The World Health Organization has released their fifth weekly detailed Ebola Response Roadmap, and the trends continue to show the situation in Liberia and Sierra Leone to be dire. Although the last reporting week shows a modest drop in the number of new cases, the WHO believes this to be a reporting artifact, and not a true reflection of conditions on the ground.
Of additional concern, a fresh analysis shows that the number of healthcare workers infected (and killed) by the Ebola virus is higher than previously reported – particularly in Sierra Leone. The WHO adds that:
It is important to emphasize that the additional HCW infections and deaths occurred throughout the course of the outbreak. Any cases of EVD in HCWs are of great concern, but there is currently no evidence to suggest a recent increase in the incidence of infections of HCWs.
As bad as the latest numbers are (6242 cases, 2909 deaths) there continues to be sizable gaps in both surveillance and reporting from the region, and the true extent and burden of this epidemic are not well defined. In Liberia – despite some apparent reporting problems this week – the number of new cases reported over the past 21 days (n=1707) represents more than half of all of the cases reported to date.
And while we tally Ebola cases and fatalities, uncounted are those that fall into the `collateral damage’ category; including the 9 Ebola Aid workers who were murdered, others who have been injured or killed providing aid or as a result of the lockdowns, and countless more denied basic medical care because many hospitals in these countries have essentially collapsed.
The full extent of this tragedy may never be fully known, and that impact is only likely to grow over the next few months. Some excerpts from today’s report – but follow the link to download the full PDF.
24 September 2014
1. COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
The upward epidemic trend continues in Sierra Leone and most probably also in Liberia. However, the situation in Guinea, although still of grave concern, appears to have stabilized: between 75 and 100 new confirmed cases have been reported in each of the past five week.
The situation in Guinea remains stable, with between 82 and 102 new confirmed and probable cases reported in each of the past five weeks (figure 2). Unlike the capitals of Liberia and Sierra Leone, transmission in the Guinean capital, Conakry, remains stable and moderate, with 3–15 newly reported cases each week. In Gueckedou, which was the origin of the outbreak, between 10 and 20 cases have been reported in each of the previous 30 weeks. Macenta, which borders Gueckedou, has continued to report a high number of new cases (37–70) for the past five weeks.
The fall in the number of new cases shown in figure 1 is largely attributable to a sharp drop in the number of confirmed new cases reported from Liberia. Notably, there were no new reported confirmed cases from the capital, Monrovia, which in previous weeks has reported a surge in cases. These data differ from credible reports obtained from responders in Liberia, who indicate a deterioration of the situation in the country, and in Monrovia in particular. In addition, there have been a large number of suspected new cases (and deaths among suspected cases) reported from Liberia over the past week, which are not included in Figure 1, but are set out in table 1.
It is very likely that a substantial proportion of these suspected cases are genuine cases of EVD, and that the reported fall in confirmed cases reflects delays in matching laboratory results with clinical surveillance data. Efforts are being made to urgently address this problem, and it is likely that the figures will be revised upwards in due course. At the present time, the numbers of probable and suspected cases, together with those confirmed, may be a more accurate reflection of case numbers in Liberia. An upward revision of the figures, particularly confirmed cases, is likely to follow in due course. Elsewhere in the country, there continues to be an increase in the number of newly reported cases in Grand Bassa and Nimba. The number of new cases in Lofa, which borders Gueckedou in Guinea, had been falling in previous weeks, but that fall has now been arrested with a slight increase in cases compared with the previous week
Nationally, the situation in Sierra Leone continues to deteriorate, with an increase in the number of new confirmed cases reported over each of the past five weeks. The increase is driven primarily by a sharp increase in the number of newly reported cases in the capital, Freetown. The neighbouring districts of Port Loko, Bombali, and Moyamba have also reported increases in the numbers of cases over the past four to five weeks. The numbers of newly reported cases in Kailahun and Kenema, which have previously been stable or slowly declining, have fallen over the past week, though further investigation will be required to confirm whether this fall is genuine. Cases and deaths found during the three-day house-to-house Ebola sensitization campaign, which came to an end on 21 September, are not yet included in official data.
A recent retrospective investigation of EVD cases from throughout the course of the outbreak in Sierra Leone indicated that the number of health-care workers (HCWs) infected was higher than previously reported.
The situation in Nigeria and Senegal remain stable, with no new cases reported in Port Harcourt since September 1st. The second (unrelated) Ebola outbreak in the DRC appears to be under control.
ANNEX 2. EBOLA OUTBREAK IN DEMOCRATIC REPUBLIC OF THE CONGO
As at 21 September 2014, there have been 68 cases (28 confirmed, 26 probable, 14 suspected) of Ebola virus disease (EVD) reported in the Democratic Republic of the Congo, including eight among health-care workers (HCWs). In total, 41 deaths have been reported, including eight among HCWs.
432 contacts have now completed 21-day follow-up. Of 488 contacts currently being monitored, 468 (96%) were seen on 21 September, the last date for which data has been reported. This outbreak is unrelated to that affecting Guinea, Liberia, Nigeria, Senegal and Sierra Leone.