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- 09/02/15--22:50: Sierra Leone: Q&A: The Legacy of West Africa’s Ebola Crisis
- 09/03/15--08:39: Sierra Leone: Using solar power to beat Ebola
- 09/03/15--23:29: World: The Challenge of Stability and Security in West Africa
West Africa is making impressive progress in economic growth, democratization and regional cooperation.
While the recent rise in violence and conflict as well as drug trafficking, piracy and extremism have sparked concerns over future development, efforts to build resilience have also improved.
A new study draws lessons from the sub region, emphasizing the importance of development policy in supporting stability to reduce conflict and violence over the long term.
- 09/04/15--23:04: Sierra Leone: Ebola Outbreak Updates – September 4, 2015
- Total Survived and Discharged Cases = 4,047
- New Confirmed cases = 0 as follows:
Kailahun = 0, Kenema = 0, Kono = 0
Bombali = 0, Kambia = 0, Koinadugu = 0, Port Loko =0, Tonkolili = 0
Bo = 0, Bonthe = 0, Moyamba = 0 Pujehun = 0
Western Area Urban = 0, Western Area Rural = 0, Missing = 0
- 09/05/15--23:45: Sierra Leone: Sierra Leone: Bo District Reference Map (28 July 2015)
Dr Margaret Chan
Director-General of the World Health Organization
Presentation at the Institute of Medicine workshop on global governance for health: WHO views 18 months after the outbreak was reported
London, United Kingdom
1 September 2015
Distinguished experts, colleagues in public health, ladies and gentlemen,
I thank the Institute of Medicine for organizing this workshop and bringing together so many well-known experts representing such a wide range of disciplines. Together, we need to explore every avenue for upgrading the world’s outbreak preparedness and response capacities.
I will be giving you an outline of weaknesses and shortcomings revealed by the outbreak, an overview of some specific challenges all responders faced, and a discussion of some successes as well as setbacks.
Ladies and gentlemen,
I have been asked to speak about the views of WHO 18 months after the outbreak was reported in March of last year. Our views go back further, to the events that followed the occurrence of the first case, in a remote village in Guinea, in December 2013.
The virus circulated for nearly three months, undetected, off every radar screen, initially misdiagnosed as cholera, then later thought to be Lassa fever, a viral haemorrhagic fever that is endemic in that part of Africa.
In Liberia and Sierra Leone, the virus also circulated undetected for several weeks, gaining a head-start with explosive momentum. National and international responses ran behind the virus and did not begin to catch up until late October of last year.
This is the first point I want to make. No regime for global governance can manage the invisible.
The first core capacity required to implement the International Health Regulations is an ability to “detect events involving disease or death above expected levels for the particular time and place in all areas within the territory.”
But how can countries that routinely experience deaths from diseases like malaria, Lassa fever, yellow fever, typhoid fever, dengue, and cholera recognize an unusual event in the midst of all this background noise from diseases with similar early symptoms? This is another fundamental problem that stands in the way of early detection and response.
Ladies and gentlemen,
This is the second point I want to make. The IHR have not performed as intended.
A key objective when revising the IHR was to move away from a passive approach to controlling epidemic spread at borders to a proactive approach that could detect an event early and contain it, before it had a chance to spread internationally.
That objective was justified, as WHO and its partners had contained hundreds of outbreaks, also of Ebola, at source, with little or no international spread, for more than a decade.
However, as we have learned, this proactive approach works only when countries have core capacities for early detection, timely notification, and response in place.
The importance of having this capacity in place was well-illustrated when Nigeria, Senegal, and Mali experienced their first imported cases. They caught the first case quickly, launched an emergency response, and stopped onward transmission entirely or held it to just 20 cases.
Recent expert groups convened by WHO have identified three main weaknesses of the IHR.
First, compliance with the obligation to build core capacities for event detection and response has been dismal. Eight years after the IHR came into force, fewer than a third of WHO Member States meet the minimum requirements for core capacities to implement the IHR.
Second, many countries imposed measures, such as restrictions on travel and trade, that went well beyond the temporary recommendations issued by the Emergency Committee last August.
The third weakness is the absence of a formal alert level of health risk other than the declaration of a public health emergency of international concern.
Last week, I convened a Review Committee to assess the performance of the IHR during the Ebola outbreak and advise me on changes needed, both immediately and longer-term through possible amendments. This advice will feed into a number of reforms currently under way at WHO.
I am personally overseeing changes that include the establishment of a global health emergency workforce, a new emergency programme with an operational platform that can shift into high gear quickly, performance benchmarks that show exactly what is meant by “high gear”, and the funding needed to make this happen.
Ladies and gentlemen,
Looking back, the perception of the outbreak at WHO is that of a steep uphill struggle, with many barriers along the way. The challenges faced fall into three broad categories.
First, the absence of national detection and response capacities at nearly every level of the health system, compounded by poorly functioning transportation and communication infrastructures.
Second, the weak preparedness and response capacities within the international community, including extremely limited surge capacity.
And third, the many tensions that arise between the sovereign right of nations to govern what happens in their territories and the need for solidarity and collective action against a shared threat.
A disease like Ebola will expose every gap in health system capacity and exploit every opportunity opened by these gaps.
At the start of the outbreak, the three countries had only one to two doctors per 100,000 population. Hospitals had no isolation wards, no culture of infection prevention and control, and frequently no electricity or running water.
Systems for data collection were rudimentary, fragmented, paper-driven, and designed for monthly, not daily, reporting. Only one laboratory in the region was equipped to diagnose viral haemorrhagic fevers. Waiting a week or more for test results was the norm.
Even after the arrival of mobile labs, services were frequently overwhelmed. Backlogs in testing left gaps of a week or more when the picture of the outbreak’s evolution went blank. Hundreds of suspected and probable cases were never tested.
Populations mistrusted the government, its health system, and its staff, and preferred to seek care from traditional healers. They did not welcome teams of foreign responders and resisted their presence, often violently.
Road transportation, whether of patients or diagnostic samples, was primitive, greatly increasing the time needed to reach treatment centres or carry laboratory samples and results back and forth.
Because of the severe shortage of treatment beds, people suffering from common and treatable diseases, like malaria, were held together with very ill Ebola patients in crowded facilities, forced to wait a week or even longer for diagnostic results. The risk of getting infected under such conditions was extremely high.
The international community was also poorly prepared. Though Ebola had been known for nearly four decades, no vaccines, point-of-care diagnostic tests, or treatments beyond supportive care were available.
As Ebola had previously been a rare disease, expertise was in short supply. All responders had trouble finding sufficient numbers of experienced clinicians and epidemiologists. Previously, no clinical teams, apart from those provided by MSF or deployed under the WHO GOARN umbrella, had responded to an Ebola outbreak.
Many agencies and organizations, in their great desire to help, took on roles that went well beyond their mandates and previous experience. Those with no experience in the clinical management of Ebola took several months to become operational.
For a time, MSF, WHO staff, Samaritans Purse, and some brave teams from Uganda employed by WHO, worked on alone, shoulder to shoulder with heroic health workers in the three countries. More than 500 of them lost their lives.
Apart from the shortage of expertise, one of the biggest barriers to staffing treatment centres was the absence of referral care for ill and possibly infected health workers. Medical evacuation by air was complicated for multiple reasons, and this difficulty deterred several countries from sending medical teams.
As case incidence began to grow exponentially, no one could build treatment facilities fast enough. In September of last year, MSF announced that its capacities in Liberia were overwhelmed and began turning patients away.
No internationally agreed procedures were in place for coordinating the activities of the multiple response teams that eventually arrived.
The problems created by the tensions between the rights of sovereign states and the need for global solidarity are likely the most difficult to address.
Let me give some examples that we in WHO encountered. A WHO GOARN team was assembled, equipped, and ready to travel. The government refused to issue visas.
Our efforts to quickly put WHO country offices on an emergency footing were frustrated by one government’s insistence on reviewing and approving my hand-picked appointments. Some were initially refused, and this led to a loss of precious time.
In another case, one government abruptly decided to report only confirmed cases, and not suspected and probable cases, as required by WHO. That decision shut our eyes to what was really happening in the country.
Much has been written about the extraordinary population mobility in the three countries. People readily cross porous borders. Contact tracing teams do not.
Many countries imposed travel restrictions that isolated the three countries and vastly increased their hardship. Several airlines suspended flights to West Africa. This impeded the arrival of desperately needed response teams, equipment, and humanitarian aid.
Let me remind you. It is not the ministry of health that takes the decision to seal a border, cancel visas, or prohibit an airplane carrying an Ebola patient from passing over its airspace or landing for refuelling.
As a final example, WHO advised against certain extreme control measures, as evidence strongly suggested they would be counter-productive. WHO can advise, but we cannot interfere. No external authority can dictate what happens within a sovereign state.
Ladies and gentlemen,
One of the objectives of this workshop is to improve the resilience of the global health infrastructure to future outbreaks and emergencies. In this context, a final observation may be helpful.
We did indeed manage to climb that steep and slippery slope.
Leadership, including command and control, by the presidents of the three countries was decisive.
Community engagement was decisive. The distribution of messages and leaflets does not win the cooperation of communities. This happens when communities understand and own the problem, and carve out their own socially and culturally acceptable solutions. For example, when communities worked out their own way to separate the sick from the healthy, that solution was far more effective than quarantines enforced by armed military personnel.
With 32 labs deployed to the three countries and Nigeria, the speed and precision of diagnostic testing eventually approached that on offer in wealthy countries. Most labs deliver results within 24 hours.
With support from CDC, WHO and others, data collection and reporting improved considerably, but is still far from perfect.
The number of treatment beds grew fairly rapidly until it became more than sufficient. When building treatment centres in Liberia, WHO developed a prototype floor plan that maximized safety for patients and care providers. The floor plan was then used by UK and US military personnel to construct additional treatment centres.
To reduce some of the chaos of uncoordinated and sometimes inappropriate assistance, we made an inventory of the qualifications and skills of foreign medical teams and developed a register, so that needs during the next outbreak can be matched with the most appropriate teams. This, too, saves time.
Ebola-specific specifications were developed for personal protective equipment. WHO brought manufacturers together with experienced clinicians to select the best designs that offered maximum protection, yet allowed clinicians to work in reasonable comfort under hot and humid conditions.
The world is on the verge of having a safe and effective vaccine. We have pre-qualified four rapid point-of-care diagnostic tests. We are developing a blueprint, with generic clinical trial protocols and arrangements for fast-track regulatory approval, to expedite the development of new medical products during the next emergency.
As we moved into the final phase of tracking the last cases and breaking the last transmission chains, WHO deployed nearly 1000 staff to 68 field sites in the three countries.
The outbreak is not yet over, but we are nearly there.
All of these achievements were made possible by the unprecedented collaboration of multiple partners. As just one example, laboratory support involved collaboration with 19 institutions and partners in two major networks.
At the same time, as the head of the World Health Organization, I do not want this distinguished audience to leave with the impression that this Organization showed no leadership. This is certainly the impression created by the narrative in most media reports.
We were slow at the start, but we made quick course corrections. These changes created many of the conditions that made it possible for multiple responders, national and international, to work to their full advantage.
Ladies and gentlemen,
Managing the global regime for controlling the international spread of disease is a central and historical responsibility of WHO. We have much experience and many networks of collaborating laboratories and institutional partners that kick in and work well for well-known epidemic-prone diseases.
However, these assets are insufficient to manage a disease event that is unexpected, severe, and sustained. As I said, we need to explore together every avenue for upgrading the world’s outbreak preparedness and response capacities.
I have a final comment. Informal arrangements exist between WHO and the UN Secretary-General for activating all assets within the UN system to address an urgent health problem.
Previous triggers include the threat from H5N1 avian influenza, the 2009 influenza pandemic and, of course, the Ebola outbreak in West Africa.
These arrangements can be formalized. Triggers can be more precisely defined, so that UN assets kick in quickly. This is one proposal for strengthening global governance for health that can move forward rapidly.
Posted by Clara Wagner on Tuesday, August 25th 2015
In this Q&A series, we are profiling the experts who have worked tirelessly to stop the spread of the deadly Ebola virus in West Africa and are helping societies rebuild and strengthen health systems in the aftermath of the outbreak.
Denise Rollins, the senior coordinator of the Africa Ebola Unit, has worked at USAID for 28 years. She rejoined USAID in March after retiring last October because she felt a tremendous commitment to help those in need. She is USAID’s liaison coordinating with other U.S. Government agencies to help West African countries strengthen their ability to respond to future disasters.
What will the legacy of Ebola be in the countries affected by it?
Ebola has changed the lives of those affected by the virus and those who helped fight the disease. Ebola has left behind pain, sadness and death; we cannot keep our heads in the sand knowing what we now know about the disease.
However, as these countries get to and remain at zero, the international community will help build more enduring social and economic systems that will allow the countries to handle not only Ebola, but other infectious diseases, as well. We will once again see progress in health, agriculture, education and the overall economy. While Ebola leaves a legacy of caution and preparedness, it also gives us a future based on hope and resilience.
In July, USAID and other donor partners and governments gathered at the International Ebola Recovery Conference held at the UN. What are your thoughts on the conference?
The conference was a platform for representatives of Guinea, Liberia, Sierra Leone and the Mano River Union to outline their recovery strategies, and for the UN to foster a dialogue between the African countries and the donor community about recovery priorities and expectations.
Donors then pledged an unprecedented $3.4 billion in new funding, with the United States pledging $266 million, in addition to the $1.8 billion already provided for the response efforts. This brings the total pledged for response and recovery to more than $5.2 billion from the donor community.
This was a great step forward in a global call to action that will lead to the creation of more resilient societies in Africa.
What made the Ebola crisis different from past health crises?
The large number of people dying, the rapid spread of the virus, and an initial inability to treat patients made this crisis different. In terms of geography, Ebola reached bustling capitals and heavily populated cities, leading to a faster rate of transmission. Misunderstandings and lack of information about the disease also increased fear and panic, causing some victims to avoid reporting their illness. We have never seen a humanitarian public health crisis quite like this one.
What role has communications played in controlling Ebola?
Due to pre-existing issues with digital and communications infrastructure, it was hard to share information about the disease during the crisis. It was difficult to control the outbreak without accurate and timely information to detect Ebola, trace contacts of people who were infected, organize patients’ transport to treatment centers, and coordinate teams to conduct safe burials. Poor information hampered our ability to understand where the outbreak was occurring.
In Liberia, USAID sent a data logistician to serve on the Disaster Assistance Response Team to develop a better data sharing platform. He helped significantly reduce the time it took to get information from outlying areas to the capital. USAID is working with all three countries on improving data and communication technologies.
We are also strengthening public and private partnerships to bring low-cost Internet and mobile phone service to urban and lower-income, rural settings.
How are we helping to strengthen governance?
USAID is expanding the roles of community groups, NGOs and civil society to manage the effects of Ebola and more effectively work with the government to improve the quality of public services.
Our plan includes help with reopening schools, empowering civil society, and supporting open data policies and using technology for government services and information.
Interest in Ebola has been declining as the situation improves. Why are our response efforts still important?
The focus of the response continues to be ending the Ebola epidemic. While there is Ebola in West Africa, nothing prevents it from entering the United States, so this is a matter of national security.
In terms of the countries themselves, Ebola quickly damaged weak institutions, disrupted vulnerable communities and stymied health systems’ ability to address other infectious diseases or basic health care. We strive to rebuild and strengthen health systems there to enable societies to fend off future threats, while making sure those who’ve experienced setbacks can return to a path of prosperity.
These efforts are core to USAID’s mission to end extreme poverty and promote resilient, democratic societies.
Amid the Ebola crisis, many stories have emerged describing heroic aid efforts and acts of bravery. What stories touched you most?
Access to education and the preservation of arts and culture are important to me, so I was heartened to hear stories of children in Sierra Leone eagerly tuning in to an education radio program; of an American artist who stuck photos of smiling health workers on their protective suits so patients could see who was underneath the mask; of actors, taxi drivers, traditional leaders and musicians working together to raise awareness and stop Ebola.
By: Alif Iman Nurlambang, IFRC
Isatu Kamara could not attend the community meeting in her village. The location was not far, just about 400 metres away. But her home was full with the red line. Her family had been quarantined because of Ebola.
Isatu and her family live in Mamusa in Port Loko, a previous hot spot for the deadly virus. A few days earlier, her neighbour had died of Ebola. Isatu and her family had had contact with the neighbour, and, as a result, were told to stay home, along with 15 other families in the village. A total of 134 people were quarantined in their own homes for the next 21 days. “The figure includes 40 students of the local primary and secondary schools,” said Albert Kamara, Principal of Amazonian Secondary School.
The community meeting was conducted by beneficiary communications volunteers with the Sierra Leone Red Cross Society. Attended by 180 people including youth and elders, men, women, village heads, religious leaders, school principals, and the heads of women’s groups, the meeting was to discuss what the community could do to act together to free people from Ebola. Instead of talking at the community members, the Red Cross volunteers asked questions, aiming to give a voice to the people.
“The days of one-way communication have ended,” said Patrick Massaquoi, beneficiary communication manager of the Sierra Leone Red Cross Society. “We have heard from communities that local practices such as conducting traditional burials are very important. So now we work with them to find a viable solution that will allow families to grieve their loved ones while at the same time preventing the further spread of Ebola.”
Before the meeting, Red Cross volunteers visited several villages and, using mobile loudspeakers, announced the event which would also be broadcast on radio.
Radio, a popular medium
Radio is a medium that can reach the most people in Sierra Leone. Statistics indicate that 80 per cent of people across the country have access to one. Television is still a very expensive item, electricity is scarce, and many do not read newspapers because the illiteracy rate is high. But people also need to buy batteries for the radio which creates an additional financial burden for each struggling family. To address this, the Red Cross recently distributed 3,000 radios to various communities in all 14 districts of the country. The radios are solar powered and wind-up. With solar energy abundant in Sierra Leone, like many regions in Africa, it made handing out radios the most sensible option.
Isatu, who did not have a radio, received one from the Red Cross and despite being in quarantine, she sat on the front porch of her house, cranked the radio and listened in on the community meeting.
“When the night comes, we also utilize the radio as a flashlight to look for something in the dark,” said Isatu. Indeed, this tiny radio can also be used to charge mobile phones, although Isatu and her family do not yet have one.
In the neighbouring village of Komrabai, the Red Cross programme was also heard, however, the Red Cross did not have enough radios for everyone, but still wanted to ensure the proper Ebola messages were being heard by all. To cover this gap, volunteers formed groups of listeners in the village while distributing the radios they did have, so that they could be used by more than one family. Now, the villagers regularly listen to the weekly Red Cross talk show and radio drama programmes.
The radios are proving popular and they are being put to good use. On the day of that meeting in Isatu’s village, a listener’s group in the neighbouring community gathered around the chief’s radio. They listened in, and then, as the Red Cross theatre group took the floor to close the meeting, this listener’s group got to their feet, dancing and singing a local song, “Se tama neday til hoo, manie nu bor.
The Ebola virus disease (Ebola) outbreak in West Africa began in late 2013 in Guinea (1) and spread unchecked during early 2014. By mid-2014, it had become the first Ebola epidemic ever documented. Transmission was occurring in multiple districts of Guinea, Liberia, and Sierra Leone, and for the first time, in capital cities (2). On August 8, 2014, the World Health Organization (WHO) declared the outbreak to be a Public Health Emergency of International Concern (3). Ministries of Health, with assistance from multinational collaborators, have reduced Ebola transmission, and the number of cases is now declining. While Liberia has not reported a case since July 12, 2015, transmission has continued in Guinea and Sierra Leone, although the numbers of cases reported are at the lowest point in a year. In August 2015, Guinea and Sierra Leone reported 10 and four confirmed cases, respectively, compared with a peak of 526 (Guinea) and 1,997 (Sierra Leone) in November 2014. This report details the current situation in Guinea and Sierra Leone, outlines strategies to interrupt transmission, and highlights the need to maintain public health response capacity and vigilance for new cases at this critical time to end the outbreak.
Data on reported Ebola cases from January 2014 through August 30, 2015 were obtained from daily situation reports from each country, supplemented by information from Guinea's viral hemorrhagic fever database. Individual case reports were obtained from in-country field investigators. In Sierra Leone, 13,609 cases (8,698 [63.9%] confirmed) with 3,953 (29.0%) deaths were reported (Figure 1). All 14 districts reported at least one confirmed case. During August 2015, Sierra Leone had a 22-day interval without a reported case, but on August 29, a new confirmed case in an adult female was reported as a community death in Kambia District. The source of this case is under investigation. During November 2014, an average of 15,361 identified contacts needed to be visited daily; during August 1–30, 2015, the average number of contacts followed was 334. In Guinea, 3,792 cases (3,337 [88.0%] confirmed) and 2,529 (66.7%) deaths were reported (Figure 1); 26 (79%) of 33 prefectures reported at least one confirmed case, but as of August 30, active cases were reported only in Forécariah and Dubreka prefectures and in the capital city Conakry (Figure 2). At the peak of the outbreak (November 2014), an average of 3,394 identified contacts needed to be visited daily; during August 1–30, 2015, the average number of contacts being followed was 728.
Despite progress in controlling the outbreak, a number of factors have led to ongoing transmission. Cases should be recognized and isolated quickly, and should arise from among known Ebola contacts. During the peak of the outbreak in Guinea, patients were isolated an average of 5.0 days after symptom onset. During August 2015, some patients with confirmed Ebola died in the community as unknown contacts (two patients), were known contacts lost to follow-up (one patient), or were isolated in an Ebola treatment unit (seven patients) an average of 3.3 days following symptom onset, suggesting that identification and monitoring of all contacts remains challenging.
Recent Case Reports, 2015
In August 2015, inability to find a known contact led to ongoing transmission in Guinea. A medical student who did not report his Ebola exposure and did not adhere to contact follow-up procedures was admitted to a hospital in Conakry, where he shared a room with another patient. Before receiving a diagnosis of Ebola, the medical student was assisted by one of his roommate's visitors. When Ebola was diagnosed in the medical student, the roommate's visitor and his family could not initially be found, despite intensive efforts at contact tracing. The roommate's visitor subsequently developed Ebola, visited multiple doctors and hospitals via 12 taxis, and transmitted Ebola to his mother, a cousin, another person, and a taxi driver.
Deliberate evasion of disease control interventions can hamper monitoring of contacts and identification of cases. In late July, on day 4 of contact monitoring, a female contact of an Ebola patient in Conakry stopped adhering to provisions of the 21-day period of close community monitoring. The contact left the community and traveled widely through several areas of the adjacent Forécariah prefecture by multiple motorcycle taxis. She visited a traditional healer and might have crossed into Sierra Leone before Ebola was diagnosed and she was isolated in an Ebola treatment unit on day 16. Contact identification for this patient was particularly challenging, because she provided inconsistent information.
Obscure transmission chains might reveal weaknesses in surveillance or hidden reservoirs of disease. In August 2015, an Ebola case was diagnosed through routine postmortem swab surveillance in Forécariah prefecture. Although health officials initially thought this case resulted from contact with a recently deceased relative who was buried secretly, molecular sequencing demonstrated a likely chain of transmission from a different community.
Delayed consideration of Ebola as a cause of illness or death and delayed isolation of persons with illness that meets the suspected Ebola case definition can lead to transmission and sometimes reintroduction of the virus into areas where transmission was previously interrupted. In late July, a man traveled from Freetown to Tonkolili District in Sierra Leone for a religious event. He sought care at two facilities, where he potentially exposed many health care workers and ultimately died. Ebola was confirmed by postmortem swab, ending the district's 150-day period without an Ebola case.
Active case ascertainment, investigation, and daily interaction with all known contacts, combined with community engagement, safe burials, robust laboratory support (including genetic sequencing), and social mobilization are all tools for controlling Ebola in West Africa. In Guinea, social anthropologists have been engaged to create locally appropriate interventions, enhance adherence, and overcome barriers to effective disease control. Ebola transmission in Guinea and Sierra Leone has slowed, and the number of patients has fallen to record low levels, suggesting that containment is achievable. If all contacts of an Ebola patient are identified and monitored, then the population at risk can be defined, and new cases can be rapidly diagnosed and isolated; the number of contacts to be monitored is reduced by rapid isolation of the patient, before transmission occurs. Thus, the proportion of new cases that arises among monitored contacts is a key indication of program effectiveness.
Ensuring that contacts of patients with Ebola are monitored for a full 21 days after their last exposure is among the most important aspects of effective Ebola control. Over time, in both Guinea and Sierra Leone, emphasis has shifted from efforts to enforce cooperation toward efforts to support identified contacts to ensure that they are able and willing to cooperate with monitoring. In April, Sierra Leone implemented voluntary quarantine for contacts in a housing facility with nutritional and social support, in lieu of home quarantine. In June, Guinea began to implement a strategy termed "cerclage," triggered by 1) an Ebola case, 2) a death with a positive postmortem swab, or 3) identification of two or more probable cases in populations of ≤300 persons. Cerclage incorporates movement restrictions based upon risk classifications of individual community members; ensures provision of health care services, food, and other commodities; and is supported by awareness and educational campaigns. Local police assist with coordination, and although monitored contacts are asked not to leave the general area, they are permitted to move within the area, for example, to tend crops. Symptomatic patients with suspected Ebola are sent to the nearest Ebola treatment unit for isolation and testing as needed.
In June, 2015, Sierra Leone began two parallel 21-day campaigns to apply maximum resources to Port Loko and Kambia, and to Western Urban and Rural districts to identify, contain, and stop the spread of Ebola. Components included enhanced community engagement activities, checkpoints with hand washing and temperature screening, improved referral practices at high-risk health care facilities, and delivery of health care services and support packages to quarantined households.
Because the symptoms of Ebola are similar to those of diseases more common in West Africa such as malaria and typhoid fever, it is essential that health care providers have a high index of suspicion for Ebola and identify cases rapidly in health care settings. This is simplified when new cases arise from among contacts. But because patients with Ebola might not seek health care or might not receive a diagnosis, complete case ascertainment also requires monitoring of deaths. Safe burials are mandated for deaths in Guinea and Sierra Leone; however, this requirement is difficult to enforce, and traditional practice frequently leads to secret burials or unsafe manipulation of the body before safe-burial teams arrive (4). In Guinea, a plan to pilot newly available rapid diagnostic tests for decedents could permit routine burial practices for those testing negative, thus reducing reluctance to report community deaths.
On April 1, 2015, WHO and partners began an Ebola ring vaccination trial in Guinea to evaluate the efficacy of a recombinant, replication-competent vesicular stomatitis virus-based vaccine expressing a surface glycoprotein of Ebola virus (rVSV-ZEBOV) (5). Preliminary results suggest that the vaccine is safe and efficacious (6). The trial is expanding into Sierra Leone.
Epidemiologic milestones are recognized at 21 days (the maximum Ebola incubation period) and 42 days (twice the maximum incubation period) without known transmission within a given geographic area. However, achieving these milestones does not assure the end of the Ebola outbreak; WHO recommends an additional 90 days of heightened surveillance, given the risk for missed transmission chains, new introductions, possible sexual or reproductive transmission, or possible new emergence from an animal reservoir (7). CDC and its partners are investigating how long viable Ebola virus persists in semen. Ebola virus has been isolated from semen at 82 days and viral RNA detected at 101 days after symptom onset (8); sexual transmission is a possible source of infection in the weeks and months after recovery (9).
Current control strategies in Sierra Leone and Guinea have markedly reduced transmission, but ongoing enhanced surveillance and rapid response capability are needed, both to recognize ongoing transmission or reintroduction from persistent reservoirs and to respond to resurgent disease in the future.
1CDC Sierra Leone Response Team; 2CDC Guinea Response Team; 3Sierra Leone Ministry of Health and Sanitation; 4National Coordination Cell in the Fight against Ebola, Ministry of Health, Guinea; 5World Health Organization, Sierra Leone. *These authors contributed equally to this report. Corresponding author: Kathryn Arnold, email@example.com, 404-421-7458.
Learning from West Africa to Build Stability and Security
What do Sierra Leone, Liberia, and Côte d'Ivoire have in common? They are all countries in West Africa that have successfully exited from civil war and large-scale conflicts, offering lessons in building resilience.
The recent Ebola outbreak provided a tragic reminder of the long-term consequences of conflict in this sub region, but overall, West Africa has suffered fewer casualties from conflicts over the past 60 years than any other part of Sub-Saharan Africa.
In addition to the critical role of strong leadership, their experiences highlight the importance of development organizations in helping to rebuild institutions and address grievances in the aftermath of conflict or political turmoil.
“It is more important than ever for governments and their development partners to draw lessons on the dynamics of resilience to violence and conflict from the experiences of countries in West Africa,” said Alexandre Marc, Chief Specialist for Fragility, Conflict and Violence, World Bank.
To support these efforts, a new study “The Challenge of Stability and Security in West Africa” captures lessons and analyzes the drivers of conflict and violence to make recommendations on how to improve the way development partners can support stability.
The study comes at a critical time for West Africa. In recent decades, the sub region has moved ahead making strides in democratic consolidation, economic growth, and regional cooperation, boasting some of the most stable countries in Africa. But future progress could be undermined unless development policies take a strong role in fostering stability.
According to the study, while large-scale conflicts and wars have receded in West Africa, a new generation of threats has emerged over the past few years, including drug trafficking, maritime piracy and extremism – suggesting that the nature of violence is changing.
For example, progress in democratization that began in the 1990s has enabled power transfer through elections, not military coups. However, this has also led to an increase in election-related violence, precipitated by greater political competition among ethnic or religious constituencies. Countries of the region are working to address this challenge, including efforts by civil society organizations to deploy election monitors and develop a guide to manage election disputes.
Critical areas identified by the study to improve stability and peace in the long term include:
1) directing development efforts to lagging regions,
2) strengthening local governance especially in the framework of policies promoting decentralization,
3) improving land management,
4) reducing grievances around the management of extractives,
5) improving the management of migrations and the rights of migrants,
6) improving prospects for youth especially making them more active actors in society,
7) supporting security sector reform and strengthening justice and the rule of law.
The challenges are complex, and require coordination and sustained engagement over long periods of time.
“Development policies are a central part of peacebuilding and stability efforts, because economic and social development is critical to reducing tensions linked to grievances whether over exclusion or unequal access to resources,” said Marc, the main author of the study. “Focusing on strengthening stability as an important objective of development policy will help to reduce conflict and violence in the long term.”
Freetown, Sierra Leone | Friday 9/4/2015 - 13:15 GMT
A village of almost 1,000 people has been placed in quarantine in Sierra Leone after the death of a 67-year-old woman from Ebola, officials said on Friday.
The three-week lockdown comes after officials announced on Tuesday that the food trader had died in Sella Kafta village in the northern district of Kambia, after being sick for up to 10 days without the authorities' knowledge.
"Over 970 people are being monitored under quarantine as there is information that they had had some contact with the deceased woman who tested positive after her death," the district Ebola response office said in a report distributed to reporters.
"From those under quarantine, 48 are considered as high risk and they are in various holding centres in the district and not treatment centres, as none of them have exhibited any signs and symptoms of Ebola."
Kambia chief administrator Alhaji Abu Bangura told the local Africa Independent Radio station that the district was on "high alert" to ensure the virus did not spread.
The death brought to an abrupt end the optimism sparked by the release of Sierra Leone's last known Ebola patient from hospital in the central city of Makeni last week.
The latest victim had not travelled to either Liberia or Guinea, two other countries hit by the worst outbreak of Ebola in history, which has killed some 11,300 people since first emerging in December 2013 in Guinea.
News of the new Ebola death came as a new school year got underway Monday, with measures in place to try to prevent the spread of the virus.
Schools were closed for more than eight months at the height of the Ebola outbreak.
© 1994-2015 Agence France-Presse
Freetown, Sept. 3, 2015 (MOHS) – As President, Dr. Ernest Bai Koroma launches Health Recovery Agenda, big boosts for Government hospitals countrywide.
A key component of restoring basic health services is the referral system. The Ministry of Health and Sanitation has announced the distribution of Thirty Five (35) brand new Ambulances to all government hospitals nationwide amidst excitement and relief from District Medical Officers, Medical Superintendents, and Matrons.
The health sector in Sierra Leone was doing reasonably well prior to the outbreak of the dreadful Ebola Virus Disease (EVD) that has claimed thousands of lives. According to the 2013 Demographic and Health Survey (DHS) when compared to that of 2008; women in Sierra Leone were found to have an average of 4.8 children. This new figure represents a drop of 0.3 when compared to the figure of 5.1 in 2008. Modern contraception among married women doubled from 7% in 2008 to 16% in 2013. This means more and more women are able to plan their families to suit their current circumstances.
Six in ten births are attended by a skilled birth provider, vaccination coverage increased form 40% to sixty-eight per cent. Neonatal Mortality Rate dropped from 46/1000 live births to 29/1000 live births. Infant Mortality Rate dropped from 127/1000 live births to 92/1000 live births, and Under-five mortality rate dropped from 194/1000 live births to 156/1000 live births.
It was in the height of these gains that the EVD struck and threatens to reverse all the impressive in-roads. The Ministry of Health and Sanitation has developed a five-year Health Sector Recovery Plan (HSRP). At the moment His Excellency the President Dr Ernest Bai Koroma is focusing his attention in two key priority areas of the Health Sector Recovery Plan. These are ensuring that all health facilities are safe for both patients and health workers and restoring essential health services to the pre-EVD level. These two objectives have been identified as the most crucial ones for now and have been prioritised in the early recovery period which started in July and ends in March.
The Ministry of Health and Sanitation continues to make significant in-roads on both fronts. There has been a significant reduction in the rate of hospital acquired EVD infection among health workers. A pointer to the fact that health workers are becoming ever increasingly conscious of infection prevention and safety procedures in the work place and are taking all necessary steps to protect themselves and the patients. Moreover there is a steady increase in the number of health facilities opening for business and in the number of people attending health facilities now compared to the attendance at the height of the Ebola Virus Disease. These observations are strong indicators that the President is achieving his short term objectives of promoting safe working environments and restoring basic health services.