While there are signs of progress, with the official numbers approaching 20,000 cases (and many more uncounted) the latest numbers from the WHO illustrate just how far we are from seeing an end to the Ebola outbreak in West Africa. The worst-case scenarios may have been averted, but we are likely months away from seeing this outbreak contained.
A few excerpts from today’s lengthy report:
A total of 19 497 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in four affected countries (Guinea, Liberia, Mali and Sierra Leone) and four previously affected countries (Nigeria, Senegal, Spain and the United States of America) in the seven days to 21 December (week 51). There have been 7588 reported deaths (case definitions are provided in Annex 1).
Reported case incidence is fluctuating in Guinea and declining in Liberia. In Sierra Leone, there are signs that the increase in incidence has slowed, and that incidence may no longer be increasing. The country’s west is now experiencing the most intense transmission in the affected countries, and response efforts have been strengthened to curb the spread of disease in the area. The reported case fatality rate in the three intense-transmission countries among all cases for whom a definitive outcome is known is 70%. Interventions in these countries continue to progress in line with the UN Mission for Ebola Emergency Response (UNMEER) aim to conduct 100% of burials safely and with dignity, and to isolate and treat 100% of EVD cases by 1 January, 2015. At a national level, the capacity to isolate and treat EVD patients has improved in all three countries since the commencement of the emergency response. While every country has sufficient capacity to isolate patients, the uneven geographical distribution of beds and cases means shortfalls persist in some districts. Each country has sufficient capacity to bury all people known to have died from Ebola, although it is possible that capacity is inadequate in some districts. The number of trained burial teams has significantly grown in each of the three countries in the past month. Every district that has reported a case of EVD in the three countries has access to a laboratory within 24 hours from sample collection. All three countries report that more than 90% of registered contacts associated with known cases of EVD are being traced, although there are discrepancies at the district level. The number of contacts traced per EVD case remains low in many districts.
Social mobilization continues to be an important component of the response. Engaging communities promotes burial practices that are safe and culturally acceptable, and the isolation and appropriate treatment of patients with clinical symptoms of EVD.
A total of 666 health-care workers (HCWs) are known to have been infected with EVD up to the end of 21 December, 366 of whom have died (table 6). The total case count includes 2 HCWs in Mali, 11 HCWs infected in Nigeria, 1 HCW infected in Spain while treating an EVD-positive patient, and 3 HCWs in the USA (including a HCW infected in Guinea, and 2 HCWs infected during the care of a patient in Texas). Seven HCW infections were reported in the week to 21 December, 6 in Guinea (including 5 in Coyah and 1 in Kankan) and 1 in Montserrado in Liberia.
Extensive investigations to determine the source of exposure in each case are being undertaken. Early indications are that a substantial proportion of infections occurred outside the context of Ebola treatment and care centres.
Table 6: Ebola virus disease infections in health-care workers in the three countries with intense transmission