On Monday 25 May 2014, the Government of Sierra Leone through the Ministry of Health and Sanitation declared an outbreak of Ebola Virus Disease (EVD) in Sierra Leone following the laboratory confirmation of a suspected case from Kailahun district. This outbreak appears to be a spillover from the on-going outbreak in Guinea and Liberia since March 2014. As of 28 September 2014, the cumulative number of laboratory confirmed cases are 2090, with 552 confirmed deaths and a Case Fatality Rate (CFR) of 25% in twelve districts (Kailahun, Kenema, Kambia, Port Loko, Bo, Bonthe, Bombali, Tonkolili, Kono, Phjehun, Moyamba and Western Area)1 . On 30July 2014, the President of Sierra Leone announced a national health emergency. A Presidential Taskforce on Ebola has been established to lead the response. On the same day, the Sierra Leone Accelerate Ebola Virus Disease Outbreak Response Plan was launched. The National operational plan was also developed with the goal to reduce morbidity and mortality due to Ebola through prompt identification, notification and effective management of cases, effective social mobilization and coordination of the epidemic response activities.
According to the Sierra Leone Accelerated Ebola Virus Disease Outbreak Response Plan, major challenges contributing to the on-going outbreak include:
Inadequate understanding within the communities of the EVD as this is the first major outbreak reported in the country
Lack of experience among health care workers and limited capacities for rapid response
High exposure to Ebola virus in the communities through household care and customary burial procedures. This has resulted in a high level of community deaths leading to panic and anxiety
Denial, mistrust and rejection of proposed public health interventions arising from misinterpretation of the cause of the new disease
Fear of the disease by frontline health workers leading to either suboptimal care for patients or substandard implementation of protective measures
Close community ties and movement within and across borders has led to difficulties in tracing and following up of contacts for the three countries
The magnitude and the geographical extent of the EVD outbreak in the country require significant and robust response capacities and structures. This outbreak poses serious challenges in terms of human capacity, financial, operational and logistics requirements and threatens national and international health.
In response to these challenges, the Ebola Operations Centre (EOC), a coordination body spearheading the Ebola response was established. The EOC serves as the Sierra Leone National Central Command and Control Center for Outbreak Response activities. The District Level Ebola Operations Centers (DEOCs) were also established at all districts to coordinate response activities at district level. The National Ebola Taskforce contains four pillars which correspond to the following thematic areas: 1) Coordination/finance/logistics; 2) Epidemiology/ surveillance and laboratory; 3) Case management, infection control and psychosocial support; and 4) Social mobilization/public information.