WHO congratulates Senegal on ending Ebola transmission

WHO officially declares the Ebola outbreak in Senegal over and commends the country on its diligence to end the transmission of the virus.

The introduced case was confirmed on 29 August in a young man who had travelled to Dakar, by road, from Guinea, where he had had direct contact with an Ebola patient.

Senegal’s response is a good example of what to do when faced with an imported case of Ebola. The government, under leadership of President Macky Sall and the Minister of Health Dr Awa Coll-Seck, reacted quickly to stop the disease from spreading.

The government’s response plan included identifying and monitoring 74 close contacts of the patient, prompt testing of all suspected cases, stepped-up surveillance at the country’s many entry points and nationwide public awareness campaigns.

WHO treated this case as a public health emergency and immediately dispatched a team of epidemiologists to work alongside staff from the Ministry of Health, and other partners, including Médecins sans Frontières and the United States Centers for Disease Control and Prevention (CDC).

On 5 September, laboratory samples from the patient tested negative, indicating that he had recovered from Ebola virus disease. He returned to Guinea on 18 September.

Senegal has maintained a high level of active “case finding” for 42 days – twice the maximum incubation period of Ebola virus disease – to detect possible unreported cases of infection.

While the outbreak is now officially over, Senegal’s geographical position makes the country vulnerable to additional imported cases of Ebola virus disease. It continues to remain vigilant for any suspected cases by strict compliance with WHO guidelines.

• The outbreak of Ebola virus disease in Senegal is over
  Situation assessment - 17 October 2014

For more information, contact:

Fadéla Chaib
Communications Officer, World Health Organization
Telephone: +41 22 791 32 28
Mobile: +41 79 475 55 56
E-mail: chaibf@who.int

Tarik Jasarevic
WHO Department of Communications
Telephone: +41 22 791 50 99
Mobile: +41 79 367 62 14
E-mail: jasarevict@who.int

Senegal: Officially Ebola-Free

Here's what the West African nation's apparent triumph over the virus could tell us about containing it.

ADAM CHANDLEROCT 17 2014, 12:42 PM ET

Jane Hahn/AP

On Friday, as the White House made the essentially symbolic gesture of appointing a "czar" to contain the American outbreak, some 4,000 miles to the east, Senegal was declared free of Ebola by the World Health Organization. In a statement, the U.N. agency praised the West African country's response as "a good example of what to do when faced with an imported case of Ebola."
So how did Senegal, which neighbors Guinea—one of the countries hardest hit by the largest Ebola outbreak on record—manage to successfully contain the deadly virus? Here's how Ebola coursed into and then out of Senegal:
On August 29, the first case of Ebola was confirmed after a student, despite a closed border, traveled by road from Guinea to a hospital in the Senegalese capital of Dakar. According to The Guardian, the man sought treatment, but did not disclose that he might have Ebola. "The next day, an epidemiological surveillance team in Guinea told Senegalese authorities that they had lost track of a person who had had contact with sick people."
After the student was tracked to the hospital in Dakar, according to AP reports, Senegal's response next involved "identifying and monitoring 74 close contacts of the patient, prompt testing of all suspected cases, stepped-up surveillance at many entry points and public awareness campaigns."
Also of note, the high level of communication between the federal authorities and local leadership as well as the considered monitoring of those in contact with the patient. As Lauren Silva Laughlin wrote in Fortune:

All contacts, including health care workers, were subjected to 21-day monitoring. This included in-home voluntary quarantine. They were seen twice daily by Red Cross volunteers. Symptoms and thttp://ebolavirusfight.blogspot.com/Senegal: Officially Ebola- freeemperatures were recorded twice daily. Food was provided.

She adds that for those contacts who sought to avoid working with the Red Cross, local hospitals were brought in, which was said to have boosted compliance.
The WHO did give this caveat in its statement on Friday: "While the outbreak is now officially over, Senegal's geographical position makes the country vulnerable to additional imported cases of Ebola virus disease."
Nevertheless, as the country garners praise for its response, a national effort to train health workers before the first Ebola case was even confirmed leaves the country well-poised to handle any future cases.
Senegal isn't the only success case. Nigeria, which has had nearly two dozen Ebola cases and a handful of deaths, is also said to be nearly free of Ebola. Should things hold steady there until Monday, it will also be declared Ebola-free.  

STATUS: DECLARED EBOLA FREE 17 OCTOBER Single imported case from Guinea in late August. All contacts of the country's lone case, which was reported on 28 August, have completed 21 days monitoring with no further cases identified. FACILITIES Dakar: Fann Hospital has a dedicated infectious disease ward in which potential cases can be isolated CASES Total: 1 confirmed case Confirmed: 1 | Probable: 0 | Suspected: 0Deaths: 0 (Source: WHO roadmap 1 October) UPDATES 11 DecemberThe Senegalese government has stepped up health surveillance measures in Touba ahead of the Magal festival which may see over a million visitors. The annual Muslim festival of brotherhood is observed by pilgrims who visit the city. A team has been deployed and several transit and treatment centers have been identified which will cater to the health needs of patients or isolate an Ebola suspect. 19 OctoberThe World Health Organization (WHO) has issued a situation assessment report after it declared the Ebola outbreak over in Senegal. The document recounts lessons learned from the outbreak response, the most important one being "...an immediate, broad-based, and well-coordinated response can stop the Ebola virus". A number of factors that contributed to sucess have also been listed. However the WHO also cautions that vigilance and basic hygiene measures should continue. 17 OctoberThe World Health Organization has declared Senegal to be free of Ebola. The statement praises the country as an example of what to do with an imported case. Senegal was supported by a range of public health experts from WHO, MSF and CDC. The ongoing high level of active "case finding" for the past 42 days has led to the declaration that the outbreak is over, although the country remains at risk of another imported case. 14 OctoberThe WHO has not yet declared the Ebola outbreak over in Senegal, but will do so on 17 October in the event there continues to be no new cases in the country. This represents 42 days (or two complete incubation periods) between Ebola cases and is the official period after which an outbreak of Ebola is typically declared to be over. A formal announcement will be made on the WHO website to confirm that the outbreak is over. 1 October The WHO roadmap #6 reports no new cases. A 42-day follow up period needs to have elapsed before an outbreak in a country is considered to have ended. The only confirmed Ebola case was reported on 28 August. 27 SeptemberThe WHO roadmap reports no new cases in Senegal since the last confirmed case detected on 28 August and all contacts have completed 21-day follow-up. 23 SeptemberThe World Health Organization published a summary of the situation in Senegal from its start in August. So far, there has been no spread detected in Senegal. WHO officials point to the country as an instance in which infection control measures were implemented quickly and, so far, effectively. The government and WHO acted quickly once they realized a man with Ebola had entered the country. Contact tracing was “excellent” and no additional cases have been reported. As long as the nation goes 42 days without cases, the country can be considered free of the virus. Half that time has already elapsed. However, they caution that "no one can predict with certainty how the outbreak [...] will evolve." 19 SeptemberAll people known to have had contact with the nation's only case (the infected student from Guinea) have been monitored for 21 days, the presumed incubation period for Ebola. None have developed symptoms. News sources report that the infected student, who recovered, will return to Guinea. 16 SeptemberThe Ministry of Health reported that 74 contacts of the index case had been identified in total since August. None have Ebola. No new contacts have been identified. 12 SeptemberThe World Health Organization's update on Senegal confirms that the Ebola situation remains stable. There has only been one case, the student infected in Guinea who then travelled to Senegal while infected. Though a few people who were in contact with him developed symptoms, none had Ebola. Three other suspected cases across Senegal also tested negative. If there are no Ebola cases for 42 days (two incubation periods), the nation can be declared "transmission free" by WHO. However, there must be active, reliable case detection in place for that to happen. Regardless, WHO cautions that Senegal is at continued risk for imported cases given Ebola activity in neighbouring countries. 10 SeptemberMedia sources have reported that the Ebola case has recovered. On testing blood samples from the patient, the virus was not detected. In the WHO Response Roadmap Situation Report, 3 clinical cases (1 confirmed and 2 suspected) with 0 deaths were reported. 9 SeptemberNo new suspected or confirmed cases beyond the first, imported case reported in late August. Officials have identified a few additional contacts of this man, and placed them under surveillance. In all, at least 70 people (including 34 family members and 36 healthcare workers) are under surveillance. A meeting was held among members from the Red Cross, Ministry of Health, WHO, MSF and other partners. The national case management capacity was assessed and was found to be very limited. Currently, there are 9 functional beds in Fann Hospital's isolation unit. MSF plans to set up a field isolation unit within one to two weeks. Other aspects of outbreak response were also discussed. BACKGROUND The Senegalese Ministry of Health announced the nation's first Ebola case on 29 August. No other cases have been reported since then. The disease does not appear to be spreading in the community. It was an imported case, meaning the patient was not infected in Senegal but contracted the disease elsewhere and then brought it with him ("imported" it) when he travelled to Senegal. The World Health Organization reported the patient is a 21-year-old man who was studying in Guinea (a country where Ebola is actively spreading). He was a contact of known Ebola cases and had been under surveillance in Conakry, Guinea. However, he left the surveillance system and travelled to Senegal. He arrived, by road, to Senegal's capital city Dakar on 20 August and stayed with relatives there. He became ill with fever, diarrhoea and vomiting, and sought medical treatment on 23 August. He was not bleeding at the time, and he did not tell healthcare staff that he had been exposed to Ebola. He was treated for malaria, but did not recover. He left the medical facility while still ill and returned to stay with his relatives. On 26 August, he was referred to a specialised centre and was hospitalised. One day later, authorities in Guinea issued an international alert advising Senegal (and other neighboring countries) that a person who had close contact with an Ebola patient had evaded the surveillance system. Following this alert, the student was tested for Ebola and isolated in the infectious disease ward of Fann Hospital, Dakar. His condition was reported to be "satisfactory". Authorities began tracing people who may have come into contact with the student in late August. The World Health Organization made the Senegal situation a "top priority emergency" and sent personnel to Dakar. By the end of August, the student was improving and the Ministry of Health advised that the residence where he stayed had been decontaminated. All contacts were identified and placed under twice-daily medical monitoring. The student remained in isolation and was reported to have recovered by 10 September.

© International SOS Report by © International SOS 2014

Diseases and Conditions Ebola virus and Marburg virus

Ebola virus has been found in African monkeys, chimps and other nonhuman primates. A milder strain of Ebola has been discovered in monkeys and pigs in the Philippines. Marburg virus has been found in monkeys, chimps and fruit bats in Africa.

Experts suspect that both viruses are transmitted to humans through an infected animal's bodily fluids. Examples include:

• Blood. Butchering or eating infected animals can spread the viruses. Scientists who have operated on infected animals as part of their research have also contracted the virus.
• Waste products. Tourists in certain African caves and some underground mine workers have been infected with the Marburg virus, possibly through contact with the feces or urine of infected bats.
• Infected people typically don't become contagious until they develop symptoms. Family members are often infected as they care for sick relatives or prepare the dead for burial.
  Medical personnel can be infected if they don't use protective gear, such as surgical masks and gloves. Medical centers in Africa are often so poor that they must reuse needles and syringes. Some of the worst Ebola epidemics have occurred because contaminated injection equipment wasn't sterilized between uses.
• There's no evidence that Ebola virus or Marburg virus can be spread via insect bites.   Mayo Clinic is a not-for-profit organization. Make a difference today..

Several US states break with CDC and enact stricter ebola guidelines

Since the diagnosis of Craig Spencer with Ebola in New York last week, states around the US have introduced a flurry of new policies on how to monitor those returning from west Africa’s most affected countries.

That’s resulted in a patchwork of rules for those flying into the US from the Ebola-ravaged west African countries of Guinea, Liberia and Sierra Leone.

The Centers for Disease Control and Prevention (CDC) published new guidelines on Monday. But with ambitious governors mindful of public fear over Ebola, some states have enacted tighter restrictions.

New York & New Jersey

At a press conference, the governors of New York and New Jersey on Friday declared a mandatory quarantine for anyone arriving from Liberia, Sierra Leone or Guinea who had had contact with an Ebola sufferer. Just as the policy was introduced, a nurse, Kaci Hickox, landed at Newark airport in New Jersey. She ended up in isolation in a New Jersey hospital despite testing negative for Ebola, and published a scathing letter in the Dallas Morning News about her treatment on Saturday.

The efficacy of such a mandatory quarantine was criticised by the White House, the UN, public health experts, aid groups and civil liberties advocates.

Questions still remain over the specifics of the Ebola quarantine policy. The governors under pressure appeared to soften their stances on the hastily drafted policy in the days since it was introduced, even though both say they have not.

Anyone arriving at John F Kennedy airport in New York or Newark airport in New Jersey from the three countries will pass through three layers of screening that will determine who should be quarantined.

Travellers who arrive from one of the countries and have symptoms of the Ebola virus will be immediately transported to a designated hospital and placed in isolation, according to a fact sheet distributed by the office of Governor Andrew Cuomo of New York on Sunday.

Those who are asymptomatic but have had direct contact with an Ebola sufferer can carry out their three-week quarantine at home. Although, on Friday, Cuomo said high-risk travellers could be quarantined at a “government regulated facility”. The fact sheet said accommodations would be made for those without homes in New York.

On Monday, Governor Chris Christie of New Jersey also said asymptomatic travellers who had contact with Ebola sufferers could carry out their quarantines at their homes, wherever in the country that may be.

“If you are screened and you are asymptomatic, you can be allowed then to go to your home, travel to your home, whether it’s in New Jersey, New York or someplace else in the country and be quarantined for 21 days there,” he told reporters.

Under quarantine, health officials will make two unannounced visits each day to take the traveller’s temperature and check for symptoms. New York state said it will provide financial assistance to quarantined healthcare workers and adults whose employers will not compensate them while they are not allowed to work during this three-week period. It is not clear if this is the case for those quarantined in New Jersey.

Asymptomatic travellers who did not have direct contact with Ebola patients will be handled on a case-by-case basis, the fact sheet said.

Virginia & Maryland

On Monday, the governors of Virginia and Maryland announced that all travellers arriving from Guinea, Liberia and Sierra Leone will be actively monitored by public health officials.

Travellers arriving from those three countries at Dulles international airport, outside Washington DC in Virginia, already undergo screenings for the disease. Dulles is the third of five airports in the US through which passengers travelling from the region must enter.

The states’ new policies require airport screeners to provide local health departments with passengers’ contact information so officials can follow up with them about their health. Such passengers will be asked to record their temperature twice daily and report to local health officials for a 21-day period.

The policy says a traveller who develops an Ebola-like symptom, such as a fever, but does not test positive for the virus, may still be asked to quarantine for the remainder of their three-week incubation period.

Illinois

On Friday, the state’s health department issued a memo that calls for travellers with a high risk of exposure to the virus to be issued with a formal 21-day home quarantine order. The memo said the updated policy was to offer local health departments guidance on how to follow up with travellers who are screened for the disease upon arrival at Chicago’s O’Hare International, the fourth designated US airport for those coming from west Africa.

The state’s health department identifies “high risk” individuals as those who have had direct contact with the blood or body fluids of an Ebola sufferer or the body of someone who died from the virus. There is an exemption for healthcare workers who wore appropriate personal protective gear and had no known lapse of infection control protocol while treating patients. But those healthcare workers who did not wearing proper protective clothing, or were exposed to the virus via a needle or other injury, will be quarantined in their homes.

Georgia

On Monday, Georgia’s governor, Nathan Deal, updated the state’s monitoring policy for travellers returning from the most affected region of Africa, adding measures that go beyond what the CDC recommends. (Georgia is home to the fifth designated airport for west Africa arrivals: Hartsfield-Jackson International in Atlanta.)

Such passengers are placed in a quarantine station where officials take their temperatures and check for symptoms. If travellers show symptoms, they will be isolated immediately and transferred to a designated hospital for evaluation.

Asymptomatic travellers returning from the region are divided into three categories: high-risk, low-risk and medical personnel.

High-risk travellers, those known to have had direct exposure to the Ebola virus, will be subject to a 21-day quarantine at a designated isolation facility; low-risk travellers, those with no known exposure to the disease, must take their temperature and check for symptoms twice daily and report their status to a public health official once a day. Those who don’t comply with the daily reporting requirement will be tracked down and could be issued with a mandatory quarantine order.

Healthcare workers who have cared for Ebola patients will be monitored daily by public health officials either by video or in-home visits for a three-week period.

Florida

On Saturday, Florida’s Governor Rick Scott signed a strict executive order mandating twice-daily 21-day health monitoring by state health officials for people returning from Liberia, Sierra Leone and Guinea, regardless of whether the travellers show symptoms or not.

Travellers from these countries will face a risk assessment upon their arrival in Florida, as well as active monitoring by state health officials.

Scott said he decided to move ahead with the order when the CDC failed to respond to a request for more information on the risk levels posed by travellers returning from the region. Passengers cannot travel directly from west Africa to Florida.

Ebola: How Nigeria and Senegal stopped the disease ‘dead in its tracks'

It seemed like the nightmare scenario: Ebola had reached Africa’s biggest city, a chaotic and densely populated metropolis of slums and shantytowns where the virus threatened to spread to millions of people.
Health experts were terrified when Ebola struck Lagos in late July. They were deeply worried that it would be unstoppable in Nigeria, a rapidly urbanizing country of 170 million, far bigger than the nations where Ebola had begun. Their fears were heightened in August when the virus leaped another border and reached Senegal, another key West African country.

Yet today, in a remarkable display of how to beat the lethal virus, both Nigeria and Senegal have defeated their Ebola outbreaks. The World Health Organization announced on Friday that the outbreak was officially over in Senegal, and made the same declaration for Nigeria on Monday. In both countries, 42 days have passed since their last reported case – the standard rule for declaring an outbreak over, since it is twice the maximum 21-day incubation period for the virus.

“The most important lesson for the world at large is this: An immediate, broad-based and well-co-ordinated response can stop the Ebola virus … dead in its tracks,” the WHO said on Friday after declaring the end of the Senegal outbreak.

Based on the successes of Nigeria and Senegal, here are the strategies that can be adopted by other countries, including the United States and Canada, as they prepare for the threat of the virus.

Nigeria’s first Ebola patient, Patrick Sawyer, was initially thought to have malaria. But when malaria treatment failed at a local hospital, doctors immediately began treating him as a possible Ebola patient, and he was kept in isolation at the hospital. Officials were notified and a blood sample was rushed to a testing lab.

On July 23, just three days after Mr. Sawyer arrived in Lagos on an indirect flight from Liberia, the Nigerian health ministry set up an Ebola Incident Management Centre, which evolved into an Emergency Operations Centre to co-ordinate the response and the decision-making.

The centre took over the management of each suspected Ebola case. It investigated every possible case and supervised the decontamination of their homes. Each suspected case was isolated in a special ward of a treatment facility. Blood tests were rapidly conducted to verify if suspected cases were genuine or not.

Senegal, meanwhile, had been well-prepared with an Ebola response plan as early as March. It created a National Crisis Committee as the “nerve centre” for its response, and deployed its emergency plan nationwide in August, even though only a single case had been detected. “The whole country moved into a heightened state of alert,” the WHO said.

Nigerian health teams visited 18,500 homes in Lagos and Port Harcourt, the two cities where Ebola cases were reported, as they searched for anyone who had been in contact with the 20 Ebola patients in the country. More than 150 contact tracers were deployed.

The tracing teams tracked down 894 people who had been in contact with Ebola patients, and began monitoring their health closely. The WHO described it as “world-class epidemiological detective work.” Even mobile-phone data and law-enforcement agencies were employed to trace contacts, using an emergency presidential decree, and airplane manifests were scrutinized. Health workers visited any contact who reported symptoms – or who failed to provide health updates via cellphone text messages.

In Senegal, tracers found 74 close contacts of the country’s sole Ebola patient. The health of each of these 74 people was carefully monitored, twice a day. To encourage their co-operation, the contacts were offered food, money and psychological counselling.

In Nigeria, social mobilization teams went house-to-house to visit 26,000 families who lived within two kilometres of the Ebola patients. They explained Ebola’s warning signs and how to prevent the virus from spreading. Leaflets and billboards, in multiple languages, along with social-media messages, were used to educate the broader Nigerian population.

Education was crucial in a country where dangerous myths were spreading. There was even a rumour that drinking large amounts of salt water would protect people from Ebola – a rumour that sickened and even killed some Nigerians who attempted the harmful diet.

Senegal, too, created a national public-awareness campaign, using media experts and local radio networks.

Effective public-health institutions

Senegal and Nigeria both benefited from a stronger and better-financed system of public health than Liberia, Sierra Leone and Guinea, the impoverished countries where the current epidemic began.

Nigeria also took advantage of the infrastructure of a polio eradication program that had been active for years. A polio and HIV clinic in Lagos, financed by the Gates Foundation, was transformed into an emergency centre for Ebola, with dozens of doctors available.

Nigeria was also quick to welcome foreign help. There was remarkable co-ordination between every level of Nigerian government and global health organizations such as the WHO, the U.S. Centers for Disease Control and Prevention, and Médecins sans frontières (Doctors Without Borders). Private companies donated ambulances, disinfectant and other important supplies.

Nigeria and Senegal boosted their surveillance for Ebola, especially at land border crossings, but they never closed their airports.

“Critically important early on was the government’s decision to open a humanitarian corridor in Dakar to facilitate the movement and activities of humanitarian agencies,” the WHO said. “This decision meant that food, medicines and other essential supplies could seamlessly and efficiently flow into the country.”

 Report by Geoffrey York 

Nigeria is free from ebola

The World Health Organization has declared Nigeria Ebola-free — after more than six weeks without a new case of the disease that has claimed the lives of more than 4,500 people in West Africa, mainly in Liberia, Sierra Leone and Guinea.

“Nigeria is now free of Ebola,” WHO representative Rui Gama Vaz told a news conference in the capital Abuja, Reuters reported. “This is a spectacular success story … It shows that Ebola can be contained but we must be clear that we have only won a battle. The war will only end when West Africa is also declared free of Ebola.”

The last reported case in Nigeria was confirmed Sept. 8. The nation’s response to Ebola is being held out as an example to the still-stricken West African nations, as well to Texas. 

Ebola hit Nigeria in July when an American-Liberian citizen, Patrick Sawyer, was diagnosed in Lagos with the disease — and Nigerian officials quickly declared a public health emergency. Sawyer later died.

It was a nightmare scenario with the potential to spiral out of control, given the bustling city of Lagos, Africa’s largest, is a major transportation hub.

In total, Nigeria reported 20 people with Ebola, according to WHO. Eight of them died. But John Vertefeuille, with the U.S. Centers for Disease Control and Prevention, said Nigeria took the right steps to stop it.

“Nigeria acted quickly and early and on a large scale” Vertefeuille told Agence France-Presse. “They acted aggressively, especially in terms of contact-tracing.”

Last week, WHO announced Senegal was free of the disease. The infection was brought to Senegal in August by a man who had traveled by road from Guinea to Dakar. The government of Senegal identified more than 70 people who had come in contact with the man and began testing anyone considered at high risk. On Sept. 5, the man tested negative, recovered and later returned to Guinea, according to a statement from WHO. According to WHO, the success of Nigeria — Africa’s most populous nation — was attributable to ample funding, quick action and assistance from the WHO, the U.S. Centers for Disease Control and the non-profit Doctors Without Borders.

Unlike the situation in Guinea, Liberia and Sierra Leone, “all identified contacts were physically monitored on a daily basis for 21 days. The few contacts who attempted to escape the monitoring system were all diligently tracked” by special teams and returned to observation.

The organization noted Nigeria had resources unavailable to the poorer nations of West Africa, including experienced epidemiologists and a virology lab associated with a teaching hospital at Lagos University.

Officials conducted house-to-house information campaigns, explaining the risks and the preventive measures necessary to keep control of the situation. 

Reported by World Health Organization (WHO)

UNICEF Canada launches urgent appeal against ebola

UNICEF Canada is launching an urgent appeal for donations to respond to the Ebola outbreak that is ravaging West Africa and putting 10 million children at risk. The humanitarian organization says it needs more than $200 million to respond, but has only raised $25 million to date, amid heightened concerns about the rapidly escalating crisis.

"Ebola is spreading more quickly than we ever could have imagined and is outpacing global efforts to combat it. It's hard for us to imagine as Canadians what it's like to be in these countries where a fatal disease is spreading like wildfire. Luckily for most of us, our understanding of this kind of crisis is only what we've seen in movies. But for millions of children and families in West Africa, it's a stark reality," says David Morley, President and CEO of UNICEF Canada.

"I can't stress how urgent the need is. New cases are reported every day—and tens of thousands of new cases are expected in the coming months. Whole communities are at stake. Canadians are among the most generous people in the world when humanitarian crises hit and we're urging them to continue this legacy by donating to help children affected by Ebola."

Ebola stats and facts:

• This Ebola outbreak has claimed more than 2,600 lives and devastated communities in Guinea, Liberia and Sierra Leone where an estimated 10 million children and youth under 20 years old live in Ebola-affected areas. Of them, 2.5 million are under the age of five.
• The outbreak is spreading fast with 47 per cent of the total number of cases seen within the past 21 days.
• Guinea, Liberia, Nigeria, Senegal, and Sierra Leone, have reported 4,963 cases and 2,453 deaths (as of 16 September).
• Women have been disproportionately affected by the virus because of their role as caregivers, comprising nearly 75 per cent of all cases so far.

Other risks:

• Lack of protection for health workers, challenges in providing protective supplies to families and monitoring burials, misconceptions and social unrest, have contributed to the spread of the virus.
• In contrast to previous outbreaks, this outbreak has reached urban centres and has been transmitted across international borders.
• The potential longer term impact of this crisis – on trade, economic growth, education, employment, social services – can be minimized if affected countries are not isolated.
• The breakdown of services to prevent epidemics - such as immunization, provision of clean water and sanitation and provision of bed nets - increases the risk of outbreaks of measles, cholera and malaria as well as resurgence in polio. This would in turn seriously damage the response efforts against Ebola and lead to a significant number of deaths amongst children and their families.

UNICEF's response:

1. Providing social mobilization and information in affected countries, playing a critical role to support, mobilize and incentivize networks of community health workers and volunteers.
2. Airlifting essential supplies to the affected countries on a massive scale for use in treatment and care centres as well as for continuity of basic services. By early October, UNICEF will have delivered 1300 metric tonnes (MT) on 55 flights.
3. Planning support for water supply, sanitation, and solid waste disposal and hygiene standards in care centres, alongside support for health standards.
4. Working closely with the governments in providing alternative means of learning for children affected by the closure of schools.
5. Providing counselling for children and families severely affected by the outbreak, including orphaned children and widows.
6. In the neighbouring countries at risk (Mali, Senegal, Guinea Bissau and Ivory Coast), UNICEF is working with the governments and partners to create awareness among the communities, while emergency supplies and medical equipment are being delivered for preparedness.

Lack of Ebola volunteers has doctors scrambling to catch up

Doctors and nurses are finally volunteering to fight the Ebola virus in West Africa after a long period of paralyzing fear in which almost none stepped forward.

But, experts say, even though money is now pouring in from the World Bank, the Gates Foundation and elsewhere, and the U.S. Army is to start erecting field hospitals soon, there is likely to be a long gap before those hospitals can be fully staffed to care for the growing numbers of people sick with Ebola.

“As a result, thousands of people will die,” Dr. Joanne Liu, president of Médecins sans frontières (Doctors Without Borders), which treats more patients than any other entity, said Friday. “I can’t say the exact figure because we don’t know how many unreported cases there are. But thousands for sure.”

Because months went by this summer in which almost no volunteers could be found, and because it takes time to train them and get them to Africa, there remains a yawning gap between the number of medical professionals needed and those in place to do the work. Each 100-bed hospital needs a staff of 400, about 40 of whom are foreign doctors or nurses. Meanwhile, about 600 Ebola cases are being recorded every week, according to the World Health Organization, and that number doubles every three weeks.

“If we had 1,700 staffed beds right now, we could maybe turn the tide,” Dr. Liu said. “When we hear the pledges, we ask for timelines. Some say eight to 10 weeks. They’re going to wake up to a much bigger problem at Christmas”

The first U.S. troops with orders to build 17 100-bed hospitals are arriving in Liberia now. Other countries, particularly Britain and France, are under pressure to do the same in Sierra Leone and Guinea.

But the U.S. military now plans to staff only one 25-bed hospital for infected health workers with members of the quasi-military Public Health Service.

“Who will staff the rest?” asked Dr. Liu. “It needs to be hands-on. You have to chip in and expose yourself.”

Ebola field hospitals ideally contain three separate tents for confirmed, probable and suspected cases; separate toilet and washing facilities for each; and a double fence outside so relatives can talk without touching. They also contain separate dressing and undressing rooms for staff members wearing protective gear, and possibly laboratory and kitchen tents.

Liberia: Chief medical officer places herself under Ebola quarantine

Liberia’s chief medical officer is placing herself under quarantine for 21 days after her office assistant died of Ebola.

Bernice Dahn, a deputy health minister who has represented Liberia at regional conferences intended to combat the ongoing epidemic, told The Associated Press on Saturday that she did not have any Ebola symptoms but wanted to ensure she was not infected.

The World Health Organization says 21 days is the maximum incubation period for Ebola, which has killed more than 3,000 people across West Africa and is hitting Liberia especially hard. WHO figures released Friday said 150 people died in the country in just two days.

Liberia’s government has asked people to keep themselves isolated for 21 days if they think they have been exposed. The unprecedented scale of the outbreak, however, has made it difficult to trace the contacts of victims and quarantine those who might be at risk.

“Of course we made the rule, so I am home for 21 days,” Dahn said Saturday. “I did it on my own. I told my office staff to stay at home for the 21 days. That’s what we need to do.”

Health officials, especially front-line doctors and nurses, are particularly vulnerable to Ebola, which is spread via the bodily fluids of infected patients. Earlier this month, WHO said more than 300 health workers had contracted Ebola in Guinea, Liberia and Sierra Leone, the three most-affected countries. Nearly half of them had died.

Making sure health care workers have the necessary supplies, including personal protective equipment, has been a challenge especially given that many flights in and out of Ebola-affected countries have been cancelled.

At an emergency of the African Union on Sept. 8, regional travel hub Senegal said it was planning to open a “humanitarian corridor” to affected countries.

Senegal was expected on Saturday to receive a flight carrying humanitarian staff from Guinea — the first time aid workers from one of the three most-affected countries were allowed in Senegal since the corridor was opened, said Alexis Masciarelli, spokesman for the World Food Program.

The airport in Dakar, Senegal’s capital, has set up a terminal specifically for humanitarian flights where thorough health checks will be conducted, Masciarelli said.

The current plan calls for two weekly rotations between Dakar and Ebola-affected countries and a third weekly rotation between Dakar and Accra, Ghana, where a special U.N. mission to fight Ebola will be headquartered, Masciarelli said.

Physician credits Ebola survival to experimental, Canadian-developed drug

In his many years of medical work in Liberia, Congo and elsewhere, Dr. Omeonga has suffered bouts of malaria and has seen almost everything in tropical medicine. But nothing, he says, feels like Ebola. He was feverish, vomiting, diarrhea and unable to eat. “You can’t even get off the bed. When you get Ebola, you only think you’re going to die.”

Two things helped him survive the lethal illness. One was ZMapp, the experimental Canadian-developed Ebola treatment. He was one of just seven Ebola victims worldwide who received ZMapp before supplies ran out. He believes that the three doses of ZMapp he received intravenously in Monrovia last month were among the keys to his recovery.

The other crucial support came from his four children, three of whom live in Canada. “Daddy, you have to fight,” they told him. “We need you. You’re going to make it.”

Those daily phone calls from Canada “gave me hope,” he said in an interview. “It’s what helped me to fight.”

ZMapp, a cocktail of monoclonal antibodies, was developed at the National Microbiology Lab in Winnipeg. Of the seven people with Ebola who received the treatment, two died and five lived. Because clinical trials have not been conducted, it’s impossible to say scientifically whether ZMapp saved his life, but Dr. Omeonga is convinced it accelerated his recovery.

The 53-year-old surgeon feels even more certain that ZMapp was crucial in saving a Liberian health worker, Kyndy Kobbah, who was in a coma in critical condition when she received it. “If it wasn’t for ZMapp, she wouldn’t have made it,” he said.

“Everybody was amazed. Nobody gave her a chance to survive. She got her recovery because of ZMapp. If they can expedite the production of it, they should try, because we really need it.”

Dr. Omeonga still sometimes feels weak and tired these days, about four weeks after his discharge from hospital, but he says he is gaining strength every day. And he is determined to return to work as a doctor in Monrovia, at the same Catholic hospital, St. Joseph’s, where he has served for the past three years. The hospital was closed in August after nine of its staff and patients died of Ebola, but it is expected to reopen next month or in early November.

It didn’t even cross his mind to abandon Liberia after surviving Ebola. “Now that I’ve recovered from Ebola, it wouldn’t make sense to be selfish,” he said. “I feel strongly that I want to keep helping the people here. Now that I have a second chance, I’ll use it to help others. They really need us.”

He has already volunteered to donate blood to Ebola patients. “The recovery period is the best time to donate blood, because that’s when you have the full antibodies,” he explains.

Dr. Omeonga’s experience reveals the desperately weak state of Liberia’s health system. His hospital director, Patrick Nshamdze, caught the Ebola virus from a patient in July, but his blood results gave a “false negative” – probably because of poor labelling or specimen collection in the testing process, Dr. Omeonga believes.

So as the hospital staff provided care to the dying director, they didn’t take enough precautions, believing that he didn’t have the Ebola virus. Several staff – including Dr. Omeonga – caught the virus from him, and Dr. Nshamdze died.

Health workers are among the most vulnerable in the Ebola epidemic. As of last week, 375 health workers had been infected with Ebola in four West African countries, and 211 had died.

This is because of three key factors, Dr. Omeonga said. First, there are severe shortages of protective equipment for health workers. Second, health workers have almost daily exposure to the Ebola virus. And third, their patients often conceal the fact that they have the virus.

“Some patients don’t tell the truth,” he said. “They come to you with a different story, like ‘abdominal pain.’ It’s because of the stigma of Ebola. They think they won’t be treated and they’ll be sent away.”

Global efforts to fight Ebola are falling far short, he said. “When I discuss it with my colleagues, we don’t feel the impact of the international help. It’s not coming fast enough. The numbers of cases and deaths are just going up. The international community needs to do more – and fast. A lot of hospitals are closed, and thousands of patients are in the community. Even if we go house-to-house, where are we going to put them?”

Yet his own story is an inspirational sign that the Ebola epidemic can be beaten. “There is a lot of hope,” Dr. Omeonga says.

“I’d like to spread the message of hope. It’s a deadly disease, but it doesn’t kill everyone. The key is to diagnose it early and go to treatment early. If you do that, you can survive.”

Questions and Answers on Ebola

What is Ebola?

Ebola, also known as Ebola virus disease, is a rare and deadly disease caused by infection with one of the Ebola virus strains (Zaire, Sudan, Bundibugyo, or Tai Forest virus). Ebola viruses are found in several African countries. Ebola was discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Since then, outbreaks have appeared sporadically in several African countries.

Has patient zero been identified?

Reports in the medical literature and elsewhere have attempted to identify the patient who might have been the initial person infected in the West Africa Ebola outbreak. Descriptions of these reports are available online. It’s important for CDC to learn as much as it can about the source and initial spread of any outbreak.

With regard to the West Africa Ebola outbreak, tracing the lineage of how Ebola has spread thus far can help CDC apply that knowledge toward better prevention and care techniques. The knowledge gained in this work might entail details about specific patients. CDC generally refrains, however, from identifying particular patients in any aspect of an outbreak.

Signs and Symptoms

What are the signs and symptoms of Ebola?

Signs and symptoms of Ebola include fever (greater than 38.6°C or 101.5°F) and severe headache, muscle pain, vomiting, diarrhea, stomach pain, or unexplained bleeding or bruising. Signs and symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, although 8 to 10 days is most common.

How is Ebola spread?

The virus is spread through direct contact (through broken skin or mucous membranes) with blood and body fluids (urine, feces, saliva, vomit, and semen) of a person who is sick with Ebola, or with objects (like needles) that have been contaminated with the virus. Ebola is not spread through the air or by water or, in general, by food; however, in Africa, Ebola may be spread as a result of handling bushmeat (wild animals hunted for food) and contact with infected bats.

Can I get Ebola from a person who is infected but doesn’t have fever or any symptoms?

No. A person infected with Ebola is not contagious until symptoms appear.

If someone survives Ebola, can he or she still spread the virus?

Once someone recovers from Ebola, they can no longer spread the virus. However, Ebola virus has been found in semen for up to 3 months. People who recover from Ebola are advised to abstain from sex or use condoms for 3 months.

Can Ebola be spread through mosquitos?

There is no evidence that mosquitos or other insects can transmit Ebola virus. Only mammals (for example, humans, bats, monkeys and apes) have shown the ability to spread and become infected with Ebola virus.

Could Ebola be brought to the U.S. through imported animals?

Because of the tough restrictions the U.S. federal government has in place for importing animals from Africa, it is highly unlikely for Ebola to be brought into the U.S. through imported animals.

The animals most commonly associated with Ebola are nonhuman primates (for example, apes and monkeys) and bats. Both the CDC and the U.S. Fish and Wildlife Service regulate importation of nonhuman primates and bats. These animals, products made from these animals, and research samples from these animals may only be imported into the United States with a permit. The permit specifies that the animals, animal products, or research samples are arriving ONLY for scientific, educational, or exhibition purposes. It is illegal to import these animals into the United States as pets or bushmeat.

Risk of Exposure

Who is most at risk of getting Ebola?

Healthcare providers caring for Ebola patients and family and friends in close contact with Ebola patients are at the highest risk of getting sick because they may come in direct contact with the blood or body fluids of sick patients.

In some places affected by the current outbreak, care may be provided in clinics with limited resources (for example, no running water, no climate control, no floors, inadequate medical supplies), and workers could be in those areas for several hours with a number of Ebola infected patients. Additionally, certain job responsibilities and tasks, such as attending to dead bodies, may also require different PPE than what is used when providing care for infected patients in a hospital.

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Treatment

How is Ebola treated?

No specific vaccine or medicine has been proven to cure Ebola. Signs and symptoms of Ebola are treated as they appear. The following basic interventions, when used early, can increase the chances of survival.

·         Providing fluids and electrolytes

·         Maintaining oxygen status and blood pressure

·         Treating other infections if they occur

Early recognition of Ebola is important for providing appropriate patient care and preventing the spread of infection. Healthcare providers should be alert for and evaluate any patients suspected of having Ebola.

Prevention

How do I protect myself against Ebola?

If you are in or traveling to an area affected by the Ebola outbreak, protect yourself by doing the following:

·         Wash hands frequently.

·         Avoid contact with blood and body fluids of any person, particularly someone who is sick.

·         Do not handle items that may have come in contact with an infected person’s blood or body fluids.

·         Do not touch the body of someone who has died from Ebola.

·         Do not touch bats and nonhuman primates or their blood and fluids and do not touch or eat raw meat prepared from these animals.

·         Avoid hospitals where Ebola patients are being treated. The U.S. Embassy or consulate is often able to provide advice on medical facilities.

·         Seek medical care immediately if you develop fever (temperature of 101.5oF/ 38.6oC) and any of the other following symptoms: headache, muscle pain, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding.

o    Limit your contact with other people until and when you go to the doctor. Do not travel anywhere else besides a healthcare facility.

CDC has issued a Warning, Level 3 travel notice for three countries. U.S. citizens should avoid all nonessential travel to Guinea, Liberia, and Sierra Leone. CDC has issued an Alert, Level 2 travel notice for Nigeria. Travelers to Nigeria should take enhanced precautions to prevent Ebola. For travel notices and other information for travelers, visit the Travelers’ Health Ebola web page.

Infection Control

Can hospitals in the United States care for an Ebola patient?

Any U.S. hospital that is following CDC’s infection control recommendations and can isolate a patient in their own room‎ with a private bathroom is capable of safely managing a patient with Ebola.

·         These patients need intensive supportive care; any hospital that has this capability can safely manage these patients.

·         Standard, contact, and droplet precautions are recommended.

How can healthcare providers protect themselves?

Healthcare providers can take several infection control measures to protect themselves when dealing with Ebola patients.

·         Anyone entering the patient’s room should wear at least gloves, a gown, eye protection (goggles or a face shield), and a facemask.

·         Additional personal protective equipment (PPE) might be needed in certain situations (for example, when there is a lot of blood, vomit, feces, or other body fluids).

·         Healthcare providers should frequently perform hand hygiene before and after patient contact, contact with potentially infectious material, and before putting on and after removing PPE, including gloves.

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Travelers

What is being done to prevent ill travelers in West Africa from getting on a plane?

CDC works with partners at ports of entry into the United States to help prevent infectious diseases from being introduced and spread in the United States. CDC has staff working 24/7 at 20 Border Health field offices located in international airports and land borders. CDC staff are ready 24/7 to investigate cases of ill travelers on planes and ships entering the United States.

Although someone could become infected with Ebola in Guinea, Liberia, Nigeria, or Sierra Leone and then fly to the United States, it is unlikely that they would spread the disease to fellow passengers. A person infected with Ebola is not contagious until symptoms appear. Nevertheless, CDC and healthcare providers in the United States need to be prepared for the remote possibility that a traveler could get Ebola and return to the United States while sick.

CDC works with key partners like Customs and Border Protection, U.S. Department of Agriculture, U.S. Coast Guard, U.S. Fish and Wildlife Services, state and local health departments, and local Emergency Medical Services staff. CDC also works closely with the airline and cruise industries and cargo ships to ensure that suspected cases of infectious diseases are reported to CDC Quarantine Stations and that appropriate measures are taken to prevent the spread of disease. When CDC receives a report of an ill traveler on a plane, our staff work with EMS crews to evaluate the passenger on the plane, and when necessary, arrange for transfer of ill travelers to local hospitals for testing and treatment as necessary. When CDC receives a report of an ill traveler on cruise or cargo ship, we work with the shipping line to make an assessment of public health risk and to coordinate any necessary response.

CDC is providing information to partners, such as Customs and Border Protection and airlines, on signs and symptoms to look for in travelers arriving from Ebola outbreak-affected countries that should be reported to CDC quarantine station staff.

What do I do if I’m returning to the U.S. from the area where the outbreak is occurring?

After you return, pay attention to your health.

·         Monitor your health for 21 days if you were in an area with an Ebola outbreak, especially if you were in contact with blood or body fluids, items that have come in contact with blood or body fluids, animals or raw meat, or hospitals where Ebola patients are being treated or participated in burial rituals.

·         Seek medical care immediately if you develop fever (temperature of 101.5oF/ 38.6oC) and any of the following symptoms: headache, muscle pain, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding.

·         Tell your doctor about your recent travel and your symptoms before you go to the office or emergency room. Advance notice will help your doctor care for you and protect other people who may be in the office.

What do I do if I am traveling to an area where the outbreak is occurring?

If you are traveling to an area where the Ebola outbreak is occurring, protect yourself by doing the following:

·         Wash your hands frequently.

·         Avoid contact with blood and body fluids of any person, particularly someone who is sick.

·         Do not handle items that may have come in contact with an infected person’s blood or body fluids.

·         Do not touch the body of someone who has died from Ebola.

·         Do not touch bats and nonhuman primates or their blood and fluids and do not touch or eat raw meat prepared from these animals.

·         Avoid hospitals where Ebola patients are being treated. The U.S. Embassy or consulate is often able to provide advice on facilities.

·         Seek medical care immediately if you develop fever (temperature of 101.5oF/ 38.6oC) and any of the other following symptoms: headache, muscle pain, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding.

o    Limit your contact with other people until and when you go to the doctor. Do not travel anywhere else besides a healthcare facility.

Should people traveling to Africa be worried about the outbreak?

Currently, Ebola has only been reported in Guinea, Liberia, Nigeria, Senegal, and Sierra Leone (see Affected Countries). A small number of cases in Nigeria have been associated with a man from Liberia who traveled to Lagos and died from Ebola, but the virus does not appear to have been widely spread. CDC has issued a Warning, Level 3 travel notice for United States citizens to avoid all nonessential travel to Guinea, Liberia, and Sierra Leone. CDC has also issued an Alert, Level 2 travel notice for travelers to Nigeria urging them to protect themselves by avoiding contact with the blood and body fluids of people who are sick with Ebola. You can find more information on these travel notices at http://wwwnc.cdc.gov/travel/notices.

CDC currently does not recommend that travelers avoid visiting other African countries. Although spread to other countries is possible, CDC is working with the governments of affected countries to control the outbreak. Ebola is a very low risk for most travelers – it is spread through direct contact with the blood or other body fluids of a sick person, so travelers can protect themselves by avoiding sick people and hospitals where patients with Ebola are being treated.

Why were the ill Americans with Ebola brought to the U.S. for treatment? How is CDC protecting the American public?

A U.S. citizen has the right to return to the United States. Although CDC can use several measures to prevent disease from being introduced in the United States, CDC must balance the public health risk to others with the rights of the individual. In this situation, the patients who came back to the United States for care were transported with appropriate infection control procedures in place to prevent the disease from being transmitted to others.

Ebola poses no substantial risk to the U.S. general population. CDC recognizes that Ebola causes a lot of public worry and concern, but CDC’s mission is to protect the health of all Americans, including those who may become ill while overseas. Ebola patients can be transported and managed safely when appropriate precautions are used.

What does CDC’s Travel Alert Level 3 mean to U.S. travellers?

CDC recommends that U.S. residents avoid nonessential travel to Guinea, Liberia, and Sierra Leone. If you must travel (for example, to do for humanitarian aid work in response to the outbreak) protect yourself by following CDC’s advice for avoiding contact with the blood and body fluids of people who are ill with Ebola. For more information about the travel alerts, see Travellers’ Health Ebola web page.

Travel notices are designed to inform travellers and clinicians about current health issues related to specific destinations. These issues may arise from disease outbreaks, special events or gatherings, natural disasters, or other conditions that may affect travelers’ health. A level 3 alert means that there is a high risk to travellers and that CDC advises that travelers avoid nonessential travel.

In the United States

Are there any cases of people contracting Ebola in the U.S.?

No confirmed Ebola cases have been reported in the United States, with the exception of two U.S. healthcare workers who were infected with Ebola virus in Liberia and were transported to a hospital in the United States. Both patients have been released from the hospital after laboratory testing confirmed that they no longer have Ebola virus in their blood. CDC has advised the hospital that there is no public health concern with their release and that they do not pose a risk to household contacts or to the public.

CDC has received many calls from health departments and hospitals about suspected cases of Ebola in travellers from the affected countries. These calls have been triaged appropriately and some samples have been sent to CDC for testing. All samples sent to CDC have so far been negative.

What is CDC doing in the U.S.?

CDC has activated its Emergency Operations Canter (EOC) to help coordinate technical assistance and control activities with partners. CDC has deployed several teams of public health experts to the West Africa region and plans to send additional public health experts to the affected countries to expand current response activities.

On the remote possibility that an ill traveller arrives in the U.S., CDC has protocols in place to protect against further spread of disease. These protocols include having airline crew notify CDC of ill travellers on a plane before arrival, evaluation of ill travellers, and isolation and transport to a medical facility if needed. CDC, along with Customs & Border Patrol, has also provided guidance to airlines for managing ill passengers and crew and for disinfecting aircraft. CDC has issued a Health Alert Notice reminding U.S. health care workers about the importance of taking steps to prevent the spread of this virus, how to test and isolate patients with suspected cases, and how to protect themselves from infection.