Reflecting the tough challenge responders have in getting Ebola cases to zero, the number of confirmed infections increased in Guinea and Sierra Leone last week, with new cases popping up outside of known transmission chains and a number of Ebola detections found only after people died from the disease in their communities, the World Health Organization (WHO) said today in its weekly update on outbreak patterns.
Meanwhile, Liberia for the first time went a week without a confirmed case. The country reported only one confirmed case the week before.
Overall, 132 newly confirmed cases were reported in the outbreak countries last week, compared with 99 reported the week before, the WHO said. The latest reports lift the region's number of confirmed, probable, and suspected cases to 23,924, with the number of deaths rising to 9,792.
Worrisome trends in Guinea
Guinea reported 51 new cases, 16 more than the previous week. The hot spots were three neighboring areas in the western part of the country: Conakry, Coyah, and Forecariah. Two new confirmed case were also reported in Macenta district, which had not reported a case for 4 weeks. Low levels of transmission were also seen in Lola district, an area that borders Ivory Coast.
The number of security incidents dropped from the previous week; four districts reported at least one, compared with nearly a third of Guinea's 34 prefectures the week before.
Problems have been related to suspicions that responders are spreading Ebola. Aside from the risks posed to aid workers from violent attacks, community resistance has made it tough for workers to do two key steps that help curb the disease: identify sick people in the community and get them into isolation, and conduct contact tracing.
Two markers of those activities are still worrisome in Guinea. The WHO said more than half (16 of 30) deaths from Ebola last week occurred in community settings. That fact demonstrates that some patients are not being treated and perhaps saved because others are not stepping forward to notify responders.
Since Ebola virus levels are highest as people get sicker and at death, fatalities that occur in the community setting also pose the risk of spread to local residents. In addition, the WHO said 49% of Guinea's cases occurred in known contacts, a sign of gaps in the contact-tracing process.
Outbreak responders also closely track the number of unsafe burials, given the high risk of spread related to local customs. Guinea reported 16 unsafe burials last week.
The only new health worker infection was reported from Guinea last week, raising the overall outbreak total in the three countries to 839, which includes 491 deaths.
Continued cases in Sierra Leone
Sierra Leone's drop in Ebola cases earlier this year has now been reversed, and Ebola transmission there is still widespread, the WHO said. The country reported 81 new confirmed cases last week, compared with 63 the week before.
Eight of Sierra Leone's districts reported cases, and one of the drivers is an earlier reported cluster in the Aberdeen fishing community of Freetown, which has seeded outbreaks in other areas, including Bombali, which reported 22 new cases. The WHO said a response team tracking illnesses linked to the Aberdeen cluster have identified more than 2,000 contacts for monitoring.
Other hot spots included Freetown, Western Rural district, and Port Loko district. Transmission was also reported in other parts of the country, including Koinadugu, Kono, and Tonkolili districts.
For community resistance markers, 14 Ebola cases were detected only after people died in community settings, a slight decrease from the week before.
Hospital preparedness update, Ebola country risk tool
- The US Centers for Disease Control and Prevention (CDC) yesterday in Morbidity and Mortality Weekly Report (MMWR) provided an update on the country's plans for rapidly detecting and treating any US Ebola cases. When the outbreak in West Africa first began, only a few high-containment US facilities were available for treating Ebola and other highly lethal diseases. After the first cases were detected on US soil, federal health officials started funneling all West African travelers into five designated airports for enhanced screening and monitoring. They also unveiled a tiered approach for preparing health facilities, and 55 facilities have now been designated as Ebola treatment centers, alongside three US biocontainment units at Emory University Hospital, the National Institutes of Health Clinical Centers, and Nebraska Medical Center. The CDC said the next step is an increased focus on identifying and evaluating the next tier: Ebola assessment hospitals, which would be prepared to admit, isolate, and care for a suspected case-patient for up to 96 hours until he or she can be transferred to a treatment center. The agency added that experts and stakeholders have suggested that Ebola patient care take place at a small number of well-prepared facilities, and the assistant secretary for preparedness and response is developing an approach for up to 10 centers—one in each region—to be so designated for Ebola and other highly infectious diseases.
- An experimental tool developed by researchers at the Rand Corporation to gauge the vulnerability of countries to Ebola found that six other countries in Africa may be at high risk: Burkina Faso, the Central African Republic, Chad, Ivory Coast, Ethiopia, and Mali. For South Asia, Afghanistan was found to be at high risk, but no nations in the Middle East or in Southeast Asia were rated as high risk, according to a Mar 3 Rand press release. The analysis tool uses statistical indicators to assess risk in four main areas: political, economic, sociocultural, and health. It gauges factors such as government effectiveness, communications availability, and healthcare infrastructure and workforce. Rand said the tool can be used to plan tabletop preparedness exercises and to gauge vulnerability to other types of emergencies.
Mar 4 WHO situation update
Mar 3 MMWR report
Mar 3 Rand Corp press release