The numbers coming out of West Africa’s Ebola outbreak are bad, and getting worse – with 7178 cases reported and 3338 deaths – as of September 28th. A jump of nearly 1,000 cases since the last report.
More sobering, the best guesses are that the actual number of cases could be between 2 and 3 times higher.
Here are excerpts from the World Health Organization’s latest Ebola Roadmap SitRep.
The total number of probable, confirmed and suspected cases (see Annex 1) in the current outbreak of Ebola virus disease (EVD) in West Africa reported up to 28 September 2014 is 7178, with 3338 deaths. Countries affected are Guinea, Liberia, Nigeria, Senegal and Sierra Leone. Figure 1 shows the total number of confirmed and probable cases in the three high-transmission countries (Guinea, Liberia, and Sierra Leone) reported in each epidemiological week between 30 December 2013 (start of epidemiological week 1) and 28 September 2014 (end of epidemiological week 39). For the second week in a row the total number of reported new cases has fallen. It is clear, however, that EVD cases are under-reported from several key locations. Transmission remains persistent and widespread in Guinea, Liberia and Sierra Leone, with strong evidence of increasing case incidence in several districts. There are few signs yet that the EVD epidemic in West Africa is being brought under control.
1. COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
The upward epidemic trend continues in Sierra Leone and most probably also in Liberia. By contrast, the situation in Guinea appears to be more stable, though it must be emphasized that in the context of an outbreak of EVD, a stable pattern of transmission is still of grave concern, and could change quickly (figure 1; table 1).
Reports from Guinea show a slight fall in the number of new cases reported compared with each of the past five weeks (figure 2). This fall is largely attributable to a drop in the number of new cases reported from Macenta district, which had seen a surge in the number of new cases over the past five weeks.
Transmission is persistent in Gueckedou, the region in which the outbreak originated, which has reported between five and 20 new cases over the past 10 weeks. There has been a slight increase in the number of new cases reported in the capital, Conakry, with 27 new confirmed cases reported this week. Beyla district, which borders Côte d’Ivoire, has now reported its first confirmed case.
The continued fall in the number of reported new cases shown in figure 1 is largely attributable to the sharp drop in the number of confirmed new cases reported from Liberia over the past two weeks. Last week there were no new reported confirmed cases from the capital, Monrovia, which in previous weeks had reported a surge in cases. This week, five new confirmed cases have been reported in Monrovia, but there remains compelling evidence obtained from responders and laboratory staff in the country that there is widespread under-reporting of new cases, and that the situation in Liberia, and in Monrovia in particular, continues to deteriorate.
A large number of suspected new cases (and deaths among suspected cases) have been reported from Liberia over the past week. 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. The counties of Bong, Grand Bassa, Margibi and Nimba continue to report high numbers of new cases. There has been little change in the number of new cases reported in Lofa, which borders Gueckedou in Guinea, for the past three weeks, with 38 confirmed and probable cases reported this 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 six weeks. The neighbouring districts of Port Loko, Bombali, and Moyamba, which are adjacent to the capital, Freetown, have now been quarantined after a surge in new cases over the past four weeks. Tonkolili has also reported a rise in the number of new cases this week. By contrast, a very low number of new cases have been reported from Kailahun and Kenema for the past two weeks. These areas had previously reported high levels of transmission. Further investigation will be required to confirm whether this fall is genuine, or a result of under-reporting. At present, the latter appears more likely.
The high number of EVD infections in health-care workers (HCWs) continues to be a cause of great concern. 377 HCWs have now been infected with EVD as of 28 September, 216 of whom have died (table 2).