Total confirmed cases (by week, 2015)

SUMMARY

There were 3 confirmed cases of Ebola virus disease (EVD) reported in the week to 30 August: 2 in Guinea and 1 in Sierra Leone. The case in Sierra Leone is the first in the country for over 2 weeks. Overall case incidence has remained stable at 3 confirmed cases per week for 5 consecutive weeks. In addition, the number of contacts under observation continues to fall, from approximately 600 on 23 August to approximately 450 on 30 August. Of those, over 400 are located in Guinea. All 48 contacts under follow-up in Sierra Leone are associated with the most recently reported case from the western district of Kambia, which borders Guinea. A rapid-response team has been deployed to the area due to the likelihood of further localised transmission associated with the case. Both cases reported from Guinea this week had symptom onset in or near the capital, Conakry. One of the cases was symptomatic for an extended period in the community. There remains a risk of short-term increases in case incidence as a result of isolated, high-risk cases, and rapid-response teams are on alert to deal with any such cases.

The 2 confirmed cases reported from Guinea in the week to 30 August were identified in or near the Ratoma area of the capital, Conakry. The first case, a 9-month-old girl, was not a registered contact and had onset of symptoms on the outskirts of Conakry in Dubreka, before being taken to the Ratoma area of the capital by her family, where she died before she could be admitted to an Ebola treatment centre. The second case is a 56-year-old male and registered contact of a case reported from Ratoma on 18 August. Of 410 contacts who were under follow-up on 30 August in Guinea, 289 were located in Conakry, with 26 in Dubreka and 95 in Forecariah. The previous week 600 contacts were located in 4 western prefectures (Conakry, Coyah, Dubreka, and Forecariah).

No new cases were reported from Liberia in the week to 30 August. All contacts in Liberia have now completed their 21-day follow-up period. The last 2 patients with EVD in Liberia were discharged after completing treatment and testing negative for EVD for a second time on 23 July. Surveillance continues to be strengthened, with approximately 800 samples tested for EVD in the week to 30 August.

One new confirmed case was reported from Sierra Leone in the week to 30 August: the first case reported from the country for over 2 weeks. The case was a woman approximately 60 years of age who was identified as EVD-positive after post-mortem testing. She had symptom onset in the village of Sella Kafta, Tonko Limba chiefdom in Kambia, and was treated in the community before her death. Kambia, which borders the Guinean prefecture of Forecariah, had not reported a confirmed case for 48 days. A rapid-response team was immediately deployed to the area. As at 30 August a total of 48 contacts had been identified, although this figure is expected to rise in due course. The origin of infection remains under investigation. The Phase 3 efficacy trial of the VSV-EBOV vaccine has now been extended from Guinea to Sierra Leone. Contacts and contacts of contacts associated with the confirmed case in Kambia will therefore be offered the vaccine. Contacts associated with all other chains of transmission in Sierra Leone have now completed follow-up.

No new health worker infections were reported in the week to 30 August. There have been a total of 881 confirmed health worker infections reported from Guinea, Liberia, and Sierra Leone since the start of the outbreak, with 513 reported deaths.

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION

There have been a total of 28 073 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia, and Sierra Leone (figure 1, table 1) up to 30 August, with 11 290 reported deaths (this total includes reported deaths among probable and suspected cases, although outcomes for many cases are unknown). Two new confirmed cases were reported in Guinea and one in Sierra Leone in the week to 30 August.

The total number of confirmed cases is similar in males and females (table 2). Compared with children (people aged 14 years and under), adults aged 15 to 44 are approximately four times more likely to be affected in Guinea and Liberia, and three times more likely to be affected in Sierra Leone.

No new health worker infections were reported in the week to 30 August. Since the start of the outbreak a total of 881 confirmed health worker infections have been reported in Guinea, Liberia, and Sierra Leone; there have been 513 reported deaths (table 5).

Figure 1: Confirmed, probable, and suspected EVD cases worldwide

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Table 1: Confirmed, probable, and suspected EVD cases in Guinea, Liberia, and Sierra Leone

Country Case definition Cumulative cases Cases in past 21 days Cumulative deaths Guinea Confirmed 3337 8 2077 Probable 452 * 452 Suspected 3 * ‡ Total 3792 8 2529 Liberia§ Confirmed 3151 - ‡ Probable 1879 - ‡ Suspected 5636 - ‡ Total 10 666 - 4806 Liberia** Confirmed 6 0 2 Probable * * ‡ Suspected ‡ * ‡ Total 6 0 2 Sierra Leone Confirmed 8698 1 3587 Probable 287 * 208 Suspected 4624 * 158 Total 13 609 1 3953 Total Confirmed 15 192 9 ‡ Probable 2618 * ‡ Suspected 10 263 * ‡ Total 28 073 9 11 290

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Table 2: Cumulative number of confirmed cases by sex and age group in Guinea, Liberia, and Sierra Leone

Country Cumulative cases By sex*

(per 100 000 population) By age group‡

(per 100 000 population) Male Female 0-14 years 15-44 years 45+ years Guinea 1594

(29) 1738

(32) 530

(11) 1898

(41) 860

(55) Liberia§ 1911

(96) 1838

(93) 561

(33) 2060

(121) 703

(132) Sierra Leone 4813

(169) 5102

(176) 1989

(82) 5616

(217) 2138

(289)

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Figure 2: Geographical distribution of confirmed cases reported in the week to 30 August 2015

Table 3: Cases and contacts by district/prefecture/county over the past 3 weeks

Data are based on official information reported by ministries of health. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results. *Data as of 30 August 2015 for Guinea and Sierra Leone and 20 August 2015 for Liberia.

Table 4: Location and epidemiological status of confirmed cases reported in the 3 weeks to 30 August 2015

Sub-prefectures/chiefdoms/districts that reported one or more confirmed cases in the 7 days to 30 August are highlighted. *Epi-link refers to cases who were not registered as contacts of a previous case (possibly because they refused to cooperate or were untraceable), but who, after further epidemiological investigation, were found to have had contact with a previous case, OR refers to cases who are resident or are from a community with active transmission in the past 21 days. ‡Includes cases under epidemiological investigation. §A case that is identified as a community death can also be registered as a contact, or subsequently be found to have had contact with a known case (epi-link), or have no known link to a previous case.

Figure 3: Geographical distribution of new and total confirmed cases in Guinea, Liberia and Sierra Leone

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Table 5: Ebola virus disease infections in health workers in Guinea, Liberia and Sierra Leone

Country Cases Deaths Guinea 196 100 Liberia* 378 192 Sierra Leone 307 221‡ Total 881 513

GUINEA

Key performance indicators for the EVD response in Guinea are shown in table 6.

Two confirmed cases were reported from 2 prefectures—Conakry and Dubreka—in the week to 30 August (table 3, table 4, figure 2, figure 3).

Both cases were reported in or near the Ratoma area of Conakry. The first case, a 9-month-old girl, was not a registered contact and had onset of symptoms on the outskirts of Conakry in Dubreka, before being taken to the Ratoma area of the capital by her family, where she died before she could be admitted to an Ebola treatment centre. The second case is a 56-year-old male and registered contact of a case reported from Ratoma on 18 August.

An interim analysis of the Ebola ça suffit! ring vaccination trial in Guinea suggests that the investigational rVSV-ZEBOV Ebola vaccine protects people exposed to EVD. The trial will continue in Guinea, with all rings around confirmed cases now receiving immediate vaccination. Previously, rings were randomly allocated to receive either immediate vaccination or vaccination 21 days after the confirmation of a case.

410 contacts remain under follow-up in 3 western prefectures in Guinea (Conakry, Dubreka, and Forecariah), compared with 600 in 4 prefectures the previous week (table 3). 289 contacts are located in Conakry, with 26 in Dubreka and 95 in Forecariah.

There were 5 (0.9%) unsafe burials reported in Guinea out of 568 community deaths in the week to 30 August, compared with 1 (0.2%) unsafe burial out of 573 recorded community deaths in the previous week.

Including both initial and repeat testing, a total of 760 laboratory samples were tested in the week to 30 August. Most tests (88% in the week to 30 August) are of post-mortem swabs taken to rule out EVD as the cause of death.

Locations of the 8 operational Ebola treatment centres (ETCs) are shown in figure 7. No health worker infections were reported in the week to 30 August.

Locations of the 10 operational laboratories in Guinea are shown in figure 8.

Table 6: Key performance indicators for Guinea

For definitions of key performance indicators see Annex 2. Data are given for 7-day periods. *Includes repeat samples. ‡Data missing for 0–3% of cases. #Outcome data missing for 0–1% of hospitalized confirmed cases.

Figure 4: Confirmed weekly Ebola virus disease cases reported nationally and by prefecture from Guinea

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SIERRA LEONE

Key performance indicators for the EVD response in Sierra Leone are shown in table 7.

One new confirmed case was reported from Sierra Leone in the week to 30 August: the first case reported from the country for over 2 weeks. The case was a woman approximately 60 years of age who was identified as EVD-positive after post-mortem testing. She had symptom onset in the village of Sella Kafta, Tonko Limba chiefdom in Kambia, and was treated in the community before her death. Kambia, which borders the Guinean prefecture of Forecariah, had not reported a confirmed case for 48 days. A rapid-response team was immediately deployed to the area. As at 30 August a total of 48 contacts had been identified, although this figure is expected to rise in due course. The origin of infection remains under investigation.

The Ebola ça suffit! ring vaccination Phase 3 efficacy trial of the VSV-EBOV vaccine has now been extended from Guinea to Sierra Leone. Contacts and contacts of contacts associated with the confirmed case in Kambia will therefore be offered the vaccine.

All contacts associated with other chains of transmission in Sierra Leone have now completed 21-day follow-up. There are currently no patients with EVD in any of the countries ETCs. The last case to be treated for EVD in an Ebola treatment centre was discharged on 24 August after testing negative twice for EVD.

Locations of the 10 operational Ebola treatment centres (ETCs) in Sierra Leone are shown in figure 7. No health worker infections were reported in the week to 30 August.

Laboratory indicators continue to reflect a heightened degree of vigilance, with 1880 new samples tested in the 7 days to 30 August. One new sample tested positive for EVD. Most tests (78% in the week to 30 August) are of post-mortem swabs taken to rule out EVD as the cause of death.

Locations of the 9 operational laboratories in Sierra Leone are shown in figure 8.

Table 7: Key performance indicators for Sierra Leone

For definitions of key performance indicators see Annex 2. Data are for 7-day periods. §Laboratory data missing for 14 July. ‡Data missing for 7–14% of cases. #Outcome data missing for 0–77% of hospitalized confirmed cases.

Figure 5: Confirmed weekly Ebola virus disease cases reported nationally and by district from Sierra Leone

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Figure 6: Days since last confirmed case by district in Guinea, Liberia, and Sierra Leone

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OTHER AFFECTED AND PREVIOUSLY AFFECTED COUNTRIES

Liberia was declared free of Ebola transmission on 9 May 2015, after reporting no new cases for 42 consecutive days. The country subsequently entered a 3-month period of heightened surveillance. On 29 June, this heightened surveillance detected an EVD-positive community death in Margibi County, Liberia—the first new confirmed case reported from the country since 20 March. The case was a 17-year-old male who first became ill on 21 June, died on 28 June, and subsequently tested positive for EVD. As at 12 July, 5 contacts associated with the first-detected case have since been confirmed as EVD-positive. Of the 6 confirmed cases reported since 29 June, 2 have died, and the remaining 4 have now all been discharged after treatment. The last case was discharged after testing negative for EVD for a second time on 23 July. All contacts have now completed follow-up.

Seven countries (Italy, Mali, Nigeria, Senegal, Spain, the United Kingdom, and the United States of America) have previously reported a case or cases imported from a country with widespread and intense transmission.

Figure 7: Location of Ebola treatment centres in Guinea, Liberia, and Sierra Leone

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PREPAREDNESS OF COUNTRIES TO RAPIDLY DETECT AND RESPOND TO AN EBOLA EXPOSURE

The introduction of an EVD case into unaffected countries remains a risk as long as cases exist in any country. With adequate preparation, however, such an introduction can be contained through a timely and effective response.

WHO’s preparedness activities aim to ensure all countries are ready to effectively and safely detect, investigate, and report potential EVD cases, and to mount an effective response. WHO provides this support through country support visits by preparedness-strengthening teams (PSTs) to help identify and prioritize gaps and needs, direct technical assistance, and provide technical guidance and tools.

Figure 8: Location of laboratories in Guinea, Liberia, and Sierra Leone

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Priority countries in Africa

The initial focus of support by WHO and partners is on highest priority countries – Côte d’Ivoire, Guinea-Bissau, Mali, and Senegal—followed by high priority countries—Benin, Burkina Faso, Cameroon, Central African Republic, Democratic Republic of the Congo, Ethiopia, Gambia, Ghana, Mauritania, Niger, Nigeria, South Sudan, and Togo. The criteria used to prioritize countries include the geographical proximity to affected countries, the magnitude of trade and migration links, and the relative strength of their health systems.

Since 20 October 2014, PSTs have provided technical support in Benin, Burkina Faso, Cameroon, Central African Republic, Côte d’Ivoire, Ethiopia, Gambia, Ghana, Guinea-Bissau, Mali, Mauritania, Niger, Senegal, South Sudan, and Togo. Technical working group meetings, field visits, high-level table-top exercises, and field simulations have helped to identify key areas for improvement. Each country has a tailored plan to strengthen operational readiness.

From October 2014 to August 2015 WHO has undertaken over 285 field deployments to priority countries to assist with the implementation of national plans.

WHO provides personal protective equipment (PPE) modules containing minimum stocks to cover staff protection and other equipment needs to support 10 patient-beds for 10 days for all staff with essential functions. PPE modules have been delivered or are in the process of being delivered to all countries on the African continent. In addition, all countries have received 1 PPE training module.

Contingency stockpiles of PPE are in place in the United Nations Humanitarian Response Depots (UNHRD) in Accra and Dubai, and are available to any country in the event that they experience a shortage.

Follow-up support to priority countries

Following initial PST assessment missions to the 14 priority countries in 2014, a second phase of preparedness-strengthening activities have provided support on a country-by-country basis.

In Gambia, WHO supported the training of a National Rapid Response Team in Banjul from 24 to 28 August.

In Guinea Bissau, preparedness support continues to be provided at the central level, and in two priority regions (Tombali and Gabu) through WHO sub-offices. Weekly progress updates are undertaken to identify and address any issues. Activities implemented by WHO and partners and with the national authorities during the reporting period include: a community engagement activity with a well-known traditional healer; a meeting with the Governor of Gabu to update him on plans and activities in the region; health worker training in health centres and Gabu regional hospital.

EVD preparedness officers

Dedicated EVD preparedness officers have been deployed to support the implementation of country preparedness plans, coordinate partners, provide a focal point for inter-agency collaboration, offer specific technical support in their respective areas of expertise, and develop capacity of national WHO staff. Preparedness officers are currently deployed to Benin, Cameroon, Central African Republic, Côte d’Ivoire, Ethiopia, Gambia, Ghana, Guinea-Bissau, Mali, Mauritania, Niger, Senegal, and Togo.

Training, exercises, and simulations

Priority countries that have achieved a minimum of 50% implementation of preparedness checklist activities are encouraged to undertake a series of drills on elements of an EVD response and a functional exercise to test the coordination of the Ebola operations centre.

Simulations are being scheduled in Benin, Burkina Faso, Ethiopia, Ghana, and Mauritania.

Rapid-response team training is currently being planned for points-of-entry in Mauritania.

Training in clinical management and IPC is being planned for Côte d’Ivoire.

Surveillance and preparedness indicators

Indicators based on surveillance data, case-management capacity, laboratory testing, and equipment stocks continue to be collected on a weekly basis from the four countries that share a border with affected countries: Côte d’Ivoire, Guinea-Bissau, Mali, and Senegal.

An interactive preparedness dashboard based on the WHO EVD checklist is now available online.

ANNEX 1: COORDINATION OF THE EBOLA RESPONSE ALONG 4 LINES OF ACTION

WHO continues to work with many partners in response to the EVD outbreak, including the African Union, the Economic Community of West African States, the Mano River Union, national governments, non-governmental organizations, and UN agencies, and technical institutions and networks in the Global Outbreak Alert and Response Network (GOARN). Agencies responsible for coordinating 4 key lines of action in the response are given below.

Lines of action Lead agency Case management WHO Case finding, laboratory services and contact tracing WHO Safe and dignified burials International Federation of Red Cross and Red Crescent Societies (IFRC) Community engagement and social mobilization UNICEF

ANNEX 2: DEFINITIONS OF PHASE 2 KEY PERFORMANCE INDICATORS