WHO maintains Ebola health emergency, airs response concerns

In light of an emergency committee assessment last week, World Health Organization (WHO) Director-General Margaret Chan, MD, MPH, today said the conditions in West Africa's Ebola virus disease (EVD) outbreak still amount to a public health emergency of international concern and extended a temporary set of recommendations that she issued on Aug 8.

In West Africa's Ebola region, the number of cases as of Sep 17 was 5,843, with the death toll rising to 2,803, the WHO said today in a separate update. The cases represent an increase of 508 infections and 181 deaths since the WHO's last update on Sep 18. Health officials have warned that the official numbers are likely to vastly underestimate the true impact of the disease on Liberia, Sierra Leone, and Guinea.

Emergency committee weighs in

The WHO panel met electronically from Sep 16 through 21, in their second consultation on the outbreak. In a statement today, the WHO said the committee heard updates and received assessments from the three hardest hit countries as well as two countries that have had a limited number of cases, Nigeria and Senegal.

In view of the findings, the emergency committee highlighted several areas urgently needing more action and attention, especially flight cancellations and other travel restrictions that are isolating outbreak countries, impairing outbreak response and hurting their economies. The group strongly repeated its recommendation against bans on international travel or trade, except for people who have EVD infections and their contacts.

When the worst-affected countries consider an extraordinary step such as quarantine, the application should be proportionate and evidence based, and nations that impose them should ensure that their people are given accurate information and essential services, including food and water, emergency committee members emphasized.

The group also aired deep concerns about health workers who have died as a result of helping with the outbreak response.  They urged countries to provide adequate security, appropriate infection control training, support to families of dead healthcare workers, and access—especially for international healthcare workers—to adequate medical services.

Areas with the most intense transmission are having a hard time following through with standard Ebola control measures, such as identifying cases, tracing contacts, providing for safe burials, and promoting social mobilization, and more efforts are needed to strengthen their implementation, the WHO said. The emergency committee also highlighted engaging international partners in the response and involving the research community in exploring topics such as the effectiveness of various public health measures.

Liberia has half of cases

Liberia remained the outbreak's hardest-hit country, with the case count reaching 3,022, accounting for roughly half of all of the illnesses reported so far. Sierra Leone's total rose to 1,813, while the number of EVD infections in Guinea is at 1,008. As for deaths, Liberia has the most, at 1,578, followed by Guinea with 632 and Sierra Leone with 593, according to the WHO.

Guinea recently confirmed a case in Kinda district in the western part of the country near the border with Sierra Leone, the first infection reported from that location.

The heavy impact on healthcare workers continues to be an alarming feature of the outbreak, with 348 infections reported in that group as of today, 186 of them fatal, according to the WHO. The total reflects 30 more illnesses and 35 more deaths since the WHO's last report on Sep 18.

On a positive note, no new infections or deaths have been reported in Nigeria or Senegal. Both countries had imported cases, with a flurry of infections and deaths in Nigeria limited to a single train of transmission. Senegal's only case involved a university student from Guinea who was hospitalized in Dakar; all of his contacts have now completed the 21-day follow-up, with no other cases reported.

In the Democratic Republic of Congo, which is experiencing a small outbreak from a different Ebola strain, only a few more cases and deaths have been reported. The totals stand at 68 infections and 41 deaths, 6 more illnesses and 6 more deaths than in the last WHO update on Sep 10. Eight cases and eight deaths have been reported in health workers.

Other developments inside and outside outbreak region

  • A second Spanish priest who worked in West Africa has been infected with EVD and has been airlifted to Spain, where he is in serious condition at a Madrid hospital, Reuters reported today. The man was medical director of a hospital in Sierra Leone and was flown home yesterday after the country's 3-day lockdown ended. Hospital officials said supplies of the experimental EVD drug ZMapp have been depleted, but they are considering other experimental treatments, including convalescent serum. The priest is the ninth sick foreign medical worker to be airlifted out of West Africa's EVD area.
  • Tekmira Pharmaceutical Corp., based in Vancouver, announced today that the US Food and Drug Administration (FDA) has authorized the company to provide TKM-Ebola, its experimental antiviral for treating the disease, to people with confirmed or suspected EVD infections. Mark Murray, MD, the company's president and chief executive officer, said in a statement that regulators in both the United States and Canada have established a framework for use of the drug in multiple patients, and he added that the company has already responded to requests for use of the drug in several patients under emergency protocols. The drug was developed with support from the US Department of Defense. The FDA cleared it for clinical trials in 2011, but placed a clinical hold on phase 1 studies in July, scaling it back to a partial hold the following month.
  • Sierra Leone's 3-day government imposed lockdown, a step intended to curb the disease and help responders conduct contact tracing, has ended. Health officials said they reached more than 1 million households to check for infected people and distribute soap and prevention information, the Associated Press (AP) reported today. Teams buried at least 77 bodies during the shutdown, with half of them testing positive for the virus. The government is expected to announce tomorrow how many EVD cases were detected during the shutdown.
  • In Liberia, a new 120-bed EVD treatment facility has opened in Monrovia, AllAfrica reported today. The center was built by Liberia's government with technical support from the WHO. Six ambulances containing 24 suspected EVD patients were waiting at the center's gates during its opening ceremony.
  • The WHO's Eastern Mediterranean regional office (EMRO) is urging countries to boost their preparedness for EVD, especially since a number of the countries have travel hubs that connect to the outbreak countries. In the statement, the WHO summed up possible scenarios for spread of the disease to the area, though the risk of transmission through international travel is thought to be low. It said arrival of the virus by air would be the most probable scenario, with many nations connected by daily or weekly flights to many cities in West Africa. It said arrival by land or sea would be less likely, since a long journey would be difficult for someone with EVD. The second scenario is silent importation and cases appearing in health facilities, given the long incubation period and that someone with EVD may appear healthy while crossing a border point.
  • The US Centers for Disease Control and Prevention (CDC) on Sep 19 released recommendations on breastfeeding in EVD settings. It said that though the Ebola virus has been found in breast milk, it's not clear if it can be transmitted from mothers to infants by that route. When safe alternatives to breastfeeding and infant care are available, mothers with probable or confirmed infections should not have close contact with their babies, the agency said. However, it said the risks and benefits should be carefully weighed in resource-limited setting where non-breastfed babies are at increased risk of death from starvation and other infectious diseases.

See also:

Sep 22 WHO emergency committee statement

Sep 22 WHO Ebola response roadmap update

Sep 22 Reuters story

Sep 22 Tekmira press release

Sep 22 AP story

Sep 11 AllAfrica story

Sep 21 WHO EMRO statement

Sep 22 CDC Ebola and breastfeeding guidance

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