In Guinea and Liberia, the incidence of reported Ebola cases is no longer increasing, but intense transmission is occurring in several districts, the World Health Organization (WHO) said today. In Sierra Leone, however, disease incidence is still rising, driven by intense activity in a wide swath of the country's north and west that includes Freetown.

As of Nov 16, the global number of Ebola cases linked to the outbreak is 15,145 infections, along with 5,420 deaths. The totals reflect an increase of 732 cases and 243 deaths since the WHO's last update on Nov 14.

Sierra Leone activity still rising

In the three main outbreak countries, Sierra Leone reported 487 more infections and 207 more deaths since Nov 16, Liberia reported 191 more illnesses and 152 fatalities since Nov 15, and Guinea reported 52 more cases and 26 more deaths since Nov 16, according to the WHO.

Eight of Sierra Leone's districts reported high numbers of cases over the past week, with 168 newly confirmed cases in Freetown, the country's capital. One bright spot is that very few cases were reported in two areas that had been hot spots for several months—Kenema and Kailahun, the WHO said. It added that Kenema has not reported a case since Nov 1, with strong evidence that the drop-off in activity is a result of response efforts.

In Liberia, cases have stabilized over the past 4 weeks, after declining between the middle of September through the middle of October. Over the past week about half of the country's cases were from Montserrado district, which includes Monrovia.

Only five other districts reported cases last week, and Lofa district, in the northern part of the country near the border with Guinea, didn't report any cases for the third week in a row, according to the WHO.

Most of the new cases in Guinea over the past week were from the southeastern part of the country near Liberia's northern border. Three districts—Macenta, N'Zerekore, and Kerouane—reported about two thirds of Guinea's cases over the past week.

Gap in treatment centers

All three countries still have a gap in Ebola treatment center (ETC) beds; overall, 18 of 56 ETCs are open, with 1,159 beds operational, the same numbers as in the WHO's last full report on Nov 12. In Guinea, 7 ETCs are being built or are waiting on staffing. Foreign medical teams have been found to staff 18 more of the units in Liberia and 9 more ETCs in Sierra Leone.

The WHO reported that the region has 166 safe burial teams, considered a key tool in slowing the outbreak. It estimates that the need is 370 of the trained teams.

In a related development, incident management teams from the US Centers for Disease Control and Prevention (CDC) and their counterparts at health ministries in Guinea, Liberia, and Sierra Leone yesterday released a big picture view of the outbreak's most recent trends. The group published its findings yesterday in Morbidity and Mortality Weekly Report (MMWR).

The group estimated that Liberia's peak in new Ebola cases occurred in the middle of September, Sierra Leone's peak occurred in late October, and Guinea's in the middle of September. In Guinea and Liberia since Oct 19, the number of cases has been more widely distributed compared with earlier in the month.

The main hot spots for both periods were around Monrovia, the north and western parts of Sierra Leone, and three of Guinea's districts.

Ebola strikes two doctors, one fatally

The Ebola virus continues to exact a heavy toll on health workers battling the outbreak in West Africa, infecting two more doctors in Sierra Leone, one of them from Cuba's delegation and the other from Sierra Leone who died from his infection.

A British medical team is treating the Cuban doctor, Felix Baez Sarria, MD, until he can be airlifted within the next 48 hours to a specialized treatment unit in Geneva at the WHO's recommendation, the Associated Press (AP) reported today.

The man's brother told the AP that the doctor was likely infected when he rushed to help a patient who was falling and could have violated protocols designed to protect medical workers. Cuba's state media said the doctor, an internist, came down with a fever on Nov 16 and was diagnosed as having Ebola the following day.

Sarria's infection is the first known case in the workers from Cuba, a country that won praise from global health officials when it was one of the first to send health workers to West Africa. Cuba committed the health workers on Sep 12, and they arrived in West Africa on Oct 22, according to earlier reports.

Meanwhile, another doctor from Sierra Leone died from Ebola, the country's seventh physician to die in the outbreak, Reuters reported today. Michael Kargbo, MD, died yesterday and was a dermatologist working at Magburaka Government Hospital, located in the central part of the country, and wasn't on the Ebola treatment frontline.

The report did not say how the 64-year-old doctor might have been infected with Ebola. However, the WHO has said a substantial number of health worker infections occur outside the context of Ebola treatment and care. For example, some are exposed by patients thought to have other infections.

The WHO said in its latest update that 584 health workers have been infected in the outbreak so far, and 329 have died.

UN mission update

Liberian officials recently announced that campaign activities for special senatorial elections will begin tomorrow, despite the Ebola outbreak, according to the latest United Nations Mission for Ebola Emergency Response (UNMEER) today. The country's elections commission urged the candidates and their supporters to observe the government's regulations to prevent the spread of Ebola during campaign activities.

Meanwhile, Sierra Leone's president suspended his uncle from a position as tribal chief for disregarding laws meant to curb the spread of Ebola, according to UNMEER. The man, head of the northern village of Yeli Sanda, was accused of covering up secret burials of victims that should have been reported to health officials.

In Guinea, the investigation into the September killings of Ebola health workers and a journalist in a southeastern village of Wome is proceeding quickly, with a trial expected by the end of the year. UNMEER said 81 people have been indicted, with 39 in custody and arrest warrants for 40 more.

Health officials in Mali continue to probe a cluster of illnesses linked to a clinic that treated a sick imam from Guinea. UNMEER said that so far nearly 600 contacts have been identified, and the WHO said in its report that the country's number of illnesses remains at 6, including 5 deaths.

Mali's health ministry has increased the number of staff doing contact tracing by tapping into polio surveillance teams and medical students who have epidemiology training. In addition, Mali is boosting its capacity to do exit screening for Ebola at the Bamako airport.

The mission report also highlighted an announcement from the Bill and Melinda Gates Foundation that it would help Guinea and other affected countries scale up production and evaluation of convalescent blood and serum products as potential treatments for Ebola. According to a press release, the foundation committed $5.7 million to launch the effort, with trial designs and locations to be coordinated with national health officials and the WHO.

Other foundations and industries are part of the effort, including the Paul G. Allen Family Foundation. The Gates-supported project will also evaluate other drugs, including the experimental antiviral brincidofovir.

In other response news, UNMEER said Denmark's government is providing $19.5 million more in aid, plus $5.1 million to a United Nations trust fund for Ebola, to help battle the disease. The nation is also deploying health personnel to Sierra Leone, where they will also establish training facilities.

Other developments

The World Bank's chief economist, Francisco Ferreira, today dramatically scaled back an estimate of the Ebola outbreak's impact on sub-Saharan Africa's economy, Reuters reported. Speaking at a lecture in Johannesburg today, he said the cost would be closer to $3 billion to $4 billion, compared with an earlier worst-case scenario of $32 billion. He said the lower projection comes from the success some countries in the region have had at containing the disease, but warned that the economic damage could grow if the countries and the world become complacent.





A public-private partnership to help train people in West Africa's outbreak region to sequence Ebola viral genomes was announced today, according to a press release from the three involved groups. They include the US Agency for International Development (USAID), the Broad Institute at Massachusetts Institute for Technology (MIT) and Harvard, and Illumina, Inc. The collaboration is intended to help with surveillance efforts and will bring state-of-the-art genome sequencing technology to help with the current outbreak response. Sequencing and patient monitoring facilities will be rolled out first in Liberia, Nigeria, Senegal, and Sierra Leone, with longer term plans to include more West African countries.





India's health ministry announced yesterday that it has quarantined a man who tested negative for the virus after he recovered from an Ebola infection in Liberia, because traces of the virus were found in his semen, the Times of India reported yesterday. The man arrived at the New Delhi airport on Nov 10. The UNMEER report said India will keep the man in quarantine until the virus is no longer present, though he had documents from Liberia confirming that he had recovered from his infection and was no longer a health threat. The CDC said Ebola can stay in semen after recovery and that men should abstain from sex for 3 months, though sexual transmission of Ebola has never been reported.

See also:

Nov 19 WHO situation update

Nov 18 MMWR report

Nov 19 AP story

Nov 19 Reuters story on Sierra Leone doctor

Nov 19 UNMEER report

Nov 18 Gates Foundation press release

Nov 19 Reuters story on World Bank projection

Nov 19 genome sequencing press release

Nov 18 Times of India story