Ebola pace shows little let-up in Sierra Leone

The Ebola virus in West Africa continues to exact its worst toll in Sierra Leone, which reported 337 new cases last week, more than double those in Guinea and Liberia combined, the World Health Organization (WHO) said today in its weekly update.

Western Sierra Leone is still seeing the most intense transmission of all three countries, though there are still signs that the increase in incidence is slowing, the WHO said. Guinea's case levels remain in flux, and while Liberia's overall level is decreasing, it reported a bump in cases last week.

Globally, the number of Ebola cases has reached 20,206, which includes the United Kingdom's first case, a nurse who got sick upon her return from Sierra Leone. So far, 7,905 deaths have been reported.

Hot spots and trends

Over the past week, along with Sierra Leone's 337 additional cases, Guinea reported 114 and Liberia reported 31. Liberia's number was slightly higher than the 21 cases it reported the week before, while Guinea's was lower.

In Sierra Leone, Freetown accounted for much of the transmission, with 149 cases last week. Activity was high in neighboring Port Loko, which reported 69 new cases. Other western districts also reported several fresh cases, and the WHO said the western area response surge being conducted by Sierra Leone's government and its health partners continues in the region, targeting the identification and isolation of patients and contact tracing.

Another hot spot is Kono district in the eastern part of the country, which reported 39 cases last week, its highest weekly count so far.

In Guinea, Ebola transmission persisted in areas in and around Conakry, with the Dubreka area reporting a sharp rise in cases last week, the WHO said. Other active areas include Kindia, which borders Sierra Leone. Meanwhile, transmission dropped in some southeastern areas, including Macenta and Kerouane.

The WHO said community resistance and population movements continue as roadblocks to containing the disease in Guinea.

Liberia's main hot spot is still Montserrado County, which includes Monrovia. However, 10 new cases were reported from Grand Cape Mount County in the northern part of the country.

Tracking other measures

Regarding response activities, all three countries have the capacity to isolate all reported cases, but in some areas, treatment beds are unevenly distributed, the WHO said. Guinea faces the toughest challenge, with cases widely distributed across the country but treatment centers concentrated near Conakry and in the southeast, causing patients in other parts of the country to travel long distances for treatmenta factor that fuels the spread of the disease.

The countries vary in their capacity to trace contacts, with 96% of registered contacts visited daily in Guinea, 90% in Liberia, and 94% in Sierra Leone. However, the WHO said the proportion receiving visits is much lower in some districts.

Two more Ebola infections in health workers were reported last week, one in Liberia and one in Guinea, raising the total to 660. So far 375 health workers have died.

Ebola causes drop in maternal healthcare

Sierra Leone's health ministry, concerned about a drop in antenatal and postnatal care visits between May and July in Kenema district, where a third of the country's Ebola cases had been reported, collaborated with other groups to see what led to the decline and how it could be reversed, according to an article today in Morbidity and Mortality Weekly Report. The ministry estimated a 29% drop in antenatal care and a 21% decline in postnatal care.

The issue is a concern because Sierra Leone has the world's highest maternal mortality ratio and its fourth highest infant mortality rate, the report says. Focus group discussions, led by collaborators including experts from the US Centers for Disease Control and Prevention (CDC), were held with health workers and women to explore the reasons for the healthcare utilization drop.

Investigators found that maternal health clinic visits dropped sharply after the Ebola outbreak began and that the primary reason was that patients were afraid of getting infected at the outpatient facilities. Women had several misconceptions, including that clinic staff were paid to refer patients to Ebola treatment units and that health staff would inject the women with Ebola or take their blood for profit. Health staff believed that they, like health workers on the Ebola front lines, were at risk for the disease.

Women and health workers both reported that maternal care usage was improving and that infection control training and additional equipment, such as hand washing stations, are gradually increasing the use of the services. They noted that more messaging could be done to reverse negative attitudes, focusing on, for example, reinforcing the good experiences women have previously received at the facilities and having women who received recent care share their experiences with others.

Other developments

  • Researchers at the University of California, Davis, have received a $200,000 rapid response grant from the National Science Foundation to explore ways to speed production of the experimental Ebola drug ZMapp, an antibody cocktail produced in whole tobacco plants. The team's goal is to explore a way to produce antibodies from plant cells grown in bioreactors rather than in whole plants. In a statement from UC Davis, Karen McDonald, PhD, professor of chemical engineering and materials science, said extracting antibodies from plants is a proven process, but production capacity is limited. "Whereas if we can produce it in a bioreactor, a lot of biotech companies and contract manufacturers can do that, and it would allow for much more rapid production," she added.

  • A Scottish nurse who got sick with Ebola after working in Sierra Leone and was taken to Royal Free London hospital yesterday has decided to be treated with convalescent serum and an experimental antiviral drug, the facility said in a statement today. It said the nurse, who has been identified as 39-year-old Pauline Cafferkey, is sitting up in bed, talking, and reading. In a related development, Public Health England (PHE) said today it has contacted 85 passengers who were on the same flights as the nurse and that authorities will reach 100 passengers and international partners will contact 32 more. PHE said the infection risk to other passengers is extremely low, because the woman didn't have symptoms when she flew, but it will monitor the health of 21 passengers who sat in the two rows adjacent to Cafferkey. The WHO said yesterday that the woman started having a fever around the time she arrived in London. Her final destination was Glasgow.

  • FluTrackers, an infectious disease news message board, today found foreign and English-language media reports from Iraq that said a few Ebola cases had been detected in fighters, which some reports said were of African descent, in Mosul. Analysts from FluTrackers cautioned that the area is unstable because of conflict, and it's difficult to gauge the reliability of the reports. Gregory Hartl, a WHO spokesman, said on Twitter today that the WHO is following up on the reports.

See also:

Dec 31 WHO Ebola situation report

Dec 31 MMWR report

Dec 30 UC Davis press release

Dec 31 Royal Free London statement

Dec 31 PHE statement

Dec 30 WHO statement

FluTrackers thread

Gregory Hartl Twitter feed

Newsletter Sign-up

Get CIDRAP news and other free newsletters.

Sign up now»

OUR UNDERWRITERS

Unrestricted financial support provided by

Bentson Foundation 3M Gilead 
Grant support for ASP provided by

  Become an underwriter»