Liberia: Zero cases since 20 March 2015

• Guinea: 9 confirmed cases in the country on 4 May.
• Sierra Leone: 21 confirmed cases in the country on 27 April: 6 new cases (3 in Kambia, 3 in Western Area) from 22–29 April

MSF Staff on ground (as of 21 April)

Total: 185 international and about 1,150 national

• Guinea: 83 international, around 500 national
• Sierra Leone: 61 international, around 310 national
• Liberia: 39 international, around 350 national

Overview 

1. The epidemic is at its lowest but not over yet

The recent weeks have seen an important decrease in new confirmed Ebola cases across West Africa. Liberia is now close to being declared Ebola-free on 9 May, while Sierra Leone and Guinea are finally getting close to zero. However, the outbreak is not over until it’s over at the regional level. No country can really be thought to be Ebola-free until all three countries in the outbreak have no recorded cases for 42 days.

Even after the end of this outbreak, West Africa will have to remain vigilant against a re-emergence of Ebola; there must be strengthened epidemiological surveillance and a rapid response alert system for when –rather than if, a new Ebola case occurs.

2. Key ‘pillars’ of the response are still missing

Regional cooperation: Given the high mobility of the population across the three most-affected countries, surveillance must be ensured across borders and coordinated on the regional level to avoid new cases to be ‘imported’ in Ebola-free zones.

Community awareness remains low in some areas, raising the risk of local people panicking, which can lead to violence against medical and aid workers. Community mobilization and sensitization efforts supported by national and local leaders must be reinforced rapidly.

3. Non-Ebola needs are a persisting concern

Already weak public health systems have been seriously damaged by the epidemic. The long period of interrupted health services has caused significant gaps in preventive activities, such as routine immunization of children, and in retention in care for people on long-term treatments such as HIV and other chronic diseases. There is a need to catch up and mitigate the consequences of the treatment interruption.

4. MSF involvement in clinical trials

MSF is currently actively involved in three different studies in Guinea, focusing on three different aspects of the medical response: diagnosis, prevention and treatment.

Vaccination Trial: Since March 7, MSF has launched a clinical trial for the rVSV-EBOV vaccine in partnership with WHO. This clinical trial aims to verify the safety and effectiveness of the vaccine against Ebola. It consists of two arms: a ring vaccination arm, which means that contacts of a confirmed patient will be vaccinated; and the vaccination of Ebola front line workers (such as doctors, nurses, ambulance drivers, staff involved in contact tracing, and individuals responsible for burials). WHO is responsible for the ring vaccination. MSF focuses on the front line workers and aims at enrolling 1,200 volunteers.

Convalescent Plasma Trial: The clinical trial for convalescent plasma began in the Donka Ebola Treatment Centre (ETC) in February in partnership with the Tropical Medicine Institute in Antwerp. Plasma from volunteering recovered patients is given to Ebola patients, expecting to boost their immune response. The study aims at enrolling 120 patients.  

GeneXpert Trial: MSF has just started assessing the feasibility of using the GeneXpert technology (already used to test MDR-TB) to improve blood-testing Ebola in terms of logistics and timing. This test is undertaken in Donka EMC in Conakry.

5. Ebola survivors are still facing stigma

Many survivors keep facing unfair exclusion and stigma in their own communities. By helping out with patients within the Ebola centres, donating blood for plasma transfusion and participating in community awareness, survivors’ contributions are crucial to the fight against Ebola. More communication is still needed to promote the role of those extraordinary individuals that defeated the virus and are now helping others.

About potential sexual transmission from survivors, a semen analysis in a patient cured from Ebola tested positive by PCR 175 days after discharge, whereas the literature reported a maximum of 82 days until now. In light of these new scientific data, MSF decided to recommend to male survivors the use of condoms during 6 months after discharge from an Ebola Treatment Centre. MSF should also be able to respond positively to a request for semen analysis from a convalescent and offer survivor’s sexual (s) partner (s) to enrol into vaccination clinical trial.

Operational highlights

MSF’s West Africa Ebola response started in March 2014 and includes activities in Guinea, Liberia, Mali and Sierra Leone. MSF currently still employs around 185 international and 1,150 national locally hired staff in the region.

Since the beginning of the epidemic:

• 9,446 patients admitted to MSF Ebola management centres
• 5,168 patients confirmed with Ebola
• 2,449 patients recovered from Ebola in our centres

More than 1,500 tonnes of supplies have been shipped to the affected countries since March 2014.

Highlights per country

Guinea

The number of cases in Guinea keeps fluctuating, although it has significantly fallen. The situation in some others prefectures remains concerning, especially in Forecariah. The high level of stigmatization and reticence, particularly towards recovered patients, is still a problem.

Conakry

There has been no new confirmed case admitted since 20 April in MSF Donka Centre. The last confirmed patient went home cured on 28 April. On May 4^th, only 2 suspect patients were admitted.

The plasma trial is still ongoing with 92 patients received the plasma so far. Preliminary results are pending the completion of the trial, which is on standby due to the lack of new confirmed case.

The vaccination trial continues with more than 390 volunteers enrolled on May 4.

The construction of the new ETC of Nongo is ongoing and should be completed in June.

Guéckédou

The Gueckedou ETC closed its doors on March 31 following no cases since January. The site has been completely decontaminated, dismantled, and given back to the local authorities. Others actors are working in the area to ensure continued success of different activities.  

Forecariah

Forecariah is the current prefecture with the highest number of confirmed cases. MSF teams are involved in three main activities: health promotion, support to the health structure and outreach activities. 

Kankan

The Kankan ETC official handover ceremony by MSF to the local authorities took place on 18 April. MSF teams have left to the local authorities a new CTE with a capacity of around 40 beds.

Liberia

WHO should declare Liberia Ebola-free on 9 May. MSF welcomes that Liberia has had no cases of Ebola for 42 days and applaud the efforts of the Liberian people in achieving this. But with the outbreak still ongoing in neighbouring Guinea and Sierra Leone, we cannot say that Ebola is over just yet. Vigilance against re-emergence is key and close surveillance is crucial.

Monrovia

ELWA3 was officially handed over to the government on April 17.

The paediatric hospital (41 IPD beds + 10 ER beds) is full. The hospital has opened on March 23 and during the first five weeks of activity, 384 children were received at the ER, of which almost 70% (264) were admitted after consultation. The number of children in need of emergency care is relatively high, due notably to late presentations. Main reasons for hospitalisations include anaemia, malnutrition, respiratory infections, as well as neonatal pathologies, often for children delivered at home.

MSF is also running a Survivor clinic in the same site, providing medical follow-up to an average of 20 survivors per week.

The nationwide measles vaccination campaign will begin on May 8 until May 14. UNICEF, WHO, MoH and Red Cross are leading the campaign.  383 teams have been recruited countrywide and 215 vaccination centres set up. MSF will support the vaccination activities in Montserrado County (Gardnersville, Bardnersville, West Point and New Georgia communities).

Sierra Leone

The case load in Sierra Leone has stabilized to an average of ten people per week, with the majority of cases found in the Western Area and in the region of Kambia, on the border with Guinea. Today, MSF teams are focusing on outreach activities, surveillance and health promotion amongst others. In collaboration with national authorities, teams are also starting to identify other health needs in the country.

Bo

With the closing of several centres in the South, the ETC in Bo will become a “core” centre to respond to new cases in the region, with the capacity to treat 12 confirmed cases and 12 suspected cases.

Magburaka

After the discharge of the last patient, the centre will close in the coming week if there are no new cases.  Teams are investigating measles cases in the area.

Freetown – Hastings (ex. Kissy)

After the request by the government to close the centre in Kissy to allow the reopening of the school, the maternal Ebola management centre has been relocated in Hastings.  The facility, which is offering specialised care for pregnant women, will remain open until the end of the epidemic. The team also conducted an assessment of the health needs of pregnant women in quarantined houses.

Freetown - Prince of Wales secondary school ETC

The ETC closed on 23 February and the Prince of Wales school has now reopened to students. The team is now focusing on outreach activities (disinfection and health promotion), including monitoring suspected measles cases in Western Urban area. The plan is to support several primary health centres in measles case management and systemic training.

MSF is also running a Survivor clinic, providing medical follow-up to an average of 20 survivors per day, and actively advocating for the integration of survivor’s health needs into the existing health system. Health promotion and mental health teams are giving support to survivors and family of Ebola’s victims inside their communities.

Freetown – Surveillance and contact tracing

MSF is supporting the local Ebola response in nine wards of Freetown, focusing on surveillance, contact tracing and ensuring that quarantine homes receive appropriate follow up from relevant actors.