Disease Outbreak Alerts

 EBOLA VIRUS DISEASE OUTBREAK: SITUATION UPDATE, 23 OCTOBER 2014
 
The Ebola virus disease (EVD) outbreak in West Africa was first reported in a World Health Organization (WHO) communiqué on 23 March 2014. Available evidence suggests that the outbreak began in Guinea’s Guéckédou Prefecture during December 2013, with subsequent spread to other prefectures in Guinea (including the capital Conakry), as well as neighbouring Liberia and Sierra Leone.

The scale of this outbreak is unprecedented and has not been brought under control, with all three affected countries continuing to report new cases and deaths. Sustained transmission of infection is occurring at the community level in numerous regions and towns across all three countries; healthcare worker infections also continue to be reported. This is likely due to inadequate treatment facilities, insufficient human resources and, in some areas, persistent community resistance to instituting preventive measures.

Of growing international concern is the possibility of imported EVD cases. To date, three countries have each reported one imported case ex-West Africa: Nigeria, Senegal and the United States of America (USA). The most recent imported case was confirmed on 30 September 2014 in the USA.

Spain
On 06 October 2014, the Spanish Health Minister reported a laboratory-confirmed case of EVD; the case-patient is a 44-year-old nurse who took care of a known EVD patient who was repatriated to Spain from Sierra Leone for medical care. The repatriated patient arrived in Spain on 22 September 2014 and died three days later on 25 September 2014. The nurse likely had direct exposure to the patient on two occasions. It is reported that the nurse took leave and travelled after being exposed to the patient and later developed a fever of 38˚C. This is the first reported autochthonous case of EVD (through human-to-human transmission) outside of Africa since the outbreak in West Africa began.  As at 19 October 2014 there has been one case and no new case or death reported. Spain continues to monitor potential contacts and on the 21 October the EVD case tested negative for the second time.

United States of America (USA)
USA reported its first imported case of laboratory-confirmed EVD on 30 September 2014. The case-patient is reported to have travelled from West Africa to the USA (Dallas, Texas) on 20 September 2014. Four days later (24 September 2014) the case-patient developed EVD-like symptoms. On 26 September 2014 he sought medical attention and was admitted on 28 September 2014 into isolation at a hospital in Dallas, Texas. The patient died on 8 October 2014.
As at 14 October 2014, CDC has confirmed that two health care workers who provided care for the above index case have tested positive for EVD. 1Confirming test results for the nurse who developed low grade fever on the 10 October 2014 came back positive for EVD. CDC still awaits confirming results for the second nurse that presented on the 14 October 2014 with low grade fever. Both nurses are currently in isolation.
Source:  2014 Ebola Outbreak in West Africa | Ebola Hemorrhagic Fever | CDC [Internet]. [cited 2014 Oct 20]. Available from: http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/index.html

Democratic Republic of Congo (DRC)
In August 2014, DRC confirmed an outbreak of EVD in the Djera area (close to Boende town) of Equateur Province, more than 1 200 km north-east of the capital city Kinshasa (Figure 1). The index case-patient was a pregnant woman who resided in the village of Ikanamongo (Watsikengo, 100 km from Boende). She was the wife of a hunter, and became ill after preparing bushmeat. Five healthcare workers were infected after being exposed to the patient.
This is the seventh confirmed EVD outbreak in DRC, close to where the virus was first identified in 1976 in Yambuku near the Ebola River. This current outbreak has no association with the ongoing outbreak in West Africa affecting Sierra Leone, Guinea and Liberia or the focal outbreak in Nigeria (Figure 2).
 
Status of EVD outbreak in West Africa (Guinea, Liberia and Sierra Leone)
As at 19 October 2014, a cumulative total of 9911 EVD cases (laboratory-confirmed, probable, and suspected) including 4868 deaths with an overall case fatality rate (CFR) of 49% has been reported from Liberia, Guinea and  Sierra Leone.
 

  • Guinea reported 1 540 cases (1 289 confirmed, 193 probable, 58 suspected) with 904 deaths (CFR: 59%)
  • Liberia reported 4 665 cases (965 confirmed, 2106 probable and 1594 suspected cases) with 2 705 deaths (CFR: 58%)
  • Sierra Leone reported 3 706 cases (3223 confirmed, 37 probable, 446suspected) with 1259 deaths (CFR: 34%)

A summary of case numbers reported in the current EVD outbreak in West Africa is shown in Table 1. Figure 3 shows the geographic distribution of the current EVD outbreak in West Africa.
 
Imported EVD cases in other countries (Nigeria, Senegal, USA)
Nigeria: The imported case-patient was a Liberian national who is reported to have travelled by air from Liberia to Lagos, via Lomé (Togo) and Accra (Ghana) on 20 July 2014. Focal transmission, including transmission to healthcare workers, occurred. As at 14 October 2014, 20 EVD cases (laboratory-confirmed/probable) with 8 deaths (CFR: 40%) were reported in Lagos and Port Harcourt. WHO officially declared EVD outbreak over in Nigeria on the 17 October 2014.

Senegal: The imported case-patient was a Guinean national who is reported to have travelled by road from Guinea to Dakar on 20 August 2014. As at 14 October 2014, no further suspected cases have been reported in connection with this case. WHO officially declared EVD outbreak in Senegal over on the 19 October 2014.

USA: The imported case-patient was an adult with recent travel history to West Africa. As at 19 October 2014, four cases and one death have been reported
Table 2 summarises the number of imported EVD cases and deaths in other countries.
 
 
Table 1: Number of Ebola virus disease cases and deaths in Guinea, Sierra Leone and Liberia (as at 19 October 2014)
 

Country Total cases (laboratory-confirmed, probable and suspected) Total deaths Case fatality rate Laboratory-confirmed cases Laboratory-confirmed deaths Number of cases in healthcare workers
 
 
Guinea
 
1 540
 
904
 
59%
 
1 289
 
710
 
78 (41 deaths)
Liberia* 4 665 2 705 58% 965 1241  
222 (103 deaths)
Sierra Leone**  
3 706
 
1 259
 
34%
 
3223
 
986
 
129 (95 deaths)
Totals 9911 4 868 49% 5477 2937  
429(239 deaths)
 

* For Liberia, 276 more confirmed deaths have been reported than have confirmed cases. **For Sierra Leone, 127 more probable deaths have been reported than have probable cases. 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.
 
Source: World Health Organization Global Alert and Response: Ebola response roadmap, update of 22 October 2014 (www.who.int)  
 
Table 2: Number of imported Ebola virus disease cases and deaths in other countries as at 19 October 2014
 

Country Total cases (laboratory-confirmed, probable & suspected) Laboratory Confirmed Cases Laboratory Confirmed Deaths Probable Cases Suspected Cases Total deaths Number of cases in healthcare workers
 
Nigeria*
 
20
 
19
 
7
 
1
 
0
 
8
 
11 (5 deaths)
Senegal* 1 1 0 0 0 0 0 (0 deaths)
United States of America 4 3 1 ** ** 1 2(0 deaths)
 

** No data available and * Senegal and Nigeria declared EVD outbreak over by WHO on the 17 October and 19 October 2014 respectively.
Source: World Health Organization Global Alert and Response: Ebola response roadmap, update of 22 October 2014 (www.who.int)
 
Status of EVD outbreak in DRC
As at 09 October 2014, and after a retrospective review of cases, there have been a cumulative total of 66 EVD cases (confirmed, probable, and suspected) including 49 deaths with a CFR of 74% has been reported. Table 3 summarises the number of EVD cases and deaths reported in DRC.
 
 
Table 3: Number of Ebola virus disease cases and deaths in DRC as at 20 October 2014
 

Country Total cases (laboratory-confirmed, probable & suspected) Laboratory Confirmed Cases   Probable Cases Suspected Cases Total deaths Number of cases in healthcare workers
DRC 66 38   28 0 49 8 (8 deaths)
 

Source: World Health Organization Global Alert and Response:  Ebola response roadmap situation report, update of 22 October 2014 (www.who.int)
 
As this is a rapidly changing situation, the number of reported cases and deaths and their geographic location are apt to change daily due to consolidation of case, contact and laboratory data, enhanced surveillance and contact tracing activities, and on-going laboratory investigations.





Figure 1: Geographic location of EVD outbreak in Boende Town, Equateur Province, DRC




Figure 2: Geographical distribution of current Ebola virus disease outbreaks in Africa as at 19 October 2014





Data are based on official information reported by Ministries of Health. 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.
 

 

Figure 3: Geographic distribution of Ebola virus disease in West Africa as at 12 October 2014.
Source: WHO: Ebola Response Roadmap Situation report 22 October 2014 



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