Progress against Ebola in the two countries still battling the disease has stalled, with cases popping up in a wide swath of Guinea and from unidentified transmission chains, the World Health Organization (WHO) reported today in its weekly epidemiologic report on the outbreak.
As Liberia passed the 1-month mark of being free of Ebola, neighboring countries last week reported 31 more lab-confirmed cases, up from 25 the week before. The WHO said cases last week were at their highest level since late March.
The latest cases lift the overall number of confirmed, probable, and suspected cases to 27,237, including 11,158 deaths, the WHO said.
None of the latest cases affected healthcare workers, which keeps that number over the course of the outbreak at 869, including 507 deaths.
Patterns show community engagement gaps
Guinea's 16 cases last week were detected in five of its western districts, half of them from Forecariah district, an area near the border with Sierra Leone that has been a hot spot over the past several weeks. Two locations that had not reported a case in more than 40 days had infections: Conakry and Kindia district.
Five of the country's cases were from unknown transmission sources, including all three in Kindia district. In another sign that infected people are going undetected and posing a risk to the community, three of Guinea's latest cases were among people whose infections were detected only after they died in their communities.
One of Guinea's other cases occurred in Boke district, in the northwestern part of the country near the border with Guinea-Bissau. The patient, a known contact of a previous case, was lost to tracking during civil unrest and was later found to have died from the disease in the community. The WHO said an intensive search for the individual's many high-risk contacts is under way.
Ebola deaths in the community, cases in undetected transmission chains, and unsafe burials are signs of the community engagement challenges that remain in both Guinea and Sierra Leone, the WHO said.
Meanwhile, Sierra Leone reported 15 cases last week, 7 of them in Kaffu Bollum chiefdom, a densely populated area of Port Loko district. A cluster of three cases was reported in another of the district's chiefdoms, two of them from unknown transmission chains that responders suspect are linked to neighboring Kambia district, which reported 5 cases last week.
The WHO noted that community engagement is still a problem in several Kambia district chiefdoms and that better communication is needed to help health officials understand local concerns and why people aren't reporting cases, deaths, and burials.
One bright spot in Sierra Leone is that no cases were reported in Western Urban Area district, which includes Freetown. However, the WHO noted that 195 contacts in that area are still being monitored.
Liberia reaches 1-month mark amid caution
The United Nations Mission for Ebola Emergency Response (UNMEER) today recognized Liberia for going 1 month without a new case since it was declared free of the virus. Peter Graaff, head of UNMEER, said in statement today that Liberia's progress is exciting, but that risks remain. "The threat to the region remains so long as there is one single case of Ebola in any country," he said.
The group said it met with leaders of Guinea and Sierra Leone on Jun 5 to discuss cross-border cooperation needed to drive cases down to zero in both countries.
Graaff said the key to success is community participation in battling the virus. "Communities are our front-line works in the fight against Ebola."
UNMEER said it is working on handing over its capacities to the three hardest hit countries and on May 31 closed its office in Liberia, after transferring its operations to local officials. It added that it is transitioning its operations in Sierra Leone and Guinea, as well, with goals of closing its Sierra Leone office on Jun 30 and its Guinea office on Jul 31.
Graaff said increased international and national capacities for fighting Ebola have allowed UNMEER to scale back some of its operations, but he said measures are still in place to ensure that response activities continue until cases reach zero. "The UN family is committed to seeing this fight through to the end, even once UNMEER leaves."
Studies compare Ebola strains, assess lingering symptoms
- In macaques, infections with the Ebola strain responsible for West Africa's outbreak appear to be less virulent than infections with a virus that triggered the first known Ebola outbreak in 1976. A research team at the National Institutes of Health Rocky Mountain Laboratories in Hamilton, Mont., published its findings yesterday in Emerging Infectious Diseases. Though clinical symptoms and parameters were similar in animals infected with both viruses, the ones experimentally infected with the current Ebola Makona strain lagged behind in many, especially progression to end-stage disease. Though the disease was less virulent in the Ebola Makona-infected macaques, all the animals eventually died. The team concluded that the findings seem consistent with the lower case-fatality rate seen in the current outbreak, compared with the 1976 outbreak, and that the macaque model they developed can be useful for developing countermeasures against the current strain affecting West Africa.
- A survey of 105 Ebola survivors in Guinea found that anorexia and joint pain are common, according to a study by researchers in Minnesota, Guinea, and Senegal published yesterday in Clinical Infectious Diseases. The mean time between hospital discharge and when patients took the survey was about 103 days. Anorexia was reported by 103 respondents and varied by intensity, though 65 reported it as moderate. Joints were by far the most common pain site, reported in nearly 87% of participants. Most patients reported moderate or excellent recovery of functional status. Investigators found that joint pain was related to lower functional recovery, and they said there may be a role for targeted screening and symptom intervention in Ebola survivors.
See also:
Jun 10 WHO Ebola situation update
Jun 10 UNMEER press release
Jun 9 Emerg Infect Dis study
Jun 9 Clin Infect Dis abstract
