Situation report
Now available in an interactive map journal that shows the evolution of the outbreak and the global response.
HIGHLIGHTS
|
· There have been 17 145 reported cases of Ebola virus disease (EVD), with 6070 reported deaths.
· Case incidence is slightly increasing in Guinea, stable or declining in Liberia, and may still be increasing in Sierra Leone.
· The outbreak in Spain has been declared over.
· The UNMEER targets of isolating
and treating 70% of EVD cases and burying 70% of EVD-related deaths safely
have likely been met in most districts of Guinea, Liberia, and Sierra Leone. All
three countries now have sufficient capacity at a national level to meet both
targets, though local variations mean capacity is still insufficient to stop
transmission in some areas.
|
||
cases/
deaths
|
 |
||
summary
A total of 17 145 confirmed, probable, and suspected
cases of Ebola virus disease (EVD) have been reported in five affected
countries (Guinea, Liberia, Mali, Sierra Leone, and the United States of
America) and three previously affected countries (Nigeria, Senegal and Spain)
up to the end of 30 November. There have been 6070 reported deaths. Reported case
incidence is slightly increasing in Guinea (77 confirmed cases reported in the
week to 30 November), stable or declining in Liberia (43 new confirmed cases in
the 5 days to 28 November), and is still rising in Sierra Leone (537 new confirmed
cases in the week to 30 November). The case fatality rate across the three
most-affected countries in all cases with a recorded definitive outcome is 72%;
in hospitalized patients the case fatality rate is 60%.
Response activities
in the three intense-transmission countries continue to intensify in line with the
UNMEER aim to isolate and treat 70% of EVD cases, and safely bury 70% of
EVD-related deaths by 1 December, with the ultimate goal of reaching 100% by 1
January. At a national level, there is now sufficient bed capacity in EVD
treatment facilities to treat and isolate all reported EVD cases in each of the
three countries, although the uneven distribution of beds and cases means there
are serious shortfalls in some areas. Similarly, each country now has
sufficient and widespread capacity to bury all reported EVD-related deaths; however,
because not all EVD-related deaths are reported, and many reported burials are
of non-EVD-related deaths, it is possible that the 70% target has not been met
in some areas. Every EVD-affected district in the three intense-transmission
countries has access to a laboratory for confirmation within 24 hours of sample
collection. All three countries report that more than 85% of registered
contacts associated with known cases of EVD are being traced, although contact
tracing is still a challenge in areas of intense transmission. Increasing
capacity for contact tracing in areas with low levels of transmission will be
necessary to end local chains of transmission.
OUTLINe
This situation report on the Ebola Response Roadmap[1]
contains a review of the epidemiological situation based on official
information reported by ministries of health, and an assessment of the response
measured against the core Roadmap indicators where available. Substantial
efforts are ongoing to improve the availability and quality of information
about both the epidemiological situation and the implementation of response
measures.
Following the Roadmap structure, country reports fall
into three categories: (1) those with widespread and intense transmission
(Guinea, Liberia and Sierra Leone); (2) those with or that have had an initial
case or cases, or with localized transmission (Mali, Nigeria, Senegal, Spain
and the United States of America); and (3) those countries that neighbour or
have strong trade ties with areas of active transmission.
1. COUNTRIES WITH WIDESPREAD AND
INTENSE TRANSMISSION
A total of 17 111
confirmed, probable, and suspected cases of EVD and 6055 deaths have been
reported up to the end of 30 November 2014 by the Ministries of Health of
Guinea and Sierra Leone, and 28 November by the Ministry of Health of Liberia
(table 1). The data are reported through WHO country offices.
Table 1: Confirmed,
probable, and suspected cases in Guinea, Liberia, and Sierra Leone
Country
|
Case definition
|
Cumulative cases
|
Cases in past 21 days
|
Cumulative deaths
|
Guinea
|
Confirmed
|
1929
|
306
|
1117
|
Probable
|
210
|
*
|
210
|
|
Suspected
|
25
|
*
|
0
|
|
Total
|
2164
|
306
|
1327
|
|
Liberia§
|
Confirmed
|
2801
|
278
|
‡
|
Probable
|
1792
|
*
|
‡
|
|
Suspected
|
3042
|
*
|
‡
|
|
Total
|
7635
|
278
|
3145
|
|
Sierra Leone
|
Confirmed
|
5978
|
1455
|
1374
|
Probable
|
79
|
*
|
174
|
|
Suspected
|
1255
|
*
|
35
|
|
Total
|
7312
|
1455
|
1583
|
|
Total
|
17 111
|
2039
|
6055
|
Data are based on
official information reported by ministries of health, through WHO country offices.
These numbers are subject to change due to ongoing reclassification,
retrospective investigation and availability of laboratory results. *Not
reported due to the high proportion of probable and suspected cases that are reclassified.
‡Data not available. §Data
missing for 29 and 30 November.
Guinea
A total of 77 new confirmed
cases were reported nationally during the week to 30 November (figure 1),
compared with 148 cases in the week before. The national trend in Guinea since
early October has been slightly increasing, with between 75 and 148 confirmed
cases reported in each of the past 6 weeks, though this picture of relative
stability masks important changes in the pattern of EVD transmission within the
country. The previous 3 weeks saw a large number of new cases in the eastern
districts of N’Zerekore (6 new confirmed cases in the week to 30 November; 29
cases in the previous week), Macenta (15 new confirmed cases; 26 in the
previous week), and Kankan (7 new confirmed cases; 7 in the previous week). The
persistent transmission in Kankan, and the surrounding areas of Kerouane, Kouroussa
and Kissidougo (figure 4), is of particular concern, because the local
populations are likely to seek treatment in the north, and in neighbouring Mali
in particular, rather than at existing facilities in the nearby south-eastern
districts of Gueckedou (1 new confirmed cases in the week to 30 November) and
Macenta. The first case imported to Mali travelled from a city in the northern
district of Siguiri, which borders Mali, and where there has been persistent
transmission since early November (2 new confirmed cases this week; between 1
and 3 cases for the past 7 weeks). The lack of established EVD treatment and
isolation facilities in this northern, Sahelian zone of the country, combined
with a higher than usual degree of resistance among local communities to safe
burial practices, make this area vulnerable to an increase in cases.
In the centre of
the country, the district of Faranah, which borders the north Sierra Leonean
district of Koinadugu, has reported an average of 8 cases per week for each of
the past 4 weeks. In the west of the country, the capital, Conakry, reported 14
new confirmed cases in the week to 30 November (figure 1). Together with the
neighbouring district of Coyah (15 new confirmed cases in the week to 30
November), Conakry has now reported an increase in the number of new cases during
each of the past 2 weeks. Although 10 districts are yet to report a case of EVD,
there has been a geographical expansion in transmission: as at 1 October, 9
districts had reported an infection during the past 7 days; as at 1 December 14
districts had reported an infection during the past 7 days).
Figure
1: Confirmed Ebola virus disease cases reported each week from Guinea and
Conakry
The graphs in
figures 1–3 show the number of new confirmed cases reported each week in
situation reports from each country (in dark blue; beginning from
epidemiological week 38, 15–21 September) and from patient databases (light
blue). The patient databases give the best representation of the history of the
epidemic. However, data for the most recent weeks are sometimes less complete in
the database than in the weekly situation reports. These numbers are
subject to change due to ongoing reclassification, retrospective investigation
and availability of laboratory results.
Liberia
Case incidence has stabilized over the past 5 weeks, after
declining from mid-September until mid-October. A total of 43 confirmed cases were
reported in the 5 days to 28 November, down from 78 the previous week.
The district of Montserrado, which includes the capital
Monrovia (figure 2), reported 34 confirmed cases, and accounted for 79% of all confirmed
cases reported nationally in the week to 28 November. Bomi (2 confirmed cases),
Grand Bassa (4 confirmed cases), Grand Cape Mount (2 confirmed cases, compared
with 21 the previous week), and Margibi (1 confirmed case) are the only other
districts to report a case during the same period.
The district of Lofa, in the north of the country and
on the border with Guinea and Sierra Leone, reported no cases for the fifth
consecutive week.
Figure 2: Confirmed Ebola
virus disease cases reported each week from Liberia and Monrovia
Data
missing for 29 and 30 November. Systematic data on laboratory confirmed
cases have been available since 3 November nationally, and since 16 November
for each district.
Sierra leone
EVD transmission
remains intense in Sierra Leone, with 537 new confirmed cases reported in the
week to 30 November (more than Guinea and Liberia combined), compared with 385
cases the previous week. The worst affected area remains the capital, Freetown,
which reported 202 new confirmed cases (figure 3). Transmission remains persistent
and intense across the country with the exception of the south, with the
districts of Bo (23 cases), Bombali (66 cases), Kambia (14 cases), Kono (15
cases), Koinadugu (6 cases), Moyamba (3 cases), Port Loko (94 cases), Tonkolili
(40 cases), and Western Rural Area (72 cases) all reporting high numbers of new
confirmed cases. Of the above districts, all but Moyamba reported an increase
in the number of new cases compared with the previous week, although the
overall trend in these districts may not be increasing. By contrast, the southern
districts of Kenema and Kailahun reported 0 and 1 case, respectively. Kenema has
reported one case since 1 November. Bonthe has not reported a case for the past
2 weeks.
Figure 3: Confirmed
Ebola virus disease cases reported each week from Sierra Leone and Freetown
Figure 4: Geographical distribution of new
and total confirmed and probable* cases in Guinea, Liberia, Mali and Sierra
Leone
Data
are based on situation reports provided by countries. The boundaries and names
shown and the designations used on this map do not imply the expression of any
opinion whatsoever on the part of the World Health Organization concerning the
legal status of any country, territory, city or area or of its authorities, or
concerning the delimitation of its frontiers or boundaries. Dotted and dashed
lines on maps represent approximate border lines for which there may not yet be
full agreement.
Data are missing from Liberia for 29 and 30 November. *Data for the past
21 days represent confirmed cases in Guinea, Sierra Leone, and Mali. Data for
the past 21 days represent probable cases in Liberia due to the unavailability
of systematic district-level data on laboratory confirmed cases before 16
November.
RESPONSE IN COUNTRIES
WITH WIDESPREAD AND INTENSE TRANSMISSION
A comprehensive
90-day plan is being implemented to control and reverse the EVD outbreak in
West Africa (see UN Mission for Ebola Emergency Response: Annex 2). Among the plan’s
key objectives is, by
1 December 2014,
to treat
and isolate 70% of EVD cases, and bury 70% of patients who die from EVD safely
and with dignity, with the ultimate goal of reaching 100% by 1 January. Tables 2
to 4 provide information on progress towards these goals for each of the three
countries with widespread and intense transmission.
Case management
Putting
the capacity in place to treat patients with EVD in facilities that allow them
to be isolated from other patients and the wider community is central to the EVD
response. At present, most of this capacity is concentrated in Ebola Treatment
Centres (ETCs); large facilities ranging from 20 to 400 beds. Community Care
Centres (CCCs) provide
an alternative to care in ETCs in areas where there is insufficient ETC capacity,
and remote areas that are not yet served by an ETC. Compared with ETCs, CCCs
are smaller, with 8 to 15 beds per facility. This means they are easier to set
up, which enables response coordinators to provide more rapid, flexible
coverage dispersed over a wider geographical area.
Table 2. Key
performance indicators for the Ebola response in Guinea
Definitions
for each indicator are found in Annex 2.
At present, it is
difficult to measure directly the proportion of patients who are isolated. Usually,
information from clinical investigation forms could be used to provide an
accurate estimate, but inconsistencies in the way different clinical
investigation teams interpret and define when and how a patient is hospitalized
and isolated mean that this information is not reliable enough at present to
draw any conclusions about isolation. The most robust method of estimating
isolation currently available is to use the capacity to treat and isolate
patients by geographical area as a proximate measure of the proportion of EVD
cases who are isolated. This can be achieved by dividing the number of
available EVD-treatment beds by the number of reported cases over a given
period of time in a given location, taking account of varying patterns of
health-seeking behaviour (e.g., in areas with poor transport links, cases are
unlikely to travel large distances for diagnosis and treatment).
Using this
proximate measure of isolation at a national level, all three
intense-transmission countries currently have the capacity to isolate all
reported cases. In Guinea (table 2) there are 2.3 available beds per reported
probable and confirmed EVD case; in Liberia (table 3) there are 11.7 beds for
every probable and confirmed case, and in Sierra Leone there are 1.5 beds for
every probable and confirmed case (table 4). However, these numbers are, to a
degree, an oversimplified representation of a more complex situation within
each country. In several areas, such as the districts of Kenema and Kailahun in
south Sierra Leone, the low number of new cases means that there is spare
isolation and treatment capacity in each district, though patients with EVD can
and do seek treatment there from neighbouring districts. Conversely, in western
areas of Sierra Leone such as Freetown and Port Loko, treatment and isolation
capacity continues to be stretched by a large volume of new patients.
Ideally, capacity
would be sufficient to treat and isolate a given EVD patient within the patient’s
home district. This would have the twin benefits of reducing the time between
the onset of symptoms and hospitalization, thus increasing the likelihood of survival,
and reducing the distance travelled and time in transit of each patient, thus reducing
the risk of further transmission.
As at 30 November, 245 EVD-treatment and isolation beds were
operational in Guinea,
concentrated in 3 ETCs located in the capital, Conakry, and the south-eastern
districts of Gueckedou and Macenta. This uneven distribution
of capacity means that any patient with EVD in the north and centre of the
country needs to travel long distances to access treatment. In addition, the
populations of several areas in the eastern, Sahelian region of Guinea are more
likely to seek treatment in the north of the country or in neighbouring Mali
than they are to seek treatment in nearby Guekedou or Macenta. Planned ETCs in
the eastern districts of Kerouane, N’Zerekore, and Beyla should address this
problem. There are currently no CCCs operational in Guinea.
Figure
5. Ebola Treatment Centres in Guinea, Liberia and Sierra Leone
In Liberia, 1269
beds are operational in 12 ETCs: 6 ETCs are located in the capital, Monrovia, 2
are in Margibi, and the districts of Bomi, Bong, Lofa, and Nimba each have 1 ETC.
There are currently 2 CCCs open, 1 each in Grand Cape Mount and Margibi. Of the
three countries with widespread and intense transmission, capacity for
treatment and isolation is most evenly distributed in Liberia.
A total of 517
treatment and isolation beds are operational in 12 ETCs in Sierra Leone, with
190 beds provided in CCCs. There are 8 ETCs under construction, 4 of which will
be located in western Sierra Leone; these will augment capacity in areas such
as the capital, Freetown, and Port Loko, where a large volume of cases
continues to put pressure on treatment capacity.
Case fatality
The cumulative
case fatality rate in the three intense-transmission countries among all
patients for whom a definitive outcome is recorded is 72%. For those patients recorded
as hospitalized, the case fatality rate is 60% in all three
intense-transmission countries (tables 2–4). In a subset of 400 EVD-infected HCWs
for whom a definitive outcome has been reported, the case fatality rate is 68%,
which drops to 63% in the subset of 267 HCWs who were hospitalized.
Safe and dignified
burials
The
bodies of patients who have died from EVD are highly infectious. Therefore, conducting
burials in a safe and dignified manner is a crucial component of efforts to
halt the transmission of the disease.
Estimation
of the proportion of EVD deaths that are buried safely is complicated by
several factors.
First, many of the safe burials that do take place are of people who did not
die of EVD. This is explained by the fact that the symptoms of EVD are similar
to many other common causes of death in the three intense-transmission
countries. The second and most important factor is that deaths have been
consistently under-reported during this outbreak and, related to this, some
communities are still reticent to adopt safe burial practices that can decrease
the risk of viral transmission.
Table 3. Key performance
indicators for the Ebola response in Liberia
As at 23 November,
221 trained safe burial teams were operational: 50 teams in Guinea, 77 teams in
Liberia, and 94 teams in Sierra Leone. Both Guinea and Sierra Leone now have
more than 80% of planned trained safe burial teams in place, whilst Liberia has
77% of teams in place. However, based on the current number of reported deaths
in each country, capacity exists to safely bury far in excess of 100% of
reported EVD-related deaths. By contrast with the distribution of capacity to
isolate and treat patients, the geographic distribution of safe burial teams is
far more even across the three intense-transmission countries, though some more
remote areas may still be underserved.
During
the week
to 23 November there were 118 safe and dignified burials in Guinea, 73 in
Liberia, and 372 in Sierra Leone. The International
Federation of Red Cross and Red Crescent Societies (IFRC) is currently the only
organization involved in safe burials across all three of the
intense-transmission countries. The non-governmental organization Global
Communities operates in Liberia, and Concern Worldwide operates in Liberia and
Sierra Leone. Data on the number of safe burials to have taken place only
includes burials done by IFRC and Global Communities.
Case confirmation and surveillance
Providing
capacity for prompt and accurate diagnosis of cases of EVD is an integral part
of the response to the EVD outbreak. All 53 EVD-affected districts (those that
have ever reported a probable or confirmed case) have access to laboratory support
(figure
6). Access is defined as having the logistical
capacity to transport a sample to a laboratory by road within 24 hours of
sample collection. Going forward, the focus will be on providing results on the
same day as sample collection.
Eighteen
laboratories have the capacity to confirm EVD cases – 4 in Guinea, 9 in
Liberia, and 5 Sierra Leone. These laboratories currently serve 24 affected
districts in Guinea, 15 in Liberia and 14 in Sierra Leone.
Between
1150 and 1170 samples are tested daily in laboratories in the three countries.
The maximum testing capacity for each laboratory ranges from 50 to 100 samples
per day.
Table 4. Key
performance indicators for the Ebola response in Sierra Leone
Effective
contact tracing ensures that the reported and registered contacts of confirmed
EVD cases are visited daily to monitor the onset of symptoms during the 21-day
incubation period of the Ebola virus. Contacts presenting symptoms should be
promptly isolated, tested for EVD, and if necessary treated, to prevent further
disease transmission.
During the week to
29 November, 96% of all registered contacts were visited on a daily basis in
Guinea, 84% in Liberia, and 97% in
Sierra Leone. However, the proportion of contacts reached was lower
in many districts. Each district is reported to have at least one
contact-tracing team in place.
On average, 15 contacts were listed per new case in
Guinea during the week to 30 November, 23 in Liberia, and 5 in Sierra Leone.
Active case finding teams are being mobilized as a complementary case-detection
strategy in several areas.
Figure 6. Status
of laboratories deployed in the affected countries to support the Ebola
outbreak response
Health-care workers
A total of 622
health-care workers (HCWs) are known to have been infected with EVD up to the
end of 30 November, 346 of whom have died (table 5). The total case
count includes 2 HCWs in Mali, 11 HCWs infected in Nigeria, 1 HCW infected in
Spain while treating an EVD-positive patient, and 3 HCWs in the US (including a
HCW infected in Guinea, and 2 HCWs infected during the care of a patient in
Texas).
Table 5: Ebola
virus disease infections in health-care workers in the three countries with
intense transmission
Country
|
Cases
|
Deaths
|
Guinea
|
106
|
59
|
Liberia*
|
361
|
174
|
Sierra Leone
|
138
|
106
|
Total
|
605
|
339
|
Data are based on
official information reported by ministries of health. These numbers are
subject to change due to ongoing reclassification, retrospective investigation
and availability of laboratory results.*Data missing for 29 and 30 November.
Extensive
investigations to determine the source of exposure in each case are being undertaken.
Early indications are that a substantial proportion of infections occurred
outside the context of Ebola treatment and care centres. This
reinforces the need to adhere to infection prevention and control measures at
all health-care facilities, not just EVD-related facilities. WHO has conducted a
review of personal protective equipment (PPE) guidelines for HCWs who provide
direct care to patients, and has updated its guidelines in the context of the
current EVD outbreak.
Comprehensive
mandatory training in the use of PPE, and mentoring for all users before
engaging in clinical care, is considered fundamental for the protection of HCWs
and patients.
Social mobilization and
community engagement
UNICEF is the lead agency in social
mobilization during this outbreak. A joint WHO-UNICEF team has visited the
three intense-transmission countries to review and assist them with their
social mobilization plans.
Budget
As at 28 November,
WHO had received US$171.5 million, with a further $26 million pledged.
2.
COUNTRIES WITH AN INITIAL CASE OR CASES, OR WITH LOCALIZED TRANSMISSION
Five countries (Mali, Nigeria,
Senegal, Spain and the United States of America) have reported a case or cases
imported from a country with widespread and intense transmission (table 6).
Table
6: Ebola virus disease cases and deaths in Mali and the United States of
America
Country
|
Cumulative cases
|
Contact tracing
|
|||||||
Confirmed
|
Probable
|
Suspect
|
Deaths
|
Health-care workers
|
Contacts under follow-up
|
Contacts who have completed 21-day follow up
|
Date last patient tested negative
|
Number of days since last patient tested negative
|
|
Mali
|
7
|
1
|
0
|
6
|
25%
|
227
|
206
|
-
|
-
|
United States of America
|
4*
|
0
|
0
|
1
|
75%
|
0
|
177
|
**
|
**
|
*Includes two HCWs
infected in the USA while treating a patient with EVD from Liberia, and a HCW
infected in Guinea who developed symptoms in the USA. **Data not available. Data
are based on official information reported by ministries of health. These
numbers are subject to change due to ongoing reclassification, retrospective
investigation and availability of laboratory results.
A total of 8 cases
(7 confirmed and 1 probable), including 6 deaths (5 confirmed, 1 probable),
have now been reported in Mali (figure 1). The most recent cases are in the
Malian capital Bamako, and are not related to the country’s first EVD case, who
died in Kayes on 24 October. All identified contacts connected with the initial
case have now completed 21 day follow-up. On 2 December 2014, 219 of 227
current contacts linked with the outbreak in Bamako were monitored.
In
Spain, more than 42 days have now passed since the HCW infected while caring
for a patient with EVD in Madrid tested negative twice and was discharged from
hospital, therefore the outbreak in that country has now been declared over.
In
the United States of America, there have been 4 cases of EVD and 1 death. One
HCW in New York and 2 HCWs in Texas have tested negative for EVD twice and have
been released from hospital. All contacts in the country have completed the
21-day follow-up period.
In Nigeria, there
were 20 cases and 8 deaths. In Senegal, there was 1 case and no deaths.
However, following a successful response in both countries, the outbreaks of EVD in
Senegal and Nigeria were declared over on 17 October and 19 October 2014,
respectively.
3. PREPAREDNESS OF
COUNTRIES TO RAPIDLY DETECT AND RESPOND TO AN EBOLA EXPOSURE
The
evolving EVD outbreak highlights the considerable risk of cases being imported
into unaffected countries. With adequate levels of preparation, however, such
introductions of the disease can be contained before they develop into large
outbreaks.
The success of
Nigeria and Senegal in halting the transmission of EVD highlights the critical
importance of preparedness. Key factors in preventing the spread of EVD in both
countries included strong political leadership, early detection and response,
public awareness campaigns, and strong support from partner organizations.
Following
the consultative meeting between WHO and Partners on Ebola Virus Disease (EVD)
Preparedness and Readiness held in Brazzaville from 8–10 October, 2014, WHO, in
collaboration with the UN and other partners, is accelerating the deployment of
international preparedness teams (PSTs) to ensure immediate EVD outbreak
response capacity and help unaffected countries build on their existing
preparedness work and planning. The PSTs are formed with national and
international implementing partners and networks such as the International
Associations of National Public Health Institutes (IANPHI), the Global Outbreak
Alert and Response Network (GOARN), and national public health authorities such
as the US Centres for Disease Control and Prevention and Public Health England.
EVD preparedness efforts follow the capacity building recommendations of the
International Health Regulations (IHR) and are supported by UNMEER.
The
initial focus of support by WHO and partners is on highest priority countries –
Cote d’Ivoire, Guinea Bissau, Mali and Senegal – followed by high priority
countries – Benin, Cameroon, Central African Republic, Democratic Republic of
Congo, Gambia, Ghana, Mauritania, Nigeria, South Sudan, and Togo. The criteria
used to prioritize countries include geographical proximity to affected
countries, trade and migration patterns, and strength of health systems.
WHO
is also expanding preparedness efforts to other countries in Africa and in all
regions. WHO’s
immediate preparedness efforts are channelled into two streams: preparedness
missions and country visits; and the provision of guidance and tools.
Building
on existing national and international preparedness efforts, a set of tools has
been developed to help any country identify opportunities for improvements in
order to intensify and accelerate their readiness. One of these tools
is a comprehensive checklist of core principles, standards, capacities and
practices, which all countries should have or meet. The checklist identifies 10
key components and tasks for both countries and the international community
that should be completed within 30 and 60 days respectively from the date of
issuing the list. These include: overall coordination, rapid response, public
awareness and community engagement, infection prevention and control, case
management and safe burials, epidemiological surveillance, contact tracing,
laboratory capacity, and capacity building for points of entry.
A
team was deployed to Mali and Cote d’Ivoire in October. In the week of 10
November, teams were deployed to Cameroon, Ghana, Guinea Bissau and Mauritania.
In the week of 17 November teams visited Benin, Burkina Faso, Gambia, and
Senegal. In the week of 24 November team visited Togo. During the week of 1
December teams will visiting the Central African Republic, Niger, and Ethiopia.
The
immediate objective of each mission is to ensure that the country is as
operationally ready as possible to effectively and safely detect, investigate,
and report potential EVD cases and to mount an effective response that will
prevent a larger outbreak from developing.
In-country training
and capacity-building activities are undertaken during each mission, including
technical working group meetings, field visits, table-top exercises and field
simulation exercises. Key areas for improvement are identified on the basis of
the mission activities, and strengths and weaknesses identified and discussed
within the country. Where possible, one or more technical experts remain after
the initial mission to maximize capacity building efforts and help ensure sustainability,
in readiness for other public health events and emergencies. A plan of action
with priorities and cost of implementation is prepared during the mission or
just after, so that follow-up capacity-building activities can be carried out
rapidly.
annex
1: CATEGORIES
USED TO CLASSIFY EBOLA CASES
EVD
cases are classified as suspected, probable, or confirmed depending on whether
they meet certain criteria (table 7).
Table 7: Ebola
virus disease case-classification criteria
Classification
|
Criteria
|
Suspected
|
Any person, alive
or dead, who has (or had) sudden onset of high fever and had contact with a
suspected, probable or confirmed Ebola virus disease (EVD) case, or a dead or
sick animal OR any person with sudden onset of high fever and at least three
of the following symptoms: headache, vomiting, anorexia/ loss of appetite,
diarrhoea, lethargy, stomach pain, aching muscles or joints, difficulty
swallowing, breathing difficulties, or hiccup; or any person with unexplained
bleeding OR any sudden, unexplained death.
|
Probable
|
Any suspected
case evaluated by a clinician OR any person who died from ‘suspected’ EVD and
had an epidemiological link to a confirmed case but was not tested and did
not have laboratory confirmation of the disease.
|
Confirmed
|
A probable or
suspected case is classified as confirmed when a sample from that person
tests positive for EVD in the laboratory.
|
annex
2: UN MISSION FOR EBOLA EMERGENCY RESPONSE: DEFINITIONS OF KEY PERFORMANCE
INDICATORS
The first-ever UN
mission for a public health emergency, the UN Mission for Ebola Emergency
Response (UNMEER), has been established to address the unprecedented EVD
outbreak. WHO is a partner in the mission. Its strategic priorities are to stop
the spread of the disease, treat infected patients, ensure essential services,
preserve stability, and prevent the spread of EVD to unaffected countries. Response monitoring
indicators are calculated using the following numerators and denominators:
No comments:
Post a Comment