Ebola total tops 18,000, with hints of slowing in Sierra Leone

Sierra Leone's rising Ebola activity seems to be slowing as a major effort to knock down the disease gets under way; disease incidence is still fluctuating in Guinea and cases continue to decline in Liberia, the World Health Organization (WHO) said today in its latest update.

The global Ebola total as of Dec 14 has reached 18,603 cases, along with 6,915 reported deaths, the WHO said. Numbers reflect an increase of 661 infections and 527 deaths since the last report Dec 10. Sierra Leone, with 327 new cases, accounted for more than half the increase, while Guinea reported 76 more. Liberia reported eight new confirmed cases, but its total includes only those reported as of Dec 9.

A profile of progress and impacts

The WHO said progress is occurring in all three of the hardest-hit countries toward the United Nations' goal of isolating and treating 100% of Ebola patients and safely burying 100% of those who die from the disease by Jan 1. All countries now have enough treatment beds, though some are unevenly distributed, resulting in shortages in some areas, the WHO said.

Nationally, all three countries have the capacity to bury Ebola victims, though there may be gaps in some areas. The WHO said all districts in the countries can access a lab within 24 hours after sample collection and that, overall, more than 80% of contacts are being traced.

A running tally of Ebola infections in health workers, the hardest-hit group in the outbreak, shows that 632 cases have been reported so far, and 358 of them have been fatal. The WHO said five new health worker infections were reported through Dec 14, all of them from Guinea.

In a breakdown of cases by gender and age, the WHO said the gender distribution is nearly equal at 65 per 100,000 population in males and 66 per 100,000 population in females. Compared with children, individuals between ages 15 and 44 years are three times more likely to be infected and those 45 and older are nearly four times more likely to be infected.

Surge targets intense Ebola spread in western Sierra Leone

In Sierra Leone, the WHO still characterized Ebola activity as intense, with the disease especially persistent in the western part of the country. The surge is targeting Freetown and surrounding areas, where the goal is breaking transmission chains by increasing the number of beds so sick patients are adequately isolated and treated.

Hot spots elsewhere in Sierra Leone include Kono, neighboring Koinadugu, and Tonkolili districts in the east and central parts of the country, and in the south, Bo district. The WHO said only two of Sierra Leone's districts didn't report any new cases.

In Sierra Leone, President Ernest Bai Koroma announced that authorities on Dec 24 will launch a house-by-house search for sick people in the Freetown Peninsula (Western Area), according to today's report from the United Nations Mission for Ebola Emergency Response (UNMEER). The announcement didn't say whether people will need to stay in their homes or how long the search would last. UNMEER said Freetown and surrounding areas account for more than half of Sierra Leone's new infections.

The country's government recently announced a ban on Christmas and holiday gatherings to curb the spread of Ebola, as well as a surge in response activities.

Britain said yesterday that it wouldn't ask for US military help in battling Ebola in Sierra Leone, though talks are under way to see if the US government might be able to provide more foreign health workers and build more labs for Ebola testing. Donal Brown, who heads the British task force in Sierra Leone, said the group expects to see "enormous change" by late January, in the wake of a response surge. "The pieces are in place to fight the disease, which weren't here a month ago," he said. UNMEER said the United Kingdom has asked for more WHO resources to help with surveillance in Sierra Leone's rural areas.

Guinea trends still in flux

Guinea's Ebola activity has been fluctuating since September, and there is still no clear upward or downward trend in national incidence, the WHO said. Transmission is still intense in the capital, Conakry, and in neighboring Coyah district. A surge of new cases has been reported from Forecariah, south of Conakry, with transmission persisting in the eastern district N'Zerekore and new cases reported in the outbreak's epicenter around Gueckedou.

Suspected Ebola cases in the northern district of Siguiri require close monitoring, because the area is close to Mali. Though 10 of Guinea's districts still haven't reported an Ebola cases, vigilance is needed, because the geographic reach of the disease has expanded.

Liberia's capital area still in Ebola's sights

In Liberia, case numbers are still declining at the national level, though six districts reported new or probable cases last week. Transmission is still intense in Montserrado County, an area that includes Monrovia.

In its overview of treatment beds, the WHO said they are most evenly distributed in Liberia. Guinea has shortages in the north and central parts of the country but new beds coming online in the eastern region with the opening of a new Ebola treatment center in N'Zerekore.

A running tally of Ebola infections in health workers shows that 632 cases have been reported so far, and 358 of them have died from their infections. The WHO said five new health worker infections were reported through Dec 14, all of them from Guinea.

Other developments

  • The number of people who could face food shortages due to Ebola's impact on Guinea, Liberia, and Sierra Leone could pass 1 million by March unless access dramatically improves and measures are put in place to protect crop and livestock production, the UN Food and Agriculture Organization (FAO) and the World Food Programme warned today. In separate reports addressing issues in each country, the groups said border closures, quarantines, hunting bans, and other restrictions are hampering people's access to food, posing a threat to livelihoods, disrupting markets and processing chains, and worsening shortages from crop losses in locations with the highest infection rates. As of December, 500,000 people in the outbreak region face severe food insecurity, the groups estimate. They called for urgent steps to reestablish farming systems and enable access to agricultural supplies such as seeds and fertilizer by the next planting season as well as technology improvements to address labor shortages.

  • An analysis of Ebola patterns in Sierra Leone suggests that the disease spreads in social clusters rather than randomly, which could mean the number of unreported cases is lower than previously thought and which could have implications for vaccination planning. The Yale University–led group published its findings, based on genomic and epidemiologic data from Sierra Leone, in an early online edition of Clinical Infectious Diseases. They found evidence of significant social clustering, estimating that for every case, less than one went unreported. Previous models of Ebola spread assumed that the disease spread between random pairs of individuals, but transmission is known to occur most often in hospitals, households, and at funerals. The group concluded that their findings show the importance of contact tracing and rapid isolation and treatment. Though more research is needed, people in clustered situations with Ebola patients, such as in households and hospitals, may be at greater risk for multiple exposures and would benefit most from vaccination.

  • Lab screening of existing drugs that may be able to prevent Ebola from entering human cells, a key step for infection, identified 53 of them, researchers from the Icahn School of Medicine at Mount Sinai Hospital and the National Institutes of Health (NIH) reported today. Their findings were in an early online edition of Emerging Microbes and Infections. They developed a biosafety level 2 (BSL-2) assay to screen for Ebola virus–like particle inhibitors, testing 2,816 compounds already approved by the Food and Drug Administration (FDA) for other uses. The group of 53 that blocked Ebola from entering human cells by at least 50% included cancer drugs, antihistamines, and antibiotics. The team reported that the most effective drugs for blocking Ebola cell entry were microtubule inhibitors used for treating cancer.

  • An American health worker who was admitted to the NIH Clinical Center on Dec 11 after possible exposure to the Ebola virus while working in Sierra Leone has not tested positive for the disease and is still being observed and monitored, the NIH said in a statement today. The patient was airlifted out of the outbreak region and was slated to enroll in a clinical trial while being monitored.


See also:

Dec 17 WHO Ebola situation report

Dec 17 UNMEER update

Dec 17 FAO press release

Dec 16 Yale University press release

Dec 15 Clin Infect Dis abstract

Dec 17 Emerg Microbes Infect abstract

Dec 17 Mount Sinai press release

Dec 17 NIH press release

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