-eastern Guinea in Guéckédou prefecture near the border with Liberia and Sierra Leone.

AS OF 7 APRIL

BACKGROUND LABORATORY SUPPORT/RESULTS • The Institut Pasteur in Lyon, France, the Institut Pasteur in Dakar, Senegal, the

European Consortium mobile laboratory, and the Metabiota/Tulane University laboratory in Kenema, Sierra Leone, and CDC Atlanta, and are some of the laboratories collaborating to test samples

• A team of EU scientists have set up a field laboratory to test suspect cases, working alongside Médecins Sans Frontières at an isolation center near the borders with Sierra Leone and Liberia. (ECDC 11 APR)

• Results from sequencing done by CIRI showed strongest homology of 98% with Zaire Ebolavirus last reported in 2009 in Kasai-Occidental Province of e Democratic Republic of Congo. This Ebolavirus species has been associated with high mortality rates during previous outbreaks. (WHO, 25 Mar 2014)

SOURCE: WHO - 10 APR

CONTROL ACTIVITIES

• Control activities supported by WHO, UNICEF, Médecins Sans Frontières and other stakeholders are being implemented, including contact tracing, enhanced surveillance and strengthening of infection control practices, free-of-charge access to healthcare for suspected cases, case isolation and management, and social mobilization.

• Information and education materials have been developed and distributed, intensive multimedia communications are underway and psychosocial support is being provided to patients, their families and the affected communities.

• There is ongoing training for carriers in safe practices and for members of local communities in safe burials.

Health workers in Conakry, Guinea, teach people about the Ebola virus and how to prevent infection (AP / YOUSSOUF BAH)

Experts from the European Union Mobile Laboratory (EMLab) ready to support Ebola samples testing's in Guéckédou, Guinea. Photo: WHO/S. Hugonnet

BACKGROUND

• The strain of Ebola virus that has killed 121 people in West Africa may have been circulating there undetected for some time, according to a new study by The New England Journal of Medicine.

• Epidemiologic investigation linked the laboratory-confirmed cases with the presumed first fatality of the outbreak in December 2013.

• Researchers confirmed that it 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.

• However, this study demonstrates the emergence of a new EBOV strain in Guinea.

• The study shows the emergence of EBOV in Guinea. The high

degree of similarity among the 15 partial L gene sequences, along with the three full-length sequences and the epidemiologic links between the cases, suggest a single introduction of the virus into the human population.

• This introduction seems to have happened in early December 2013 or even before.

• Further epidemiologic investigation is ongoing to identify the presumed animal source of the outbreak. It is suspected that the virus was transmitted for months before the outbreak became apparent because of clusters of cases in the hospitals of Guéckédou and Macenta. This length of exposure appears to have allowed many transmission chains and thus increased the number of cases of Ebola virus disease.

The area of the outbreak is highlighted in red. The main road between the outbreak area and Conakry, the capital of Guinea, is also shown. The map was modified from a United Nations map.(New England Journal of Medicine)

SOURCE: The New England Journal of Medicine.

Starts with: • Sudden onset of fever • Intense weakness, muscle pain • Headache, sore throat

Followed by: • Vomiting, diarrhea, rash • Impaired kidney and liver function • Internal and external bleeding

Ebola creates holes in blood vessels, often causing bleeding and shock. It does this by killing endothelial cells, which form the blood vessels’ lining and other partitions in the body. When those cells die, blood and other fluids can leak out. Organs shut down. The virus replicates very quickly, before most people’s bodies can mount an attack. People often have massive bleeding 7 to 10 days after infection. It effectively disables the immune system by hampering the development of antibodies and T cells that would target the virus. Scientists are not certain exactly how. (Washington Post)

WHAT IS EBOLA?

HOW IS IT TRANSMITTED

SIGNS AND SYMPTOMS

SOURCE : CDC WHO

WHAT IS EBOLA?

• Direct contact of blood, organs, or other bodily fluids of infected people • People are infectious as long as their blood and secretions contain the

virus ‐ Infective after death ‐ Infective after recovery

• Natural reservoir is unknown • Experts hypothesize that first patient comes in contact with an infected

animal

• Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever, is a severe, often fatal illness in humans, caused by a filovirus.

• EVD outbreaks have a case fatality rate of up to 90%. • First appeared in 1976 in Sudan and Democratic Republic of Congo. The

latter was in a village situated near the Ebola River, from which the disease takes its name.

SOURCE: THE LANCET STUDENT

• Avoid all contact with blood or fluids of infected people • Isolation of Ebola patients • Basic infection control measures

‐ Equipment sterilization ‐ Routine disinfection ‐ Hand hygiene

• Prompt and safe burial of dead

DIAGNOSIS

TREATMENT

PREVENTION

SOURCE : CDC WHO

WHAT IS EBOLA?

• No specific treatment or vaccine is available for use in people or animals • Only treatment is to provide intensive supportive care • Patients frequently dehydrated and will require oral rehydration therapy

• Early diagnoses difficult because symptoms are nonspecific to Ebola • Definitive diagnoses made through laboratory testing:

‐ PCR ‐ ELISA ‐ Virus isolation ‐ IgM and IgG antibodies

RISK OF EXPOSURE

• All confirmed human cases occurred in Africa ‐ Have been historically reported in: Democratic Republic of Congo,

Gabon, South Sudan, Ivory Coast, Uganda, South Africa, Guinea, Liberia, Sierra Leone

• High Risk Individuals: ‐ Friends and Family ‐ Health workers

• Proper Personal Protective equipment (PPE) helps mitigate risk of exposure

Ebola first appeared in 1976 in 2 simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo. The latter was in a village situated near the Ebola River, from which the disease takes its name.

(WASHINGTON POST)

SITUATION GUINEA

As of 18:00 on 16 April, the Ministry of Health (MOH) of Guinea has reported a cumulative total of 197 clinical cases of Ebola Virus Disease (EVD), including 122 deaths. To date, 101 cases have been laboratory confirmed, including 56 deaths, 43 cases ( 33 deaths) meet the probable case definition for EVD and 53 cases (33 deaths) are classified as suspected cases. HEALTH CARE WORKERS: Twenty- four (24) health care workers have been affected with 13 deaths LABORATORY INVESTIGATIONS continue at the Institut Pasteur (IP) Dakar laboratory in Conakry (66 samples tested, of which 39 are positive by PCR for ebolavirus) and at the European Union Mobile Laboratory (EMLab) team in Guekedou (55 samples tested/36 positive). CONTACT TRACING ACTIVITIES continue in all affected areas including new contacts generated by a HCW who passed away 3 days ago. In Conakry, 60 community volunteers are assisting the MOH and response partners in following up the 221 contacts currently under medical observation. Seven contacts who developed symptoms have been placed in isolation as a precautionary measure. A total 249 contacts are being followed in Guekedou, 54 in Macenta 17 in Kissidougou, 63 in Dabola and two (2) in Dingaraye. HOSPITALIZED: A total of 36 patients are currently in isolation; 23 in Conakry, 12 in Guéckédou and 1 in Macenta. . SUPPORT: • Clinical teams from WHO, the Global Outbreak Alert and Response Network

(GOARN) and Médecins Sans Frontières (MSF) are supporting national medical and nursing staff at the Donka Hospital to strengthen patient triage, case management and infection prevention and control (IPC).

• Training on the safe handling of patients with EVD and the deceased was conducted jointly by the IPC and Logistics teams at the Donka hospital for staff working at the morgue, and for drivers and staff transporting patients in stretchers.

• A training of trainers activity for the directors of all 20 Centres de Santé in Conakry on 17 April as well as IPC training at two community health centers

IMPACTED DISTRICTS (AS OF 16 APRIL) • Conakry - 47 cases, including 16 deaths • Guekedou -117cases/80 deaths • Macenta - 22 cases/16 deaths • Kissidougou - 6 cases/5 deaths • Dabola - 5 cases/1 deaths • Djingaraye - 1 case /1 death

CHALLENGES: • Guinea recently experienced measles outbreak and is currently undergoing a

cholera outbreak • The meningitis season in Guinea will remain until the rain period concludes.

Current seasonal infection disease already burdens resources and capacity of the National Society

• Seasonal rains due to start within the next 6 weeks will potentially limit transportation and access to remote areas

• In Conakry, contact tracing currently of concern. Red Cross to mobilize resources and volunteers to scale up contact tracing

• Guinea has the lowest ratio of hospital beds per capita in a World Bank survey of 68 nations in 2011, with just 0.3 hospital beds per 1,000 people

SOURCE: WHO- EBOLA VIRUS DISEASE, WEST AFRICA (SITUATION AS OF 16 APRIL 2014) IFRC- GUINEA – EBOLA VIRUS OUTBREAK 11 APRIL 2014

SITUATION LIBERIA

As of 16 April, the Ministry of Health and Social Welfare (MOHSW) of Liberia has reported a cumulative total of 27 clinical cases of EVD (6 laboratory confirmed, and 21 probable and suspected cases of EVD), including 13 deaths. The most recent clinical case was identified on 11 April while the date of admission of the most recent laboratory confirmed case is 4 April.

HOSPITALIZED: 2 patients are currently hospitalized. UNDER MEDICAL OBSERVATION: At present 35 contacts remain under medical observation and 32 have been released from follow-up. IMPACTED COUNTIES

• Lofa County - accounts for 38% of the clinical cases reported to date , 4 laboratory confirmed and 6 suspected cases

• Margibi County - accounts for 23%, 1 confirmed and 5 suspected cases • Bong County - 5 suspected cases • Nimba County - 3 suspected cases • Montserrado County - 1 suspected case • Grand Cape Mount County - 1 suspected case.

DEAD: A cumulative number of 13 deaths are being attributed to EVD; Lofa (9), Nimba (1), Margibi (2) and Montserrado (1). All 6 laboratory confirmed cases have died; this includes 3 health care workers (HCW).

SOURCE: WHO Ebola virus disease, West Africa (Situation as of 14 April 2014) Ministry of Health and Social Welfare (MOHSW) of Liberia SITREP 11 - 13 APRIRL 2014

CHALLENGES • Limited health promotion materials • Inadequate isolation units established in affected counties • Information campaign is still inadequate, not reaching all parts of the

community. • Poor infection control and facilities does not have the necessary capacity to

manage cases in isolation unit • Community norms and practices has the potential to increase number of

contacts • Re-enforcement of universal precaution and adherence to basic infection

control measures • Number of contact tracers is very limited and in some counties nonexistent:

‐ Need to identify volunteers who will be providing support to vulnerable communities in tracing and follow-ups of the contacts of the suspected/probable cases.

• No or limited Inter Personal Communication (IPC) activities in the communities

PLANNED ACTIVITIES • Improve in-country laboratory capabilities to conduct both Lassa and Ebola

test • Rehabilitate Foya proposed isolation unit • Provision of Ambulance and MSF plan to concentrate on case management,

infection control and waste management services • Reproduction and distribution of SOPs for Health Workers and awareness

posters and flyers • Strengthen contact tracing and follow up activities to interrupt

transmission. • Increase support to isolation units and psychosocial interventions

SOURCE: LIBERIA SITREP 16 APR

RESPONSE ACTIVITIES

• Currently more than 65 public health experts are working with WHO and its Global

Outbreak Alert and Response Network (GOARN) partners are working with WHO on the ground supporting Ministries of Health and other partners in the two countries to provide clinical management of patients, contact tracing, disease surveillance, laboratory work, logistics, as well as communications and sharing of information to help people living in communities protect themselves from the disease.(17 APR)

• OPERATIONS CENTER: WHO has established an operation center for alert and response activities within the Guinean Ministry of Health (MoH) to centralize the coordination of all activities linked to detection, search, transportation, hospitalization and burial of suspect cases.

• GOARN: WHO is working with technical partners in the Global Outbreak Alert and Response Network (GOARN), has deployed field lab support, as well as a number of experts in anthropology, epidemiology, logistics, clinical case management and infection prevention and control and outbreak coordination to support the emergency response efforts in Guinea.

• TRAINING ‐ WHO continues to support Healthcare Workers (HCW) in training in case

management and infection prevention and control

‐ To strengthen contact tracing in Conakry, WHO organized an intensive training for a first group of 70 trainees on 9 APRIL 2014. They will go into the communities to follow up on specific persons who had close contacts with patients with a confirmed Ebola infection. (WHO – 9 APR)

‐ Training for HCW on infection control began on 8 APRIL in different departments of the Donka National Teaching Hospital and will also take place in other health facilities in coming days.

• LOGISTICS: The United Nations Humanitarian Response Depot (UNHRD) has helped WHO’s response to an Ebola virus outbreak in West Africa by delivering protective equipment from the UNHRD depot in Dubai. Gloves, masks and other infectious control gear arrived in Guinea, Sierra Leone and Liberia beginning 1 APR

WHO delivers disposable personal protection equipment to isolation ward at the China-Guinea Friendship Hospital in Conakry, Guinea. Photo: WHO/T. Jasarevic

On 8 April, WHO said that it expects to have to confront an outbreak of the highly contagious disease in West Africa for the next two to four months, across a region where health systems are ill-equipped to cope.

UNICEF • UNICEF is working closely with partners to design culturally-sensitive

communications strategies and raise awareness of Ebola among communities and health workers in Guinea, Liberia, Sierra Leone, Cote d'Ivoire, Senegal, Mali and Guinea Bissau. (UNICEF -10 APR)

• UNICEF deployed two field coordinators and a 10 person team

specialized in interpersonal communications to Lofa County, Liberia where they will work with communities to increase awareness of Ebola. (UNICEF -16 APR)

• With logistical support from Samaritan’s Purse, UNICEF air-lifted

urgently needed tarps, sprayers, chlorine and other supplies to Lofa County, for use in completing the isolation unit at Foya Hospital. (UNICEF -16 APR)

WORLD HEALTH ORGANIZATION (WHO) / UNITED NATIONS CHILDREN ‘S FUND (UNICEF)

RESPONSE ACTIVITIES THE INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESCENT SOCIETIES (IFRC)/INTERNATIONAL COMMITTEE OF THE RED CROSS (ICRC)

THE INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESCENT SOCIETIES (IFRC) FIELD ASSESSMENT COORDINATION TEAM (FACT) • The International Federation of Red Cross and Red Crescent Societies

(IFRC) has deployed a FACT to Guinea assist in the response.

• FACT includes an infectious disease specialist from the French Red Cross Society, as well as a psychosocial support delegate. Together they will assess the situation on the ground and help inform a comprehensive response plan. (IFRC – 25 MAR)

LOGISTICS ERU (SWISS RED CROSS): two-person team supporting the mobilizing of local procurement and support to incoming teams deployed Guinea forestière and for the operation hub in Guéckédou. Support to the National Society logistics personnel.(IFRC – 15 APR 2014)

HEALTH ERU (FRENCH RED CROSS) • Three-person team (team leader, admin / finance, and nurse) arrived in

Conakry on 8 April and deployed to Guéckedou on 10 April to begin support to the National Society branches in Guéckédou and surrounding areas affected by Ebola.

• A senior medical officer arrived in Conakry on 13 April 2014 to support the Guinea Red Cross Health Department(IFRC – 15 APR 2014)

Red Cross volunteers in Guinea learn how to use protective gear to prevent them from contracting the Ebola virus. Photo: Panu Saaristo/IFRC

RED CROSS SOCIETY OF GUINEA • With support from IFRC, the Red Cross Society of Guinea is working

closely with the Ministry of Health, WHO and Médecins Sans Frontières to stop the spread of the deadly virus.

• Volunteers with the Red Cross Society of Guinea are already involved in the collection and removal of dead bodies. (IFRC – 25 MAR)

• Trained Red Cross volunteers are working in affected areas, identifying and tracking those who have come into contact with suspected cases, disinfecting the homes of Ebola victims, and raising awareness among communities on how to protect themselves from becoming infected. (IFRC - 1 APR )

INTERNATIONAL COMMITTEE OF RED CROSS( ICRC) • ICRC is the lead agency for the Movement in Guinea, and has

welcomed the IFRC’s involvement and collaboration in the Ebola operation and support of the Guinea Red Cross.

• Weekly coordination meetings are taking place with the ICRC, the IFRC, and the Guinea Red Cross to take stock of the evolving situation, address areas of concern (ie. volunteer protection), and to adjust the operation to the actual caseload situation (IFRC – 15 APR 2014)

SOURCE: IFRC – 25 MAR 2014 IFRC - 1 APR 2014 IFRC – 15 APR 2014

Guinea Red Cross volunteers preparing personal protection kits (PPE’s) at the NS HQ in Conakry, 9 April 2014, to be despatched to Guéckedou where the French Red Cross health ERU is operational. Photo courtesy of the Swiss Red Cross ERU

RESPONSE ACTIVITIES MÉDECINS SANS FRONTIÈRES (MSF) - DOCTORS WITHOUT BOARDERS

GUINEA • An outbreak of Ebola in Guinea prompted Médecins Sans Frontières (MSF) to

launch an emergency response. (22 MAR)

• Twenty-four MSF doctors, nurses, logisticians and hygiene and sanitation experts are already in the country.

• MSF has set up an isolation unit for suspected cases in Guéckédou, in collaboration with the Ministry of Health, and is currently doing the same in the town of Macenta, also in the Nzérékoré region in the south of the country.

• In Macenta, in southeast Guinea, MSF activities were temporarily suspended for a 4 days following an incident where local people threw stones at buildings and vehicles, under the mistaken impression that the disease had been brought into the country by MSF. None of the MSF team was injured in the incident. (11 APR)

• MSF has currently sent some 33 tons of supplies to Guinea on two charter planes leaving from Belgium and France, containing medicines, medical equipment and the supplies necessary for isolating patients, putting sanitation measures in place and protecting its teams.

LIBERIA • After Ebola cases were reported in neighboring Liberia, MSF sent an Ebola

specialist to provide training and improve the small isolation unit set up by Liberia’s ministry of health at JFK hospital

• On April 6, MSF flew in medical supplies and isolation materials from Brussels to the capital, Monrovia, while an MSF team arrived on the ground on April 7 to provide further support.

• On 16 April, with the logistical support of Samaritan’s Purse, UNICEF air-lifted a new batch of urgently needed supplies of chlorine, plastic tarpaulins, sprayers and other materials to Lofa, where MSF is providing support for emergency health services at the isolation unit in Foya Hospital. The delivery came a day after MSF requested this support at the NTF meeting on 15 April. (UNICEF – 16 APR)

Battle: Health specialists work in an isolation ward for patients at the Médecins Sans Frontières facility in Guekedou, southern Guinea

MSF and WHO personnel consult at Donka Hospital. SOURCE: WHO

RESPONSE ACTIVITIES

EUROPEAN MOBILE LAB PROJECT (EMLab) On 26 March six European specialists of the European Mobile Lab project (EMLab) for dangerous infectious disease arrived in Gueckedou, Guinea, with a mobile laboratory unit. This consists of easily transportable equipment for high security virus manipulation packed in boxes. It will substantially enhance the available capacity for rapid analyses of samples and confirmation of Ebola cases, reducing the number of undiagnosed cases and preventing the further spread of the disease, the statement said. CDC ATLANTA • CDC has sent a 5 person team to Guinea to assist Guinea MOH and WHO led

international response to the Ebola outbreak.

• An outbreak-management software program developed by the US Centers for Disease Control and Prevention will soon be deployed to the area. The software package, called Epi-Info, collects outbreak information into a single database that produces statistical and visual reports.

• CDC Atlanta has sent a 2 person team to Liberia to assist Liberia’s Ministry of Health and Social Welfare (MOHSW) and the WHO led international response to the Ebola outbreak

USAID • Along the Liberia-Guinea border, where six suspected Ebola cases have occurred,

the United States Agency for International Development (USAID) funded Improved Water, Sanitation and Hygiene (IWASH) Program is delivering materials to prevent potential spread of the disease.

• Materials have been distributed to health facilities that are in the “front line” in responding to the Ebola outbreak in the Foya District border region, in Lofa county.

DoD U.S. Department of Defense on 14 April opened a laboratory on the outskirts of Monrovia to test the rising number of samples of suspected cases in Liberia. It will eliminate the need to send samples overland into Guinea's remote southeast, where the disease was first confirmed and tests from Liberia are now being carried out. (Reuters – 15 April)

• Samaritan’s Purse (SP) Liberia is responding by conducting public awareness health campaigns in Lofa, River Gee, Gbarpulu, and Nimba counties and Monrovia, providing emergency medical supplies to a partner hospital, and transporting medical response personnel and supplies to various parts of the country.

• CATHOLIC RELIEF AGENCY - CRS’ local partners have sent 30 teams to the affected areas of Guinea-Conakry and CRS will be supporting its Caritas partners in awareness campaigns, prevention, diagnosis and treatment, and alerting health officials of suspected cases for diagnosis and treatment.

• ACT: The Lutheran Development Service in Liberia has been holding meetings to plan how to intervene in the situation to save lives. Moreover, the Phebe Hospital and School of Nursing in Bong County and the Curran Memorial Hospital in Lofa County are preparing to respond to possible cases of Ebola whenever they are brought to their attention despite the risk involved. This is why it is critical that they are well prepared and protected as they strive to save lives.

RISK OF HUMAN TO HUMAN TRANSMISSION

Ebola viruses are highly transmissible by direct contact with blood, secretions, organs or other body fluids of dead or living infected persons.

No transmission has been reported without direct physical contact.

Risk of transmission may increase with transition to later stages of the disease.

Healthcare workers can become infected through close contact with infected patients, but risk for infection can be significantly reduced through appropriate use of infection control precautions.

RISK OF FURTHER CASES

As the incubation period can be up to three weeks, it is likely that the Guinean health authorities will identify additional cases in the coming weeks.

Additional cases may be identified in neighboring regions.

Of particular concern is the spread of the disease to countries with no previous experience in managing outbreaks.

RISK OF INTERNATIONAL SPREAD

It is unlikely, but not impossible, that travellers infected in Guinea could arrive in the EU while incubating the disease and develop symptoms while in the EU.

WHO does not recommend that any travel or trade restrictions be applied to Guinea.

OTHER MODES OF TRANSMISSION

Transmission through sexual contact may occur up to seven weeks after clinical recovery, as observed for Marburg filovirus.

Transmission can also occur by contact with dead or living infected animals, e.g. monkeys, chimpanzees, forest antelopes and bats.

Airborne transmission has never been documented.

RISK ASSESSMENT

TWO RISK ASSESSMENT HAVE BEEN PUBLISHED:

European Centre for Disease Prevention and Control (23 March 2014)

European Centre for Disease Prevention and Control (8 April March 2014)

GENERAL INFORMATION

This is the first Ebolavirus outbreak in Western Africa but the origin of this outbreak is currently unknown.

Currently, four prefectures in Guinea are suspected to be affected, including the capital Conakry. Also, one district in Sierra Leone reported suspected cases.

Control measures, such as isolation of cases and active monitoring of contacts should be able to control this outbreak and prevent further spread of the disease.

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

Doctors without Borders staff carry the body of a person killed by bola virus disease at a center for victims of the Ebola virus in Guinea, on April 1, 2014. SOURCE: SEYLLOU AFP/Getty Image

TRAINING

• In Conakry, public health experts from WHO, GOARN and Médecins Sans Frontières (MSF) are supporting national medical and nursing staff at the Donka Hospital to strengthen patient triage and care, case management and infection prevention and control.

• Training on the safe handling of patients with Ebola and the deceased is also organized for staff working at the morgue, and for drivers and staff transporting patients. A training of trainers activity for the directors of all 20 health Centres in Conakry is planned this week as well as for health workers from non-affected regions of Guinea (Lola, Yomou, Beyla et Nzérékoré).

• Similar work is underway in Liberia, where the WHO and the GOARN team has conducted visits to two hospitals in Montserrado County, and trainings in patient triage and care and infection prevention and control.