June 23, 2015

HIGHLIGHTS

• Overall active EVD transmission decreases in Guinea and Sierra Leone since the week ending June 7
• The Government of Sierra Leone (GoSL) launches Operation Northern Push to scale up response efforts and local-level engagement in districts where EVD persists
• New chain of transmission emerges as the Government of Guinea (GoG) reports five new confirmed cases in Boké Prefecture

KEY DEVELOPMENTS

• EVD transmission continues in Guinea and Sierra Leone, with 24 new EVD cases confirmed during the week ending June 14, according to WHO. EVD transmission decreased slightly between early and mid-June, affecting four Guinean prefectures—Boké, Conakry, Dubréka, and Forécariah—and Sierra Leone’s Kambia and Port Loko districts. Of the 24 new cases identified in the two countries between June 8 and 14, 18 were found from known contact lists and five were from unknown sources of transmission.

  The GoSL’s Operation Northern Push—a 21-day surge effort to reach zero EVD cases by focusing on combined chiefdom-level activities—officially commenced on June 16 in affected areas of Kambia and Port Loko. According to WHO, response actors are aiming to end behaviors that perpetuate transmission, such as unsafe movement of EVD-affected people.

  As of June 14, health actors were monitoring nearly 1,930 contacts across eight Guinean prefectures; in Sierra Leone, contact tracers were following up with more than 440 people.

REGIONAL

WHO reported 24 confirmed cases of EVD between June 8–14, including 10 cases in Guinea and 14 in Sierra Leone, with new cases found across four Guinean prefectures and two districts in Sierra Leone. The source of infection for some cases remains unknown, highlighting continued undetected chains of transmission, according to the UN agency.

In mid-June, USG Disaster Assistance Response Team (DART) staff traveled to Guinea’s Forécariah—which borders Sierra Leone’s Kambia—to meet with partners and assess prefecture-level coordination and cross-border activities. The International Federation of Red Cross and Red Crescent Societies (IFRC), the Sierra Leone Red Cross Society, and the Guinean Red Cross noted several challenges to working on cross-border EVD activities between Guinea and Sierra Leone. Participants underscored that improved information sharing and cross-border contact tracing was essential to strengthen the countries’ joint effort to reach zero EVD cases, particularly along the common border.

Liberia

In recent weeks, health experts have emphasized the importance of continuing practices that mitigate the risk of EVD resurgence in Liberia. Given ongoing EVD transmission rates in Guinea and Sierra Leone, Liberia continues to experience a high risk of EVD re-importation despite ongoing prevention efforts. Consequently, experts are advocating for response efforts which ensure that Liberia has the capacity to rapidly identify, investigate, isolate, test, refer, and care for an EVD case if one arises.

Technical experts from the DART and CDC continue to assist the Government of Liberia (GoL) infection prevention and control (IPC) task force in developing post-EVD standard precaution guidelines to strengthen Liberia’s national health system. The task force—which includes participation from response agencies, USAID/OFDA partners the International Medical Corps (IMC), the International Organization for Migration (IOM), Jhpiego, and other nongovernmental organizations (NGOs)—is also developing a national IPC policy to ensure implementation of the guidelines, such as hygiene promotion and health-related best practices, and advocating for creation of a permanent IPC lead and support team within the GoL’s Ministry of Health (MoH). IPC task force members are also endeavoring to establish a permanent IPC lead and support team within the GoL MoH to bolster sustainability.

On June 17 and 18, the training sub-group of the GoL Incident Management System case management committee hosted a workshop to revise Liberia’s national IPC training for health care workers. The GoL and health partners had developed the previous IPC training, known as the Keep Safe and Keep Serving (KSKS) model, during the EVD outbreak; the training sub-group is now refining the KSKS curriculum to align with standard, risk-based IPC precautions. The new curriculum—referred to as the safe and quality services (SQS) training—aims to prevent the spread of EVD and other communicable diseases through the planned inclusion of facility-based surveillance training and an emergency clinical management component. The SQS training is also expected to include training for providing psychosocial support services, including psychological first aid and patient privacy and confidentiality. WHO plans to continue coordinating the training development process and begin the training in the coming months in collaboration with other partners.

The absence of a nationally standardized surveillance system remains a key gap in Liberia’s ability to respond to public health events, including EVD and other infectious disease outbreaks. Liberia’s National Disease Surveillance Technical Coordination Committee (NDSTCC) is developing a standardized disease surveillance system to rapidly detect diseaserelated events and obtain the information necessary to enable a prompt public health response. NDSTCC members expect to finalize a new integrated disease surveillance and response strategy and an implementation plan—which will include cross-border surveillance assessment tools—in the coming weeks.

Sierra Leone

Between July 20 and 26, the GoSL confirmed three new EVD cases countrywide, including two in Western Area and one in Tonkolili District—the district’s first EVD case in at least 150 days.

As part of its continued support for Operation Northern Push, USAID/OFDA partner the UN Children’s Fund (UNICEF) intensified its social mobilization and community engagement activities in the EVD-affected areas of Port Loko, Kambia, and Western Area as of mid-July. UNICEF-led social mobilization teams—in collaboration with partners the International Federation of Red Cross and Red Crescent Societies (IFRC), Health for All Coalition, Restless Development, and Oxfam—visited more than 5,000 households, promoting EVD awareness and educating individuals on EVD response activities.

In Western Area Urban District, UNICEF has focused its social mobilization activities in the hot-spot areas of Congo Water, Goderich, and Magazine Wharf, emphasizing infection prevention and control (IPC) techniques through daily community meetings. Additionally, UNICEF is collaborating with local leaders and ward councilors to engage nearly 4,500 individuals within and nearby the district’s quarantined households in an effort to strengthen community-based surveillance and monitoring.

With USAID/OFDA support, the International Medical Corps (IMC) continues to support screening and referral units (SRUs) at five peripheral health units in Port Loko. The primary objective of the SRUs is to ensure that the PHUs adhere to proper IPC protocols—including patient screening, facility sanitation and waste management, as well as maintaining a safe separation between observation rooms, treatment rooms, and suspected case isolation areas. Between July 9 and 15, nearly 300 patients were screened at the five facilities’ SRUs; local and IMC staff report no IPC protocol breaches during the reporting period..

Sierra Leone

The GoSL Ministry of Health and Sanitation (MoHS) reported eight new confirmed EVD cases in Sierra Leone between June 15 and 21—a decrease of six EVD cases from the total recorded between June 8 and 14. Kambia District reported two EVD cases, Port Loko District had four cases, and two cases occurred in Western Urban Area District following more than two weeks without a reported EVD case. Of the eight reported EVD cases, two were from unknown sources, four were from a known epidemiological link, and two were from contact lists. District Ebola Response Centers (DERCs) are currently monitoring more than 1,000 contacts in the EVD-affected districts; the high number of contacts reflects an increased amount of persons of interest identified during Operation Northern Push.

As part of the 21-day surge effort, the Kambia DERC is focusing on quarantining EVD-affected households in Kadalo and Kagboto villages, following a confirmed EVD case who was reportedly involved in an illegal burial. Coordination is ongoing between response actors in Kambia and Guinea’s Forécariah to deter unsafe, cross-border burials and slow the transmission of EVD. The Port Loko DERC also remains focused on new EVD clusters, contact tracing, and monitoring efforts in the affected chiefdoms. Port Loko paramount chiefs and traditional healers attended the operation’s launch, receiving key messages to apply in their influential role among local communities. With support from WHO, the MoHS also deployed 35 medical workers to the affected districts. USAID/OFDA partners are also participating in the operation, having recently scaled up relief activities in the affected districts.

USAID/OFDA partner the International Rescue Committee (IRC) is working to strengthen Sierra Leone’s health care system beyond EVD-related capacities through its leadership of the Ebola Response Consortium (ERC)—a group of 14 NGOs working to implement a national IPC program in more than 1,100 peripheral health units (PHUs) and 19 government hospitals in Sierra Leone, in coordination with the MoHS, the UN Children’s Fund (UNICEF), WHO, and CDC. In recent months, the ERC IPC program has expanded beyond EVD-specific staff training to now focus on expanding IPC training for all health care facilities beyond EVD treatment. The MoHS, WHO, and CDC are working to finalize and circulate an IPC guidelines package. With nearly $9.7 million in USAID/OFDA funding, IRC is bolstering IPC capacities at the PHUs and supporting NGO IPC mentors who partner with MoHS IPC focal points at 19 public hospitals to train health care staff and improve IPC at the facilities.

Through USAID/OFDA support, IOM and implementing partners World Hope International and Wellbody Alliance are working to address identified social mobilization gaps, including the continuation of harmful traditional practices such as the washing of deceased family members, in Bombali and Kono districts. IOM’s community-centered intervention has trained 100 community representatives, religious leaders, and EVD survivors to educate their communities on the outbreak. In addition, selected communities in 18 chiefdoms learned basic IPC measures and developed community-led action plans to reduce the risk of EVD transmission. To date, IOM’s implementing partners have reached more than 20,000 individuals through the use of social mobilizers and community health workers and community engagement on EVD-related issues—including culturally sensitive safe burial practices, disease identification and referral of late-stage malaria and measles, health promotion, and urging continued vigilance against possible EVD outbreaks.

On June 20, DART and CDC staff traveled with USAID/OFDA partner Medair and two quarantine response team members to Upper Allentown in Sierra Leone’s Western Urban Area to visit a household released from a 21-day quarantine the same morning. The seven-member household related a generally positive quarantine experience, reporting that response staff from Medair and local partner Lifeline visited the family on a daily basis, bringing fresh food and offering psychosocial support.

Medair is currently supporting between four and six quarantined households in Western Area. At the height of the outbreak, Medair and Lifeline were providing daily services—including fresh food, EVD interim care kits, psychosocial support, and basic first aid—to between 100 and 150 quarantined households. Medair’s response teams also conduct follow-up visits after quarantines end or people return home from EVD treatment units (ETUs). As Medair response teams visited the same quarantined households during the 21-day period, the teams developed good relationships not only with the quarantined inhabitants, but also the communities, resulting in awareness initiatives.

Guinea

In recent days, the GoG reported five new confirmed cases of EVD from Boké Prefecture. Between June 18 and 19, prefectural authorities recorded four cases in Tamarassy village, which is located three miles from Boké city. The four Tamarassy cases reportedly came from known contacts in the same area of the town, according to IMC. On June 20, the GoG reported an additional case from the city of Port Kamsar. In recent months, prefectural authorities had recorded only one case outside of Boké Prefecture’s Kamsar sub-prefecture. Epidemiologists in Guinea believe that the cluster of cases in Tamarassy is linked to a chain of transmission from Forécariah—a transmission chain independent from the cluster of cases in Kamsar, active since May.

One of the recent confirmed cases from Tamarassy included a health care worker, according to the GoG. The infection—the first EVD case among health care workers since April—reportedly occurred outside of a health care setting. As of June 22, the National Ebola Coordination Cell reported that 203 health care personnel had contracted EVD during the course of the outbreak. The nurse is receiving care at the Government of France-supported EVD treatment facility for health care workers (CTS) in the capital city of Conakry. A second health care worker from Boké— a suspected case awaiting diagnostic test results—is also receiving care at the CTS.

In mid-June, the GoG removed Kindia from the list of prefectures with active EVD transmissions, as Kindia did not have a confirmed case during the prior 21 days. Although local authorities reported three confirmed cases during the first week of June, subsequent tests at the Coyah Prefecture laboratory found that the cases were false positives, according to CDC. As of June 16, the GoG reported four active prefectures—a decrease of two prefectures from the previous week. In addition, the GoG also removed Fria Prefecture on June 16 after the prefecture passed 21 days without a case.

The UN World Food Program (WFP) is preparing to renovate the WHO-managed ETU in Coyah to address issues related to rainy season soil erosion. Renovations in the red zone―the area of the ETU where suspected and confirmed patients are isolated and receive care―are expected to take two weeks during which the ETU will close; additional structural rehabilitations outside the red zone will take longer but likely will not impede clinical operations. On June 22, the National Ebola Coordination Cell confirmed that while the renovations are in progress, health actors will transfer suspected cases from Boké―previously treated at the Coyah ETU―to the Kindia ETU; new suspected cases discovered during the ongoing case finding and EVD messaging campaign in Dubréka will be transported to ETUs in Kindia or Forécariah. As of June 22, no patients remained at the Coyah ETU.

During a June 17 meeting with DART staff, UNICEF—the lead agency for social mobilization efforts in Guinea— reported that while social mobilization and community engagement remains a challenge, overall efforts have improved in Guinea and the GoG has recently reported fewer incidents of resistance to response efforts compared to previous months. To further address reticence, UNICEF is adjusting its social mobilization strategy to work with communities, specifically targeting women and youth groups, to overcome remaining resistance. The strategy is also broadening to encourage sick individuals to seek care quickly and work with transportation actors in Guinea—the Ministry of Transportation and the police—to reinforce efforts limiting the movement of suspected cases and bodies. UNICEF’s current social mobilization program engages with community leaders and religious authorities at the community level; outreach to religious leaders typically focuses on reducing unsafe burial practices, which remains a critical behavioral gap in Guinea.

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