February 25, 2015

HIGHLIGHTS

• The Government of Liberia (GoL) documented only one new confirmed EVD case between February 17 and 23—the lowest one-week total since June 2014.
• WHO has expressed concern that the downward trend in the number of new cases seen in January in Guinea and Sierra Leone has leveled off in recent weeks.
• Staple and cash crops are available in local markets in the EVD-affected countries; however, weak household purchasing power caused by EVD-related economic disruptions may lead to localized acute food insecurity in the coming months.

KEY DEVELOPMENTS

• Between February 17 and 23, the GoL Incident Management System (IMS) documented only one new confirmed EVD case—the lowest one-week total since June 2014. Response actors isolated the individual on February 18 and confirmed EVD on February 19. The case is linked to Montserrado County’s St. Paul Bridge cluster, which is currently the only known active transmission chain in the country.
• During a February 20 news conference, UN Special Envoy for Ebola David Nabarro and WHO Director-General for the Ebola Response Bruce Aylward reported that the number of new EVD cases in West Africa, particularly in Guinea and Sierra Leone, is no longer dropping at the rate seen in January and that the region has recorded approximately 120 to 150 new cases weekly in February. The two senior officials expressed concern that the aim of reaching zero EVD cases by mid-April—a goal recently set by heads of state from the three acutely affected countries—may be difficult given the current trend.
• Initial findings of market assessments conducted in early February by the USAID-funded Famine Early Warning Systems Network (FEWS NET), national governments, and two UN agencies indicate that staple and cash crops are available in most local markets in Guinea, Liberia, and Sierra Leone despite previous concerns that the EVD outbreak would negatively affect harvests. While economic conditions across the three countries are slowly improving relative to previous months, EVD-related movement restrictions, the prolonged closure of borders and markets, and fears of frequenting EVD-affected areas have disrupted livelihood activities, particularly in communities reliant on cross-border trade. As a result, weak household purchasing power may contribute to localized acute food insecurity in all three countries in the coming months, especially among wage-dependent households once families deplete food stocks from recent harvests.

REGIONAL

During the week ending on February 22, WHO reported 99 new confirmed EVD cases across Liberia, Guinea, and Sierra Leone—the majority of which were from the latter two countries. Guinea and Sierra Leone reported 35 and 63 new cases, respectively, during the seven-day period. EVD hotspots persist in Guinea’s capital city of Conakry and Coyah and Forécariah prefectures, as well as Sierra Leone’s Western Area and Port Loko and Kambia districts. Nearly 70 percent of the region’s EVD cases were reported from these areas during the week ending on February 22, according to WHO.

Although reported EVD cases are significantly reduced across the region relative to previous months, response actors note continued under-reporting of suspect EVD cases, particularly in Guinea and Sierra Leone. EVD surveillance activities should consistently identify suspect cases due to endemic diseases, such as malaria, that exhibit symptoms similar to EVD; however, current reporting does not adequately reflect these cases. Another complication to the EVD response is the fear of stigmatization, which senior WHO officials recently highlighted as a main factor driving populations to avoid contact tracers, thereby hampering efforts to identify and break transmission chains.

Between February 19 and 21, USAID/OFDA Director Jeremy Konyndyk visited Liberia and Sierra Leone to meet with key USG personnel and observe ongoing EVD response activities. While in Liberia, Director Konyndyk visited the Monrovia Medical Unit—an EVD treatment unit (ETU) operated by 70 U.S. Public Health Service (USPHS) officers and designed to treat EVD-positive health care workers. Director Konyndyk also visited Liberia’s national EVD burial site at Disco Hill, where USAID/OFDA partner Global Communities conducts safe and dignified burials. In Sierra Leone, Director Konyndyk joined a U.S. congressional staff delegation to receive a CDC-led tour of the Western Area Ebola Response Center and visit a training center for health care workers operated by USAID/OFDA partner the International Organization for Migration (IOM).

Liberia

As of February 24, Grand Cape Mount County had not documented a confirmed EVD case during the previous 42 days, marking the passage of two 21-day monitoring periods without a confirmed case—WHO’s benchmark for declaring an area EVD-free. Currently, 13 of Liberia’s 15 counties are EVD-free, according to the GoL and WHO.

On February 20, President Ellen Johnson Sirleaf of Liberia ordered the reopening of the country’s international borders, which the GoL closed at the height of the EVD outbreak in 2014. President Sirleaf also lifted a nationwide EVD-related curfew that commenced in August 2014. Both directives took effect on February 22.

On February 19, USG Disaster Assistance Response Team (DART) members traveled to low-income neighborhoods in Liberia’s capital city of Monrovia to observe efforts undertaken by USAID/OFDA partner the MENTOR Initiative to help reduce EVD transmission risk among residents. For example, in coordination with the GoL, the USAID/OFDA partner is promoting safe hygiene among children and engaging with community leaders regarding EVD awareness and prevention methods. As part of its response, the MENTOR Initiative is also conducting infection prevention and control (IPC) protocol trainings and improving triage and isolation capabilities at community health clinics across Monrovia. In particular, the MENTOR Initiative is assisting with site modifications for the health clinic in the St. Paul Bridge community—where the only currently active EVD transmission chain in Liberia originated—to provide safe triage and isolation capacity for suspected EVD cases.

USAID/OFDA partner BRAC continues to support protection interventions for EVD-affected populations in Bong, Gbarpolu, Grand Bassa, Grand Cape Mount, Lofa, Monsterrado, and Nimba counties. In consultation with the GoL, BRAC has trained more than 880 individuals, including 580 community health promoters and 300 social worker assistants, who will operate across the seven counties to provide psychosocial services to community members approximately three times per week. Additionally, BRAC has developed brochures, as well as jingles, drama skits, and text messages, through which the organization is disseminating EVD-related information to reduce stigma and EVD-related misconceptions.

USAID/FFP recently provided approximately $8 million to Project Concern International (PCI) to support vulnerable households in Bomi and Grand Cape Mount counties in Liberia. PCI will provide cash transfers to an estimated 6,700 households to help them boost food intake during the 2015 June-to-September lean season, focusing on households directly affected by EVD, as well as families with pregnant and lactating women and children under five years of age. In addition, to reduce the impact of EVD-related economic disruptions in Liberia, PCI plans to provide cash-for-work opportunities to more than 2,500 economically vulnerable households, as well as agricultural input vouchers to more than 5,200 farming families to enable them to access high-quality seeds through local seed vendors.

Sierra Leone

Western Area and Port Loko and Kambia districts remain key areas of concern due to the presence of active EVD transmission chains and the potential for transmission across district or international borders, including from Kambia District to Guinea’s Forécariah Prefecture, according to the Government of Sierra Leone (GoSL). District-based CDC personnel are collaborating to minimize risk of cross-district transmission, particularly across Western Area, Port Loko, and Kambia’s shared borders. CDC personnel in Kambia are also engaging with Guinea-based counterparts to monitor potential EVD transmission between Sierra Leone’s northern districts and bordering Guinean prefectures.

GoSL authorities recently reiterated the need to rapidly identify, isolate, and treat all suspect EVD cases—a need underscored by the prevalence of dead bodies in the country testing positive for EVD. Since early January, the percent of EVD-positive specimens taken from dead bodies in Sierra Leone has remained largely stagnant, fluctuating between approximately one and six percent. Nearly three percent of the 173 dead body swabs tested on February 20 were positive for EVD, according to the GoSL. Response actors remain concerned, as each positive test generally indicates that a symptomatic individual spent a significant period of time in the community and likely generated a higher number of contacts compared to an EVD-positive individual who immediately seeks isolation and care at an EVD treatment facility.

With USAID/OFDA funding, the International Rescue Committee (IRC) is supporting GoSL EVD response efforts through the management of the Ebola Response Consortium (ERC)—comprising eight NGOs that operate in all of Sierra Leone’s 14 districts. ERC partners continue to support regular, countrywide supervision in Sierra Leone’s peripheral health units (PHUs) to reinforce IPC practices and monitor facilities for IPC compliance. The ERC is also collaborating with the GoSL Ministry of Health and Sanitation, CDC, IFRC, and WHO to strengthen the existing EVD surveillance system in Sierra Leone to reduce EVD transmission and decrease the time it takes district-level Ebola response center (DERC) staff to respond to new suspected EVD cases. To further support IPC in PHUs, the ERC is also training designated community health workers and traditional birth attendants to provide EVD screening.

Between September 5 and February 16, the GoSL Ministry of Social Welfare, Gender, and Children’s Affairs (MoSWGCA) registered nearly 16,870 EVD-affected children in Sierra Leone. On February 16, USAID/OFDA partner UNICEF—in collaboration with the MoSWGCA—held a protection desk officer training to increase district-level capacity to respond to EVD-related child protection needs. Thirty protection desk officers participated—including at least two representatives from each of Sierra Leone’s 14 districts. Following the training, the protection desk officers will manage protection-related alerts reported to EVD hotlines and respond by assessing and documenting the need for support, referring the case to the appropriate resource, and conducting follow-up monitoring.

From February 23 to 24, a local civil society organization Amazonian Initiative Movement (AIM) collaborated with CDC, the U.S. Embassy in Freetown, social mobilization pillar, and UNICEF representatives to conduct EVD awareness training for more than 200 female traditional healers, including more than 100 healers each in Bombali and Tonkolili districts. The training provided healers with an opportunity to discuss the intersection of religion—Christianity and Islam—with EVD prevention treatment protocols. The session also incorporated a CDC-led presentation on EVD prevention and treatment and culminated in a post-training evaluation to assess participant knowledge. AIM plans to conduct a similar training in Kono District in the coming days.

Guinea

As of February 25, WHO and the Government of Guinea have documented 187 confirmed EVD cases during the month to date, surpassing the 153 confirmed Guinean EVD cases reported in January. The weekly number of new confirmed cases, however, has decreased for each of the previous three weeks, from 65 new cases reported during the week of February 2 to 35 new cases during the week of February 16.

A team of UNICEF-commissioned anthropologists recently conducted a study on community reticence in Guinea, assessing the knowledge, attitudes, and behavior of individuals in 47 villages across 14 prefectures, including Beyla, Conakry, Coyah, Dubreka, Faranah, Forecariah, Gueckedou, Kankan, Kindia, Macenta, Mamou, N’Zerekore, Telimele, and Siguiri. Although 90 percent of interviewees said they knew that EVD was a “dangerous illness,” only 45 percent of respondents reported knowing that EVD could be contracted through contact with the body of an EVD-affected 4 individual. The study highlighted multiple drivers of reticence, including fear, misinformation, rumors, response team insensitivities, and longstanding frustrations and conflicts within communities. According to the study, approximately 75 percent of reticence stems from lack of information or misinformation, with some people doubting the sincerity of EVD-related messages, in part due to EVD’s resemblance to other diseases known in Guinea, such as malaria. The three response interventions that most often trigger individual or community reactions are safe burials, disinfection of schools and other public places, and contact tracing activities, according to the assessment.

In early February, the Logistics Cluster—the coordinating body for humanitarian logistics activities, comprising UN agencies, NGOs, and other stakeholders—facilitated the transport of two laboratories via helicopter across Guinea. One excursion delivered a laboratory from Conakry to a recently finalized ETU in Kerouane, while another transferred a laboratory from Gueckedou to the ETU in Coyah Prefecture.

On February 24, approximately 52 metric tons of USAID/OFDA-procured chlorine was transferred to the Central Pharmacy of Guinea, the national medical stock warehouse. The chlorine will be distributed to health care facilities across the country for disinfection purposes.

FOOD SECURITY AND LIVELIHOODS

In recent days, USAID/FFP partner WFP provided food assistance to more than 500 quarantined households in Freetown’s Aberdeen area in Sierra Leone. WFP continues to respond to all requests for food assistance to quarantined homes—communicated through the National Ebola Response Center—within 24 hours. Since September, WFP has provided nearly 17,120 MT of food assistance to nearly 1.6 million people in Sierra Leone, including more than 600,000 people in Western Area.

With USAID/FFP support, WFP is delivering a ration of rice, beans, oil, and fortified cereal to households under observation in Liberia to help limit the need for EVD contacts to travel to local markets and purchase food—minimizing possible EVD exposure for others in the community.

PUBLIC DONATION INFORMATION

• The most effective way people can assist relief efforts is by making cash contributions to humanitarian organizations that are conducting relief operations. A list of humanitarian organizations that are accepting cash donations for disaster responses around the world can be found at www.interaction.org.
• USAID encourages cash donations because they allow aid professionals to procure the exact items needed (often in the affected region); reduce the burden on scarce resources (such as transportation routes, staff time, and warehouse space); can be transferred very quickly and without transportation costs; support the economy of the disaster-stricken region; and ensure culturally, dietary, and environmentally appropriate assistance.

More information can be found at:

• The Center for International Disaster Information: www.cidi.org or +1.202.821.1999.
• Information on relief activities of the humanitarian community can be found at www.reliefweb.int.

USAID/OFDA bulletins appear on the USAID website at what-we-do/working-crises-and-conflict/responding-times-crisis/where-we-work