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.

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