West Africa Ebola outbreak total tops 1,000

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As 67 new Ebola virus disease (EVD) illnesses in Sierra Leone and Liberia pushed the outbreak total to 1,048 cases, the United Nations Food and Agriculture Organization (FAO) warned about the risk of virus transmission from wildlife, especially fruit bats.

Along with new infections, 19 more deaths were reported in Sierra Leone and Liberia, raising the fatality count to 632, according to a Jul 19 update from the World Health Organization (WHO) that covers new cases reported from Jul 15 to Jul 17.

The WHO said the outbreak shows a decline in Guinea, which was the first country hit by the outbreak, the biggest and deadliest one of its kind so far. The country reported no new cases or deaths during the reporting period.

However the country's neighbors Sierra Leone and Liberia reported a steady rise in cases at a level that the WHO said was serious.

Sierra Leone situation

Sierra Leone reported 45 new illnesses and 9 deaths, lifting the country's total so far to 442 cases, 206 of them fatal. The country has for the first time more cases than Guinea, which has logged 410.

Gambia has sent a team of 11 healthcare workers to help Sierra Leone with its outbreak response, based on a call for regional collaboration made at an early July health minister's meeting in Accra, Ghana. The WHO added that the team will help with critical human resource needs, but the mission will also help boost preparedness in Gambia.

Meanwhile, Sierra Leone's religious leaders have criticized the government's management of the outbreak response, noting that a lack of information is fueling rural community resistance to medical help, Reuters reported today.

Bishop John Yambasu, head of the United Methodist Church of Sierra Leone and chair of an interfaith task group, said he was disappointment that the government hasn't declared a public health emergency, which he said would increase resources for outbreak response, according to Reuters. He accused the government of being too concerned about the political ramifications of declaring an emergency.

The country's health minister has said the outbreak is serious but hasn't reached emergency levels, Reuters said.

Liberia developments

Meanwhile, Liberia reported 22 more infections and 10 deaths to the WHO. The numbers boost the country's total to 196 cases, which includes 116 deaths.

The WHO said it, Liberia's health ministry, and its other health partners are assessing the outbreak response in each country to identify challenges and help set priorities.

A recently completed assessment in Liberia identified a number of gaps, including low coverage of contact tracing; persistent denial about the disease and resistance to response activities in the community; weak data management; inadequate infection and control practices, especially in outlying health facilities; and weak leadership and coordination at the subnational level.

The WHO said some of the challenges are driven by a lack of financial resources and human technical capacity. The agency added that authorities are mapping out the financial, logistics, and human resources needs as part of a national operational plan to battle the EVD outbreak.

Similar assessments are under way for Guinea and Sierra Leone, as well, the WHO said.

In other developments, elected officials in Liberia have voted to ask the country's president to declare a health emergency due to the country's EVD outbreak, the Daily Observer, a newspaper based in Monrovia, reported on Jul 18.

A motion passed by the country's Senate on Jul 17 orders its leadership to join with the country's House of Representatives in requesting the health emergency and asks that the government free up $1.5 million to help the health ministry battle the disease.

FAO caution singles out fruit bats

The FAO said today that although curbing human-to-human EVD transmission is the most important focus, it is working closely with the WHO to raise awareness about transmission risks from wildlife among rural communities that hunt bush meat to supplement their diets and income.

The agency said the communities risk future spillover from species that carry the virus, including fruit bats, some primates, and duikers—small antelopes native to sub-Saharan Africa.

Juan Lubroth, DVM, the FAO's chief veterinary officer, said in a statement that the group isn't suggesting that people stop hunting, because that wouldn't be realistic. "But communities need clear advice on the need not to touch dead animals or to sell or eat the meat of any animal that they find already dead."

He added that people in rural communities should also avoid hunting animals that are sick or behaving strangely.

The FAO, however, said fruit bats should be avoided altogether, because they are the most likely reservoir for the virus and can carry it without showing signs of disease. In West Africa, fruit bats are usually eaten dried or in a spicy soup, the group added.

Several governments in the region have tried to ban the sale and consumption of bush meat, but bans have been impossible to enforce and have prompted suspicion from rural populations, the FAO said.

Katrinka de Balough, DVM, FAO veterinary public health officer and Ebola focal point, said in the statement that mistrust, myths, and rumors are among the challenges in controlling the disease. She added that concerns are growing about the impact the outbreak might have on food security in some parts of the region, with some farmers afraid to work in their fields and some markets shut down.

The FAO said it has committed resources and has been working with partners to improve information about the disease using existing networks that include rural radio and agricultural extension services. It also added that it will work with governments to set up wildlife surveillance systems to more quickly detect the virus.

"Rural communities have an important role to play in reporting unusual mortality in the animal population, which is another reason that their collaboration is so crucial," de Balogh said.

Another step will be to assess the role of hunting, with an eye toward identifying healthier, more sustainable livestock production options that can provide more protein and income sources, the FAO said.

See also:

Jul 19 WHO update

Jul 21 FAO statement

Jul 21 Reuters story

Jul 18 Daily Observer story

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