Though Ebola has faded from the news headlines, the epidemic in West Africa continues to claim lives today. Around 30 people become infected each week in Sierra Leone and Guinea – a number that would be considered a major disaster under normal circumstances – and the outbreak has recently re-emerged in Liberia.

• Liberia: After being declared Ebola-free on 9 May, six (6) new cases have been confirmed since the re-emergence of the virus at the end of June.
• Guinea: 13 confirmed cases in the country in the week to 12 July in three main hotspots (Forecariah, Boké/Fria, Conakry)
• Sierra Leone: 14 confirmed cases in the country in the week to 12 July in three main hotspots (Freetown, Port Loko, Kambia)

MSF Staff on ground (as of 16 July) Total: 92 international and about 1,760 national

• Guinea: 40 international, around 1,100 national
• Sierra Leone: 29 international, around 400 national
• Liberia: 23 international, around 260 national

Overview The emergency is not over – the Ebola epidemic in West Africa continues
Though Ebola has faded from the news headlines, the epidemic in West Africa continues to claim lives today. Infection rates are down from the peak of the crisis last year and progress has been made in the fight against Ebola. However, around 30 people still become infected each week in Sierra Leone and Guinea – a number that would be considered a major disaster under normal circumstances – and the outbreak has recently re-emerged in Liberia.  Ongoing infections in the capitals Freetown and Conakry, and deaths from Ebola still found too late in the community, remain of high concern.

Going from hundreds of cases to 30 per week took considerable time and massive resources, yet getting from 30 to zero requires the most meticulous, difficult work of all - we cannot lose focus now and must guard against complacency until the entire region is declared Ebola free.

The priorities today are to improve Ebola surveillance, while continuing to raise awareness to get the local communities on board to bring the epidemic to an end

Community fatigue, fear and reticence remain. Whilst Sierra Leoneans, Guineans and Liberians are understandably exhausted from the more than 16 months of Ebola in the region, fear and reticence in some communities to recognize the disease or to seek care in specialized centres is still is an issue that must be addressed.  Ebola cases continue to go undetected for too long, with 25% of positive cases identified after death in their communities in the past three (3) weeks.

Engaging the community must be the cornerstone in the fight against Ebola. Gaining the trust and confidence of the communities to help to allay the rumours and myths surrounding the disease and the response is still needed. Communities across the region are very diverse and a one-size-fits-all approach with one-way messaging instead of a community-centred approach is doomed to fail.

Improved quality of case investigation, contact tracing and monitoring is needed to stop Ebola transmission today. The surveillance systems to locate and track new Ebola cases across Sierra Leone, Guinea and Liberia need to be properly supported in all districts. This includes the so called “silent “districts where cases of Ebola have not been seen for some months. This is important to control the outbreak, and for continuing efforts to reach zero cases, but also to prevent outbreaks of other infectious diseases including measles and cholera. 

On infection control and triage in health facilities, non-Ebola healthcare, & survivors:
Already weak public health systems have been seriously damaged by the epidemic, with more than 500 health workers dying of the virus across the chronically understaffed region and fear of infection and lack of infection control closing many health facilities across the region at least temporarily. 

Strict protocols for screening and triage of both staff and patients who meet the Ebola case definition must be adhered to without exception, even in the so called “silent districts.” With the rainy season, symptoms of malaria can easily mimic those of Ebola so extra precaution and vigilance is required.

Non-Ebola healthcare: treatment programs for chronic illnesses like HIV, heart disease and diabetes, as well as routine maternal and child health services such as routine childhood vaccinations have been interrupted.  These lifesaving health services must be supported, not only financially but also by way of the provision of trained clinical staff.

Survivors and those directly affected by Ebola must be provided with tailored services including mental healthcare as they continue their recovery from the virus that has destroyed many families and their way of life.

MSF is involved in clinical trials and continues to call for increased research and development into Ebola

Clinical studies offer hope in the fight against Ebola, both for today and for future outbreaks but for now they do not constitute a miracle cure or an imminent end to the epidemic. MSF is a partner in three studies aiming to gain further understanding of the virus, and testing new treatments, diagnostic tests and vaccines.

The GeneXpert feasibility study in Conakry, Guinea evaluates the feasibility of using this diagnostic tool in an Ebola epidemic. This tool, which is already used for the diagnosis of tuberculosis, so far has shown to reduce diagnosis of Ebola from 8 to 3 hours.

The VSV vaccine clinical trial in Guinea tests the efficacy and safety of a potential vaccine that is offered voluntarily to frontline health workers. Since early March 2015, MSF has administered the vaccine to more than 900 frontline workers, over half the 1300 needed to produce conclusive results. As part of the same trial, the WHO is in charge of vaccinating direct and indirect contacts of confirmed cases in their “ring vaccination.” Preliminary results are expected soon.

Plasma trial: Since February 2015, Ebola patients in MSF’s Ebola management centre (EMC) in Conakry, Guinea, can opt to receive plasma from volunteer Ebola survivors. As of July, the Data Monitoring and Safety Board have recommended to halt the trial due to the lower number of enrolments recently; however patients can continue to receive plasma in MSF’s EMC in Conakry. Today, no results of the trial have been made public yet, though it is already known that the plasma can be given safely. MSF hope the researchers will publish the results on efficacy in the coming weeks.

Operational highlights

MSF’s West Africa Ebola response started in March 2014 and includes activities in Guinea, Liberia, and Sierra Leone. MSF currently employs around 92 international and around 1,760 national locally hired staff in the region.

Since the beginning of the epidemic:

• 9,626 patients admitted to MSF Ebola management centres
• 5,149 patients confirmed with Ebola
• 2,425 patients recovered from Ebola in our centres

Highlights per country

Guinea Week 27 saw 18 cases reported.
Week 28 saw 13 cases, with 12 patients received at MSF centres. So far in July transmission rates are on par with June. Nine (9) cases from Conakry all linked to known chains of transmission.
30 patients in total in all Ebola Treatment Centres (ETCs), 20 confirmed and 10 suspect.
Continued need for community-based surveillance

Conakry: Donka ETC Site closed on 5 July, decontamination will be finished this week.

Conakry: Outreach activities

• Continuation of health promotion with teams in all communes of Conakry.
• Continuation of ambulance service for alerts for suspected Ebola cases in severe medical conditions, and children.
• Seven MSF supervisors still working in surveillance.

Conakry: Nongo ETC

• Site opened on 5 July, 15 beds officially available up to 70 if required.
• 32 new patients were admitted in Nongo.
• Community health promotion engagement continues.

Forécariah

• 11 cases week 27, two (2) of which were not on the contact list nor had established link.
• three (3) cases week 28.
• MSF activities: outreach and sensibilisation ongoing.

Boké ETC

• opened on 3 July with 15-20 bed capacity.
• four (4) total patients admitted as of 10/7, one (1) confirmed.

Vaccine trial

MSF vaccination of frontline health care workers continues with no severe adverse effects detected so far. Over 900 already vaccinated.

Liberia

After being declared Ebola free on 9 May, a 17 year boy died on June 29. MSF is not directly involved in the patient care of the new cases, in the investigation or in the follow up of contacts but it is ready to provide help to Liberian authorities and their partners, should they require it.

With the national health system decimated by the outbreak – and hundreds of Liberian health care workers dying from Ebola – MSF is focusing on supporting the recovery of health facilities. We want to encourage Liberian people to feel confident they can go to hospital once again and have their health care needs looked after.

Monrovia

In Monrovia, MSF is running a 69-bed paediatric hospital, aiming to contribute restoring the offer of secondary healthcare in the aftermath of Ebola outbreak. 44% of the patients are less than one year old.

MSF also runs a clinic for Ebola survivors in the premises of the hospital. Former patients have to face stigma and discrimination while accessing care, as well as social and economic problems (loss of work, loss of housing, etc.). MSF provides general outpatient consultations, and addresses mental health needs. Common complaints are joint pains and ophthalmic issues, for which MSF guarantees referral to external specialists.

Sierra Leone

Total of 14 new confirmed cases for Sierra Leone during the week to 12/07, compared to nine (9) in the week to 05/07.
Active transmission in three (3) districts of Western Area Urban/Freetown, Port Loko and Kambia, same as in weeks before.
In Freetown, 10 new confirmed cases during the week to 12/07, compared to three (3) cases in the week to 05/07. This is the highest case load since week 13 (23 - 29/03 2015).
three (3) new cases from Kambia and one (1) from Port Loko districts.

Bo The “core” ETC in Bo receives all suspected patients from southern Sierra Leone, with a capacity to treat 12 confirmed cases and 12 suspected cases. Today the centre receives 5–10 suspects per week mainly from the Bo district.

Magburaka

With no patients in the last weeks, Magburaka Ebola Treatment Unit (ETU) has been closed. A survivor clinic to respond to the needs of recovered patients will start soon.  MSF teams also supported the district of Tonkili in the measles vaccination campaign.

Freetown – Hastings (replacement Kissy)

Freetown has seen a recent flare-up of Ebola with 10 confirmed cases recorded in Western Area last week, the highest weekly total since March. MSF has been running an Ebola Maternity Centre in Hastings, with specific obstetric services for Ebola positive pregnant women in need of tailored care. However, as other Ebola management centres in the city are reaching capacity, MSF´s maternity Ebola management centre in Hastings is now also taking in non-pregnant suspect and confirmed Ebola cases, with six (6) patients currently admitted.

Freetown – Surveillance and contact tracing

MSF works in coordination with the District Ebola Response Committee (DERC) to identify and respond to new cases in Freetown.