WHO: Ebola cases keep coming, but footprint is smaller

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With 116 new Ebola virus cases in West Africa last week, the incidence still has not declined significantly since late January, but Liberia has now gone 2 weeks with no new cases, and the epidemic's overall geographic footprint has shrunk, the World Health Organization (WHO) said in its weekly situation report today.

Also today, the British government announced that one of its military healthcare workers in Sierra Leone has contracted Ebola virus disease (EVD). That news came on the heels of a WHO announcement that an earlier Ebola case in the UK led to no further cases, prompting a declaration that the country is Ebola-free.

And in other developments, the WHO said a partnership with the United Nations World Food Programme (WFP) is boosting its battle to stop the virus, while the Wellcome Trust announced the launch of a clinical trial of an experimental Ebola drug, TKM-Ebola.

Cases clustered around capital cities

The WHO said new Ebola cases were confined to Guinea and Sierra Leone, with 58 in each country, compared with 51 and 81 cases a week earlier, respectively. They occurred in a "geographically contiguous arc around the coastal capital cities of Conakry and Freetown, with a total of 11 districts reporting cases."

Although overall case incidence has not dropped significantly since late January, "the recent contraction in the geographical distribution of cases is a positive development, enabling response efforts to be focused on a smaller area," the WHO said.

Guinea's 58 new cases were clustered in an area in and around Conakry, which had 13 cases. The rest were in the nearby prefectures of Boffa (2 cases), Coyah (8), Dubreka (5), Forecariah (28), and Kindia (2).

The 58 new cases in Sierra Leone marked the first time since June 2014 that the country's weekly total did not exceed Guinea's, the WHO said. Cases were reported in five northern and western districts around Freetown. The capital reported 27 new cases, and the other infections were in the neighboring districts of Bombali (6), Kambia (7), Port Loko (12), and Western Rural (6).

In Liberia, 90 suspected cases were reported from March 2 through 5, but none were confirmed, which signaled that "vigilance is being maintained," the report said. Officials were following 102 contacts of cases.

Gaps in contact tracing persist

Several statistics indicate that Guinea is still falling well short of tracing all contacts of known case-patients, while Sierra Leone is doing considerably better, according to the WHO.

Of 40 EVD deaths reported in Guinea last week, 24 occurred in the community rather than in healthcare facilities, pointing to problems with contact tracing and community engagement, the agency said. It said the count of Ebola deaths in the community has climbed for 3 weeks in a row.

In Sierra Leone, only 11 of 83 EVD deaths last week occurred in the community, the WHO said. A total of 13 unsafe burials were reported in Guinea and 2 in Sierra Leone over the same period.

Another sign of the difficulties in Guinea was that in the week that ended Mar 1, just 7 of 51 EVD cases arose among contacts of known cases, indicating that there are many untraced contacts in known transmission chains and that unknown transmission chains persist, the report said. In Sierra Leone, by contrast, 52 of 81 cases involved known contacts over the same period.

Just one new infection in a healthcare worker was reported last week, in Guinea. That raised the total for the epidemic in the three countries to 840, with 491 deaths.

The WHO said the cumulative total of confirmed, probable, and suspected cases in the epidemic has reached 24,247, with 9,961 deaths. Cases reported in the past 21 days totaled 350.

Case reported in UK military worker

Elsewhere, BBC News reported today that a female British military healthcare worker in Sierra Leone has contracted Ebola and is being treated in the Kerry Town treatment unit there.

Public Health England said in a statement, "Medical experts are currently assessing the situation to ensure that appropriate care is delivered. A clinical decision on whether the individual will be medically evacuated to the UK for treatment will be taken in due course." The agency said authorities are investigating how the woman was exposed to the virus and are tracing her contacts.

The BBC said the UK has between 600 and 700 military personnel working in Sierra Leone because of the Ebola epidemic. The story said the latest case represents the third British citizen to contact Ebola. The two others, nurses Will Pooley and Pauline Cafferkey, fully recovered, it said.

The news of the new case followed an announcement yesterday by the WHO Regional Office for Europe that the UK is free of Ebola, after it determined that a case imported from Sierra Leone in late December caused no further spread of the virus. The patient was not named, but the announcement apparently had to do with Cafferkey's case.

The WHO said the case involved a healthcare worker who returned from Sierra Leone to Glasgow on Dec 28 and fell ill and was diagnosed the next day. The patient subsequently recovered. All passengers who had flown with the person were contacted, and all completed the 21-day monitoring period without getting sick.

As of Mar 7, 42 days, or twice the incubation period, had passed since the Ebola case-patient had tested negative for the virus, the WHO said. That meant that the UK could be declared Ebola-free under WHO guidelines.

WHO partners with UN food program

In other developments, the WHO today announced a partnership with the WFP whereby the latter is providing the WHO with logistical support, such as computers and telephones, to help fight Ebola in the three affected countries.

The WHO said the arrangement "combines the logistics strength of WFP with WHO's public health expertise" to fight the epidemic and also establishes an alert and response infrastructure for future crises. The two agencies agreed to combine their expertise in more than 60 districts and prefectures in Guinea, Liberia, and Sierra Leone.

"In districts with ongoing Ebola transmission, WFP is ensuring that WHO disease detectives have the resources they need — computer equipment, phones and stable internet connectivity — to share information critical to tracking and stopping the virus," the WHO reported.

In addition, WFP is managing the fleet of vehicles carrying WHO social anthropologists and epidemiologists to isolated villages, where they work to gain the trust of communities to find and follow contacts of Ebola patients, the WHO said.

The agency said it has more than 700 employees currently working in the Ebola-stricken countries, more than ever before.

"This partnership increases both agencies' abilities to reach, monitor and respond to the needs of all people touched by Ebola," WHO Director-General Margaret Chan, MD, MPH, said. "It helps us deploy and maintain technical teams with expertise in infection prevention and control, epidemiology, and contact tracing, enabling dedicated health workers in the deep field to do their best work."

Ebola drug trial launched

And in other news, the Wellcome Trust today announced the start of a phase 2 trial of the experimental antiviral TKM-Ebola in Sierra Leone.

The drug, developed and manufactured by Tekmira Pharmaceuticals, is a synthetic small interfering RNA substance designed to target the Ebola strain circulating in West Africa, the group said in a statement. It works by blocking certain viral genes, thereby reducing replication.

An earlier version of TKM-Ebola drug was tested in healthy human volunteers, the Wellcome Trust said. The new version will now be evaluated in patients who have a confirmed EVD diagnosis in a single-arm study called RAPIDE-TKM, with results expected in the second half of this year.

The statement said TKM-Ebola is the second drug trial to be funded through the Wellcome Trust's Ebola therapeutics platform. A previous trial of the antiviral brincidofovir was abandoned earlier this year after a sharp fall in the number of Ebola cases at the study site in Liberia.

See also:

Mar 11 WHO Ebola situation report

Mar 11 BBC story on UK military health worker

Mar 11 Public Health England statement about UK health worker

Mar 10 WHO-Europe statement on UK status

Mar 11 WHO statement on WFP partnership

Mar 11 Wellcome Trust press release on TKM-Ebola trial

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