Since the Ebola outbreak in West Africa was officially declared on 22 March in Guinea, it has claimed 6,387 lives in the region. The outbreak is the largest ever, and is currently affecting four countries in West Africa: Guinea, Liberia, Sierra Leone and Mali. Outbreaks in Nigeria and Senegal have been declared over. A separate outbreak in DRC has also ended.

Three months after MSF called for states with biological-disaster response capacity to urgently dispatch human and material resources to West Africa, all three of the worst-hit countries have received some assistance from the international community. But foreign governments have focused primarily on financing or building Ebola case management structures, leaving staffing them up to national authorities, local healthcare staff and NGOs.

Across the region, there are still not adequate facilities for isolating and diagnosing patients where they are needed. Other elements that are essential to an Ebola response – such as awareness-raising and community acceptance, safe burials, contact tracing, alert and surveillance, access to health care for non-Ebola patients – are still lacking in parts of West Africa.

The clinical trials for three different treatments led by MSF and three research institutions should start soon at MSF sites in West Africa. The French National Institute of Health and Medical Research (INSERM) will lead a trial for antiviral drug favipiravir at MSF’s facility in Guéckédou, Guinea. The inclusion of patients at this site has started this week. The Antwerp Institute of Tropical Medicine (ITM) will lead a trial of convalescent plasma therapy at MSF’s Donka Ebola centre in Conakry, Guinea; and the University of Oxford will lead, on behalf of the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), a Wellcome Trust-funded trial of the antiviral drug brincidofovir at Elwa3 in Monrovia. Both the trials for Donka and Monrovia are still under discussion.

The United Nations Mission for Ebola Emergency Response (UNMEER) is based in Ghana to pursue five strategic priorities: stop the spread of the disease; treat the infected; ensure essential services; preserve stability; and prevent the spread of the disease to countries currently unaffected.

MSF has been responding to the outbreak since March, and currently has more than 3,400 staff working in Guinea, Liberia, Sierra Leone and Mali. Since the response began, 27 MSF staff members have fallen ill with Ebola, 14 of whom have recovered and 13 have died. The vast majority of these infections were found to have occurred in the community.

Operational Highlights

MSF’s West Africa Ebola response started in March 2014 and counts activities in Guinea, Liberia, Mali and Sierra Leone. MSF currently employs 306 international and around 3,078 locally hired staff in the region. The organisation operates seven Ebola case management centres (CMCs), providing approximately 600 beds in isolation, and two transit centres. Since the beginning of the outbreak, MSF has admitted more than 7,000 patients, among whom around 4,400 were confirmed as having Ebola. Nearly 1,900 patients have survived.

More than 1,305 tonnes of supplies have been shipped to the affected countries since March.

Guinea

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

Conakry

Donka Ebola Management Centre in Conakry has reached its full capacity. Admissions have therefore temporarily stopped. New patients are being transferred by WHO to the Forecariah transit centre (50km south-east of Conakry). This is the second time the Donka Ebola Management Centre has reached full capacity. MSF is currently looking for an appropriate site to setup a bigger Ebola Management Centre that will serve the Conakry area.

Macenta

The technical support that MSF was offering to the local authorities in Kérouané and to the French Red cross in Macenta ended. The whole Macenta team left Macenta on the 10 December after handed over to FRC.

Guéckédou

The number of admissions remained stable on the low side, with a bed occupancy rate between 24% and 33%. The number of recovered patient is high (29 this week) and in the last 4 weeks there have been more recoveries than deaths.
The preparation for the INSERM study (FAVIPIRAVIR) is well underway. Trials will start the week of December 15th.

Kankan

A new 20 beds CMC is being built in Kankan and Infection control has started in the Kankan General Hospital. The outbreak seems to have changed dynamic and is moving from Guinée Forestière to Haute Guinée (where Kankan is).

Liberia

Monrovia - Elwa 3

The number of patients in ELWA 3 has remained stable over the past few weeks with around 20 new admissions every week. As a result, we are working to downsize ELWA 3 to a 60 bed centre. Of course, should there again be a sharp increase in cases; we will be ready to scale up in order to accommodate them. We are also focusing on increasing the standard of care to patients, bringing in a laboratory technician to supervise the construction of a new laboratory within the ELWA 3 compound to help facilitate this.

Monrovia/Outreach

Ambulance service have been set up with a dedicated hotline that the community can call if they have Ebola suspected cases. The first teams are operational and refer Ebola patients from Gardnersville, New Georgia, Barnesville and Paynesville in Monrovia, to EMCs.
Monrovia / Support to non-Ebola health facilities
An MSF team is supporting five health centres in Monrovia with expertise in infection prevention and control; A team is also supporting the James Davis Junior Memorial Hospital (JDJ Hospital) in Monrovia providing expertise in paediatrics,, infection control and triage. Rehabilitation of the premises has started to set upstringent infection control measures.

Monrovia/Transit Unit (Redemption Hospital)

Since the opening of the Ebola Transit Unit at the Redemption hospital site in New Kru Town on 19 November, MSF has triaged more than 35 patients and admitted 16 to its Transit Unit, 7 of which tested positive. Patients who are admitted and test positive for Ebola and those who are clinically unstable upon arrival, are transferred to ELWA3 immediately. Patients are followed up by the staff of the Redemption Unit throughout their time in treatment. Their families are offered psycho social support, including transport to visit patients at ELWA 3, which can be up to an hour journey in traffic. Those who recover continue to receive support from MSF in the weeks following discharge.

In addition to running the ten-bed transit unit, MSF also supports the triage at Redemption Hospital's OPD. This is an extremely important step in the rebuilding of non-ebola health services in Monrovia as Redemption Hospital has, been unable to run its normal operations since it was used as a holding centre for Ebola patients in August.

Monrovia/ Health Promotion activities

The outbreak is at a critical stage in Monrovia, with cases remaining stable but vigilance across the city decreasing. As such, health promotion efforts are being streamlined and focused on preventing new infections. Health promotion teams are out in the community engaging in dialogue with interested community members about Ebola as well as running “training for trainers” for community based organisations and other actors, with the aim of continuing to spread correct messaging on Ebola through communities across Monrovia.

Monrovia / Treatment and prevention of malaria

The first round of malaria drug distribution was completed on November 21. In total, more than 500 000 people have received their drugs in four neighbourhoods. The second and last round of the distribution is ongoing and due to be completed on December 19. A distribution of mosquito nets will take place early January.

Rapid response teams / River Cess
There have been no new cases of Ebola in our River Cess intervention for more than the 21 day incubation period and as such, MSF has been handed over the 7 triage centres, set up at local health centres, as well as health promotion activities in the area. Health staff in the area have been trained by MSF to recognise the symptoms of Ebola and to react accordingly. The project has been successfully handed over to Partners in Health this week.

Rapid response teams / Grand Bassa

On the 29th of November, MSF was informed of a single confirmed case and several suspicious deaths in Quewein village, in a remote area of Grand Bassa. Our team reached the area on the 2nd of December and began home care for suspected and probably patients, whilst the set-up of a 12 bed EMC was finalised. In the following days, 31 suspected patients who were well enough to walk the 1.5 hours to waiting ambulances were transferred to ETCs in neighbouring counties.

Of those not well enough to walk out, 18 were tested 14 of which were confirmed). On the 7th of December, all confirmed patients were transferred from home care to the Quewein ETC. The team has ensured the safe burial of 8 people from both the ETU and the community. As of the 17 th of December, there are currently 2 suspect patients undergoing treatment at the centre. There are currently 3 expat staff as well as 15 national staff on the ground in Quewein. Since the team arrived they have referred 39 patients and treated 10 on site.

Foya

After not having had any Ebola patients since October 30th and with new actors arriving in the area to support, MSF’s Ebola Management Center in Foya, Lofa County, has been closed on December 10th. In the lead up to handing the structure back to the NGO Samaritan Purse, MSF invested strongly in health promotion activities and in the training of health staff in the districts of Foya, Kolahun and Vahun. This will ensure a robust response should cases reappear in the area.

Between 2 August and 10 December, 695 patients were admitted to the centre, 384 of whom were confirmed Ebola cases, 154 recovered from the virus and were discharged home.

Sierra Leone

President Koroma launched the ‘Western area surge’ on Dec 16th, an intensified effort to mobilize communities to identify potential Ebola cases and link them with care. The surge focuses on door-to-door social mobilization as well as engagement with community leaders, including government, religious, and tribal groups, as well as youth leaders and women.

The NERC (National Ebola Response Committee), a Presidential task force on Ebola, has initiated a coordination centre to improve communication and collaboration of country-wide and district-level responses.

New Ebola Management Centers (EMC) have been opening and increasing bed capacity to meet the anticipated demand for space as a result of the Western area surge. MSF has opened a new EMC in Freetown on December 9th and another in Magbaruka on Dec 15th.
A wide range of needs are being seen in different areas of the country. While bed capacity was identified as a critical issue in the Western Area, some treatment centres in the rest of Sierra Leone are seeing empty beds, despite having around 40 new positive cases per day nationwide. Moreover, MSF is concerned that access and the coordination of care remains a challenge as patients are being turned away from holding centers or unable to reach or receive a response from the 117 alert operator, when we know there is bed capacity in the EMCs.

For months, MSF teams in Bo and Kailahun have offered knowledge-transfer opportunities through “shadowing” and other engagements. MSF has recently launched a new project to offer more specific, structured, and targeted training opportunities for other organisations needing support in operating case management centres (CMCs) safely.

UNICEF’s Community Care Center (CCC) model was officially launched Dec 16th, and is being rolled out across the country. It provides isolation units in patients’ communities.

Kailahun 

The MSF EMC continues to see a decrease in the number of patients, with only three patients currently in isolation (two suspects and one confirmed). It had been expected that Kailahun could receive more patients from Kono District (a hotspot) but road conditions make other EMCs more accessible - including Kenema and Bo which currently have capacity to assist.

Bo

The MSF EMC in Bo has seen a slow decrease of cases, with an average 46 patients in the ETC and no new admissions for two consecutive days (14-15/12). MSF has started to systematically visit quarantined houses in Bo and in hotspots in the rest of the district, and is working to increase the coordination of the response to alerts.

Magburaka

The EMC opened on Monday (December 15th). The first two patients were admitted on the opening day. During the first stage centre will start with 20 to 30 beds, until eventually scaling up as the needs arise. The Winnipeg Lab is installed in Magburaka and with a turnaround time on lab samples of 4 hours.

 

Freetown/antimalarial distribution

In Freetown MSF completed the first round of house-to-house distributions of antimalarial medication. This initiative reached over 1.5 million people. The second round is scheduled to begin in mid-January.

Freetown/ Prince of Wales secondary school

The new EMC, which has been set up at the centrally located Prince of Wales secondary school, was able to treat its first patients on December 9 – just two weeks after the start of construction. It has a current capacity of 44 beds, more than 50 percent of which are already filled. The plan is to gradually expand to 100 beds in the next 10 days. The center has a mobile lab on premises which currently tests 30 samples per day, and can scale to 50 samples tested per day. Outreach activities are also being set up.

Nigeria

WHO declared 20 October as the official end of the epidemic after 42 days without a case. The MSF intervention has been closed.

Senegal

WHO declared 17 October as the official end of the epidemic after 42 days without a case. The MSF intervention has been closed. MSF’s West Africa Unit (Dakar) will keep in contact with the government for follow up as part of their routine activities.

Democratic Republic of Congo (DRC)

The outbreak in DRC’s Equateur province, which was unrelated to the one in West Africa, was declared over on November 21. Around 60 MSF staff worked on this outbreak and two casemanagement centres were established. The MSF teams have activated an exit plan.

Uganda

On September 29, a case of Marburg fever was declared in Uganda. MSF has helped reinforce local capacities for treating confirmed cases and for infection control. No new cases of the disease have been declared since.

Mali

Mali confirmed its first case of Ebola on 23 October. So far there have been seven reported deaths in the country (five confirmed and two probable). Among the 7 confirmed cases, 5 died and 2 recovered once treated at the EMC. To date, there are only 13 contacts in surveillance as a large number of contacts identified had already finished the 21 days.

In Bamako, MSF is running a case management centre (CMC) in collaboration with CNAM, Mali’s national disease centre. Currently there no patient in the centre, as on the 11th December last patient was discharged. The contacts from this case will finish their observation period of 21 days on 15 December.

MSF has a team in Bamako to help stop the disease spreading further. Even though the current chain of transmission is not likely to continue, there is always a risk of new cases coming from other countries. MSF is making sure that the surveillance / alert system is in place, and is training Malian staff from CNAM to manage Ebola cases, while overseeing the organisation of the intervention teams, ambulance system and safe burials.