Ebola virus in West Africa and international spread BWTC meeting 05 August 2014 Geneva, Switzerland Créd rédit t photos tos C. Black and P. P. Forme rmenty, ty, Pandemic and Epidemic Diseases department - 1 WHO WHO
Ebola in West Africa, International spread ● Ebola, the disease, its transmission and outbreak control strategy ● Assessment of the situation : an international public health issue ● The way forward Pandemic and Epidemic Diseases department - 2
Ebola virus disease The virus, the disease its mode of transmission and outbreak control strategy Pandemic and Epidemic Diseases department - 3
Ebola and Marburg virus disease ● Mononegavirides, Filoviridae, Filoviruses : ● 5 distinct Ebola strains ● 2 lineages for Marburg ● BSL 4 ● Incubation 2-21 days ● Case Fatality Ratio 24-89% ● No specific treatment available, careful rehydration, supportive, intensive care, ● Vaccines in development Pandemic and Epidemic Diseases department - 4
Ebola virus disease transmission ● Ebola Infection of index case(s) : Animal found dead in the forest: chimpanzes (6), gorillas (4), monkeys (4), forest antelopes (3), fruit bats (1), porcupine.(1)... • UNKNOWN for 13/23 Ebola events ● H2H Transmission : familial and nosocomial • Most human infections due to direct or indirect contact with skin, mucous membranes, body fluids of infected patients (blood, saliva, vomitus, urine, stool, semen) ● Amplification 216 HCW / 1872 Ebola • Hospital : health care workers, in-patients, care givers, unsafe injections • Community : contacts when caring for ill, funeral Pandemic and Epidemic Diseases department - 5
General strategy to CONTROL Ebola outbreak ● Strong leadership of Minister of Health, WHO coordinating international support ● Stop transmission chains and stop human source of infection (link with animal surveillance) ● Active investigation and registration of new cases, contacts and deaths. Detailed database ● Follow up of contacts for 21 days by mobile teams (isolate if ill). Follow-up virus persistence during recovery (semen) ● Prevention: promote the adoption of culturally- sensitive practices that reduce the risk of transmission within the community Pandemic and Epidemic Diseases department - 6
General strategy to CONTROL Ebola outbreak Women, associations Barrier Infection Anthropological Triage Traditional healers nursing In/out evaluation control Opinion leaders Psycho- Behavioural and Formal and Clinical case social informal Organize social Management support modes of funerals communication interventions Social and Clinical trials Cultural Ethics committee practices Ethical Communication Duty of care Medias Coordination Press aspects Research Journalists Active Security Epidemiological case-finding Police Control of investigation, Logistics vectors and Follow-up Lodging reservoirs in surveillance of contacts Food nature and laboratory Social and Specimens Epidemiological Laboratory Database Finances Transport Search the mobile teams testing Vehicles source analysis Salaries Pandemic and Epidemic Diseases department - 7
Ebola virus disease in West Africa and international spread, 2014. Assessment of the situation : an international public health issue Pandemic and Epidemic Diseases department - 8
Ebola outbreak in Guinea, Liberia and Sierra Leone, Epicurve by week of onset, December 2013 to June 2014 (n=1257). As of 31 July Liberia ( 274 cases) Since 24 March, Outbreak response operations started Sierra Leone ( 533 cases) 1148 cases in 3 countries Guinea (450 cases) + Nigeria Alerts: Canada, Ghana, Côte- d'Ivoire, Mali, Morocco, Senegal, Spain, USA. Laboratory Confirmation 21 March Alert 13 March 15 cases inc. 9 deaths Alert from Méliandou 26 January 5 death w diarrhoea Pandemic and Epidemic Diseases department - 9
Geographical distribution of Ebola outbreak(s) in West Africa January to June 2014. As of 31 July 2014. Locality reported Ebola cases Total 1610 cases Sénégal Dakar Locality with Ebola including 890 deaths Treatment Center Gambia Capital city Banjul Bamako Mali Ongoing Ebola transmission Guinée EDPLN - Ebola Laboratory Bissau Guinée Bissau Main roads Siguiri Dinguiraye Boké Kouroussa Télimélé Dabola Boffa Dubréka Sierra Conakry Kissidougou Leone 145 cases Côte d'Ivoire Kambia Guéckédou 80 deaths Port Loko Macenta Freetown Kailahou Daru Nzérékoré Bo Foya Voinjoma Kenema Cases Deaths HCW Gha Bong Yamoussoukro Guinea 493 360 33 (20) Monrovia Margibi Liberia 471 257 60 (35) Liberia Sierra Abidjan 646 273 49 (25) Leone Pandemic and Epidemic Diseases department - 10
Distribution of Cases and Contacts in Africa Countries with Ebola transmission: countries that are reporting EVD cases and documented human-to-human transmission. Ongoing Ebola transmission Countries with potential exposure: countries that are reporting presence of contact of EVD cases In Africa: 17 cities in 13 countries In addition: Dubai in United Arab Emirates Khartoum in Sudan New Delhi in India Pandemic and Epidemic Diseases department - 11
Outbreak response summary ● Deployment of several mobile laboratories and development of national lab capacities ● Over 200 experts deployed in the 3 countries by WHO and GOARN partners (epidemiologists, clinicians, anthropologist, communication experts, logisticians, …) ● Outbreak logistics: timely shipment of needed PPEs and others medical supplies ● Information products published (Website AFRO and HQ) daily Pandemic and Epidemic Diseases department - 12
Outbreak risk assessment ● Serious public health event that threatens global public health security ● First large Ebola outbreak in West Africa ● Weakness of surveillance ● Failure of social interventions: strong community resistance, strong traditional beliefs & cultural practice ● Mix of Ebola transmission documented: rural, urban, and cross-border. ● High number of HCW among cases (health care facilities serving as amplification places for Ebola) Pandemic and Epidemic Diseases department - 13
Critical Issues ● Cross-border infections & travelers Nigeria Ill travelers testing negative Coordination & contact tracing ● Many partners at limits of capacity Ongoing weaknesses in operations ● Socio-economic impact Pandemic and Epidemic Diseases department - 14
Mano River Union: 3 rings 1. Treat Guéckédou-Kenema-Foya triangle as unified unit Public health measures to reduce movement in / out 2. Guinea, Sierra Leone, Liberia and Nigeria Intensify current measures 3. Others countries in Africa and beyond Steps to reduce international spread Pandemic and Epidemic Diseases department - 15
IHR Emergency Committee ● 6 & 7 August ● Assess situation ● Two main questions ● Is this a public health emergency of international concern ● If yes, guidance to DG on temporary recommendations ● Summary report will be made public ● Press briefing following day Pandemic and Epidemic Diseases department - 16
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