UN sets up Ebola headquarters in Ghana

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A special representative to the United Nations (UN) secretary-general arrived in Accra, Ghana, yesterday to head the UN Mission for Ebola Emergency Response (UNMEER), as investigation reports published today show that the outbreak's spread in Nigeria and Senegal is over.

Anthony Banbury will lead operations at the UN mission headquarters in Accra, and the office will have a strong presence in Guinea, Liberia, and Sierra Leone, the World Health Organization (WHO) said today in a statement. Banbury's arrival in Ghana comes 11 days after the UN Security Council adopted the special mission for Ebola, the first such operation targeted to a public health emergency.

The WHO said most of the UNMEER team will remain in Accra this week to set up headquarters operations, but Banbury will visit the three outbreak countries to see the situation firsthand and hear from governments and other partners about the top response priorities.

In the WHO statement, Banbury praised Ghana's support for hosting the mission. "Our task now is to work with the international community and support the national authorities of Guinea, Liberia and Sierra Leone to stop this outbreak from spreading any further," he added.

US-led developments

In a related development, Nancy Lindborg, assistant administrator the US Agency for International Development (USAID) Bureau of Democracy, Conflict and Humanitarian Assistance arrived in Liberia today, part of a delegation led by Department of Defense Assistant Secretary for Special Operations and Low-Intensity Conflict Michael Lumpkin.

USAID said the group is meeting with local officials, aid groups, and staff coordinating the US government's response to West Africa's Ebola outbreak.

Over the weekend US military cargo planes landed at Liberia's international airport, bringing two mobile Ebola testing labs and equipment to build a 25-bed field hospital to treat sick healthcare workers. The labs will be placed at Ebola treatment centers at Island Clinic, a newly opened facility, and in Bong County and are slated to become operational this week, the US Embassy in Monrovia said yesterday in a statement.

Having the labs located near the clinics can help curb the spread of Ebola, because medical teams can determine if patients have the disease in a few hours rather than days, the embassy said. The labs will be operated by members of the US Navy Medical Research Unit.

The mobile hospital arrived as US Seabees broke ground at the site designated for it in Margibi County.

Outbreak contained in Nigeria

Ebola detections in Nigeria and Senegal appear to be contained, according to separate outbreak reports published by teams from the US Centers for Disease Control and Prevention (CDC) in an early online edition of Morbidity and Mortality Weekly Report (MMWR).

A sick air traveler brought the disease into Nigeria's capital, Lagos, on Jul 20 and died there from his infection on Jul 24. The man's infection triggered a three-generation chain of transmission that resulted in 19 infections and 1 probable case in two Nigerian states. Eight patients died, and only 3 of 894 contacts are still in the 21-day follow-up period.

No new cases have occurred since Aug 31, a sign that Nigeria's Ebola outbreak might be contained, the CDC team said.

The report noted that the man, a Liberian government consultant, had a fever and been under observation for Ebola at a Monrovia hospital, but left the facility against medical advice 3 days before flying to Nigeria. After he became acutely ill upon his arrival in Lagos, he was hospitalized, denied Ebola exposure, and was initially treated for malaria. Given his travel from an outbreak country, his medical team suspected Ebola and cared for him in isolation as tests were conducted.

Emergency operations center teams managed confirmed and suspected patients and decontaminated areas around them, with suspected case-patients sent to Ebola treatment wards in Lagos and Port Harcourt. Contact tracing teams identified 894 contacts and conducted about 18,500 face-to-face visits.

With Lagos as Africa's largest city, the infections posed an enormous threat, but the Nigerian government was able to blunt the impact by making quick use of its Center for Disease Control, which had experience responding to recent events, including lead poisoning in 2010 and polio eradication steps in 2012. The country established an emergency operations center as part of the polio eradication effort, and the MMWR report said the government was able to draw from those experiences in responding to the Ebola outbreak.

Another key feature of Nigeria's response was linking social mobilization efforts with contact tracing. The CDC said as of Sep 24, teams had reached about 26,000 households of people who lived around Ebola contacts in Lagos and Rivers states.

Senegal threat appears over

Similarly, the threat linked to a single travel-linked case in Senegal appears to be over, with all 67 contacts having completed the 21-day monitoring period, the CDC said in a separate report. According to the investigation, the patient, a student from Guinea, had arrived in Senegal to visit family on about Aug 14 in a seven-person taxi and developed fever, diarrhea, and vomiting 2 days later.

He sought care at a neighborhood health center in Dakar on Aug 18 and was treated as an outpatient through Aug 25, receiving intravenous therapy and symptomatic care. He was hospitalized on Aug 25, but did not reveal that he had a travel history or contact with Ebola patients.

The patient was identified, based on contact tracing by Guinea health officials. The patient's brother had contracted the disease and died after visiting a traditional healer in Guinea. The brother died of the disease on Aug 10, and his student brother and other family members had prepared the body for burial.

The CDC said prompt notification by Guinea health officials and early preparations by Senegal's health ministry helped curb the spread of the disease.

See also:

Sep 30 WHO press release

Sep 29 US Embassy-Monrovia statement

Sep 29 USAID press release

Sep 30 MMWR report on Ebola in Nigeria

Sep 30 MMWR report on Ebola in Senegal


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