Though Ebola has faded from the news headlines, the epidemic in West Africa continues to claim lives today. Around 30 people become infected each week in Sierra Leone and Guinea – a number that would be considered a major disaster under normal circumstances – and the outbreak has recently re-emerged in Liberia.
- Liberia: After being declared Ebola-free on 9 May, six (6) new cases have been confirmed since the re-emergence of the virus at the end of June.
- Guinea: 13 confirmed cases in the country in the week to 12 July in three main hotspots (Forecariah, Boké/Fria, Conakry)
- Sierra Leone: 14 confirmed cases in the country in the week to 12 July in three main hotspots (Freetown, Port Loko, Kambia)
MSF Staff on ground (as of 16 July) Total: 92 international and about 1,760 national
- Guinea: 40 international, around 1,100 national
- Sierra Leone: 29 international, around 400 national
- Liberia: 23 international, around 260 national
Overview The emergency is not over – the Ebola epidemic in West Africa continues
Though Ebola has faded from the news headlines, the epidemic in West Africa continues to claim lives today. Infection rates are down from the peak of the crisis last year and progress has been made in the fight against Ebola. However, around 30 people still become infected each week in Sierra Leone and Guinea – a number that would be considered a major disaster under normal circumstances – and the outbreak has recently re-emerged in Liberia. Ongoing infections in the capitals Freetown and Conakry, and deaths from Ebola still found too late in the community, remain of high concern.
Going from hundreds of cases to 30 per week took considerable time and massive resources, yet getting from 30 to zero requires the most meticulous, difficult work of all - we cannot lose focus now and must guard against complacency until the entire region is declared Ebola free.
The priorities today are to improve Ebola surveillance, while continuing to raise awareness to get the local communities on board to bring the epidemic to an end
Community fatigue, fear and reticence remain. Whilst Sierra Leoneans, Guineans and Liberians are understandably exhausted from the more than 16 months of Ebola in the region, fear and reticence in some communities to recognize the disease or to seek care in specialized centres is still is an issue that must be addressed. Ebola cases continue to go undetected for too long, with 25% of positive cases identified after death in their communities in the past three (3) weeks.
Engaging the community must be the cornerstone in the fight against Ebola. Gaining the trust and confidence of the communities to help to allay the rumours and myths surrounding the disease and the response is still needed. Communities across the region are very diverse and a one-size-fits-all approach with one-way messaging instead of a community-centred approach is doomed to fail.
Improved quality of case investigation, contact tracing and monitoring is needed to stop Ebola transmission today. The surveillance systems to locate and track new Ebola cases across Sierra Leone, Guinea and Liberia need to be properly supported in all districts. This includes the so called “silent “districts where cases of Ebola have not been seen for some months. This is important to control the outbreak, and for continuing efforts to reach zero cases, but also to prevent outbreaks of other infectious diseases including measles and cholera.
On infection control and triage in health facilities, non-Ebola healthcare, & survivors:
Already weak public health systems have been seriously damaged by the epidemic, with more than 500 health workers dying of the virus across the chronically understaffed region and fear of infection and lack of infection control closing many health facilities across the region at least temporarily.
Strict protocols for screening and triage of both staff and patients who meet the Ebola case definition must be adhered to without exception, even in the so called “silent districts.” With the rainy season, symptoms of malaria can easily mimic those of Ebola so extra precaution and vigilance is required.
Non-Ebola healthcare: treatment programs for chronic illnesses like HIV, heart disease and diabetes, as well as routine maternal and child health services such as routine childhood vaccinations have been interrupted. These lifesaving health services must be supported, not only financially but also by way of the provision of trained clinical staff.
Survivors and those directly affected by Ebola must be provided with tailored services including mental healthcare as they continue their recovery from the virus that has destroyed many families and their way of life.
MSF is involved in clinical trials and continues to call for increased research and development into Ebola
Clinical studies offer hope in the fight against Ebola, both for today and for future outbreaks but for now they do not constitute a miracle cure or an imminent end to the epidemic. MSF is a partner in three studies aiming to gain further understanding of the virus, and testing new treatments, diagnostic tests and vaccines.
The GeneXpert feasibility study in Conakry, Guinea evaluates the feasibility of using this diagnostic tool in an Ebola epidemic. This tool, which is already used for the diagnosis of tuberculosis, so far has shown to reduce diagnosis of Ebola from 8 to 3 hours.
The VSV vaccine clinical trial in Guinea tests the efficacy and safety of a potential vaccine that is offered voluntarily to frontline health workers. Since early March 2015, MSF has administered the vaccine to more than 900 frontline workers, over half the 1300 needed to produce conclusive results. As part of the same trial, the WHO is in charge of vaccinating direct and indirect contacts of confirmed cases in their “ring vaccination.” Preliminary results are expected soon.
Plasma trial: Since February 2015, Ebola patients in MSF’s Ebola management centre (EMC) in Conakry, Guinea, can opt to receive plasma from volunteer Ebola survivors. As of July, the Data Monitoring and Safety Board have recommended to halt the trial due to the lower number of enrolments recently; however patients can continue to receive plasma in MSF’s EMC in Conakry. Today, no results of the trial have been made public yet, though it is already known that the plasma can be given safely. MSF hope the researchers will publish the results on efficacy in the coming weeks.
MSF’s West Africa Ebola response started in March 2014 and includes activities in Guinea, Liberia, and Sierra Leone. MSF currently employs around 92 international and around 1,760 national locally hired staff in the region.
Since the beginning of the epidemic:
- 9,626 patients admitted to MSF Ebola management centres
- 5,149 patients confirmed with Ebola
- 2,425 patients recovered from Ebola in our centres
Highlights per country
Guinea Week 27 saw 18 cases reported.
Week 28 saw 13 cases, with 12 patients received at MSF centres. So far in July transmission rates are on par with June. Nine (9) cases from Conakry all linked to known chains of transmission.
30 patients in total in all Ebola Treatment Centres (ETCs), 20 confirmed and 10 suspect.
Continued need for community-based surveillance
Conakry: Donka ETC Site closed on 5 July, decontamination will be finished this week.
Conakry: Outreach activities
- Continuation of health promotion with teams in all communes of Conakry.
- Continuation of ambulance service for alerts for suspected Ebola cases in severe medical conditions, and children.
- Seven MSF supervisors still working in surveillance.
Conakry: Nongo ETC
- Site opened on 5 July, 15 beds officially available up to 70 if required.
- 32 new patients were admitted in Nongo.
- Community health promotion engagement continues.
- 11 cases week 27, two (2) of which were not on the contact list nor had established link.
- three (3) cases week 28.
- MSF activities: outreach and sensibilisation ongoing.
- opened on 3 July with 15-20 bed capacity.
- four (4) total patients admitted as of 10/7, one (1) confirmed.
MSF vaccination of frontline health care workers continues with no severe adverse effects detected so far. Over 900 already vaccinated.
After being declared Ebola free on 9 May, a 17 year boy died on June 29. MSF is not directly involved in the patient care of the new cases, in the investigation or in the follow up of contacts but it is ready to provide help to Liberian authorities and their partners, should they require it.
With the national health system decimated by the outbreak – and hundreds of Liberian health care workers dying from Ebola – MSF is focusing on supporting the recovery of health facilities. We want to encourage Liberian people to feel confident they can go to hospital once again and have their health care needs looked after.
In Monrovia, MSF is running a 69-bed paediatric hospital, aiming to contribute restoring the offer of secondary healthcare in the aftermath of Ebola outbreak. 44% of the patients are less than one year old.
MSF also runs a clinic for Ebola survivors in the premises of the hospital. Former patients have to face stigma and discrimination while accessing care, as well as social and economic problems (loss of work, loss of housing, etc.). MSF provides general outpatient consultations, and addresses mental health needs. Common complaints are joint pains and ophthalmic issues, for which MSF guarantees referral to external specialists.
Total of 14 new confirmed cases for Sierra Leone during the week to 12/07, compared to nine (9) in the week to 05/07.
Active transmission in three (3) districts of Western Area Urban/Freetown, Port Loko and Kambia, same as in weeks before.
In Freetown, 10 new confirmed cases during the week to 12/07, compared to three (3) cases in the week to 05/07. This is the highest case load since week 13 (23 - 29/03 2015).
three (3) new cases from Kambia and one (1) from Port Loko districts.
Bo The “core” ETC in Bo receives all suspected patients from southern Sierra Leone, with a capacity to treat 12 confirmed cases and 12 suspected cases. Today the centre receives 5–10 suspects per week mainly from the Bo district.
With no patients in the last weeks, Magburaka Ebola Treatment Unit (ETU) has been closed. A survivor clinic to respond to the needs of recovered patients will start soon. MSF teams also supported the district of Tonkili in the measles vaccination campaign.
Freetown – Hastings (replacement Kissy)
Freetown has seen a recent flare-up of Ebola with 10 confirmed cases recorded in Western Area last week, the highest weekly total since March. MSF has been running an Ebola Maternity Centre in Hastings, with specific obstetric services for Ebola positive pregnant women in need of tailored care. However, as other Ebola management centres in the city are reaching capacity, MSF´s maternity Ebola management centre in Hastings is now also taking in non-pregnant suspect and confirmed Ebola cases, with six (6) patients currently admitted.
Freetown – Surveillance and contact tracing
MSF works in coordination with the District Ebola Response Committee (DERC) to identify and respond to new cases in Freetown.
Ingawa Ebola imepungua katika vichwa vya habari, janga hilo katika Afrika Magharibi linaendelea kuua watu leo. Watu 30 hivi huambukizwa kila wiki nchini Sierra Leone na Guinea - idadi ambayo ingehesabiwa kuwa msiba mkubwa chini ya hali ya kawaida - na milipuko hiyo imerudi hivi karibuni nchini Liberia. Liberia, ambayo ilitangazwa kuwa haina ugonjwa wa Ebola mnamo Mei 9, imethibitisha visa sita vipya tangu virusi hivyo vikaanza kuenea tena mwishoni mwa Juni. "Hatua hiyo ilichukuliwa na shirika la afya la WHO, ambalo limesema: ""Hatua hii ya dharura ya Ebola imefikia mwisho katika Afrika Magharibi, ingawa imepotea kutoka vichwa vya habari, ugonjwa wa Ebola unaendelea leo." Kiwango cha maambukizi kimepungua kutoka kilele cha mgogoro mwaka jana na maendeleo yamefanywa katika mapambano dhidi ya Ebola. Hata hivyo, watu 30 wanaambukizwa kila wiki nchini Sierra Leone na Guinea - idadi ambayo ingekuwa ni msiba mkubwa katika hali ya kawaida - na ugonjwa huo umeibuka tena hivi karibuni nchini Liberia. Madhara ya ugonjwa wa Ebola katika miji mikuu ya Freetown na Conakry, na vifo vya watu wanaosumbuliwa na ugonjwa huo bado vimeonekana kwa muda mrefu katika jamii, bado ni jambo la wasiwasi. """Kupita kutoka mamia ya kesi hadi 30 kwa wiki ilichukua muda mwingi na rasilimali nyingi, lakini kutoka kwa 30 hadi sifuri inahitaji kazi ngumu zaidi ya wote - hatuwezi kupoteza umakini sasa na lazima tujihadhari na kujiridhisha hadi eneo lote litangazwe kuwa huru ya Ebola.""" """Upendeleo wa leo ni kuboresha ufuatiliaji wa Ebola, wakati wa kuendelea kuongeza ufahamu ili kupata jamii za mitaa ndani ya meli ili kumaliza janga hilo, uchovu wa jamii, hofu na kujizuia bado unabaki." Ingawa watu wa Sierra Leone, Guinea na Liberia wamechoka kutokana na miezi 16 ya ugonjwa wa Ebola katika eneo hilo, hofu na kutojitahidi katika jamii fulani kutambua ugonjwa huo au kutafuta huduma katika vituo maalumu bado ni suala ambalo lazima litekelezwe. "Kesi za Ebola zinaendelea kutambuliwa kwa muda mrefu sana, na 25% ya kesi nzuri zimegunduliwa baada ya kifo katika jamii zao katika wiki tatu zilizopita. """ Ushirikiano wa jamii lazima uwe jiwe la msingi katika mapambano dhidi ya Ebola. """Kupata imani na ujasiri wa jamii kusaidia kuondoa uvumi na hadithi zinazozunguka ugonjwa na majibu bado inahitajika." Jamii katika eneo hili ni tofauti sana na mbinu ya ukubwa mmoja-fits-wote na ujumbe wa njia moja badala ya mbinu ya jamii-kituo ni hatimaye kushindwa. Ubora wa ubora wa uchunguzi wa kesi, kufuatilia mawasiliano na ufuatiliaji unahitajika kuzuia maambukizi ya Ebola leo. Mifumo ya ufuatiliaji ili kugundua na kufuatilia visa vipya vya Ebola kote Sierra Leone, Guinea na Liberia inahitaji kuungwa mkono vizuri katika wilaya zote. Hii inajumuisha maeneo yanayoitwa "nyenyekevu" ambapo visa vya Ebola havijaonekana kwa miezi kadhaa. Hii ni muhimu kudhibiti mlipuko, na kwa ajili ya kuendelea na juhudi za kufikia zero kesi, lakini pia kuzuia milipuko ya magonjwa mengine ya kuambukiza ikiwa ni pamoja na homa na kipindupindu. "Kuhusu udhibiti wa maambukizi na triage katika vituo vya afya, huduma za afya zisizo za Ebola, na waokokaji, mifumo ya afya ya umma ambayo tayari ni dhaifu imeharibiwa sana na janga hilo, na zaidi ya wafanyikazi wa afya 500 wakifa kutokana na virusi katika mkoa huo ambao umekuwa na uhaba wa wafanyakazi, na hofu ya maambukizi na ukosefu wa udhibiti wa maambukizi imefunga vituo vingi vya afya katika mkoa huo, angalau kwa muda. """ """Mipango ya ukaguzi na triage ya wafanyakazi na wagonjwa ambao wanakutana na ufafanuzi wa kesi ya Ebola lazima ifuatwe bila ubaguzi, hata katika wilaya za kimya, na msimu wa mvua, dalili za malaria zinaweza kuiga kwa urahisi zile za Ebola, kwa hivyo tahadhari ya ziada na tahadhari inahitajika." "Hatua hiyo ilisababisha ""mapendekezo ya matibabu ya magonjwa ya muda mrefu kama vile virusi vya Ukimwi, magonjwa ya moyo na kisukari, pamoja na huduma za kawaida za afya ya mama na mtoto kama vile chanjo za kawaida za utotoni kuvunjwa.""" Huduma hizi za afya za kuokoa maisha lazima ziungwa mkono, si kwa kifedha tu bali pia kwa njia ya utoaji wa wafanyakazi wa kliniki waliozoezwa. "Watu waliopona na wale walioathiriwa moja kwa moja na Ebola lazima wapewe huduma zinazolingana na mahitaji yao, ikiwa ni pamoja na huduma za afya ya akili, wakati wanaendelea kupona kutokana na virusi ambavyo vimeharibu familia nyingi na njia yao ya maisha. """ MSF inashiriki katika majaribio ya kliniki na inaendelea kutaka utafiti na maendeleo zaidi ya Ebola, utafiti wa kliniki hutoa matumaini katika mapambano dhidi ya Ebola, kwa sasa na kwa milipuko ya baadaye, lakini kwa sasa haifanyi tiba ya muujiza au mwisho wa karibu wa janga. MSF ni mshirika katika masomo matatu ya utafiti wa virusi vya corona na majaribio ya matibabu mapya, vipimo vya utambuzi na chanjo. Utafiti wa uwezekano wa GeneXpert huko Conakry, Guinea unathamini uwezekano wa kutumia chombo hiki cha utambuzi katika janga la Ebola. Kwa mfano, kipimo cha ugonjwa wa kifua kikuu (TB) kinaweza kupunguza muda wa kugundua ugonjwa wa Ebola kutoka saa nane hadi tatu. Majaribio ya chanjo ya VSV nchini Guinea yanajaribu ufanisi na usalama wa chanjo inayotarajiwa ambayo hutolewa kwa hiari kwa wafanyikazi wa afya wa mstari wa mbele. Tangu mwanzoni mwa Machi 2015, MSF imetoa chanjo kwa zaidi ya wafanyakazi 900 wa mstari wa mbele, zaidi ya nusu ya 1,300 wanaohitajika kutoa matokeo ya uhakika. Katika jaribio hilo, WHO inasimamia chanjo ya mawasiliano ya moja kwa moja na isiyo ya moja kwa moja ya kesi zilizothibitishwa katika chanjo yao ya pete. Tangu Februari 2015, wagonjwa wa Ebola katika kituo cha usimamizi wa Ebola cha MSF huko Conakry, Guinea, wanaweza kuchagua kupokea plasma kutoka kwa waokokaji wa Ebola wa kujitolea. Bodi ya Ufuatiliaji na Usalama wa Takwimu imependekeza kusimamisha jaribio hilo kwa sababu ya idadi ya chini ya uandikishaji hivi karibuni, hata hivyo wagonjwa wanaweza kuendelea kupokea plasma katika EMC ya MSF huko Conakry. Hata hivyo, matokeo ya majaribio hayo hayajafunuliwa, ingawa tayari imegunduliwa kuwa plasma hiyo inaweza kutolewa kwa usalama. MSF inatarajia watafiti kuchapisha matokeo juu ya ufanisi katika wiki zijazo. Shirika la MSF la Afrika Magharibi limekuwa likijitahidi kupambana na ugonjwa wa Ebola tangu mwezi Machi mwaka 2014 na sasa linafanya kazi nchini Guinea, Liberia na Sierra Leone. MSF sasa inaajiri karibu wafanyikazi 92 wa kimataifa na karibu wafanyikazi wa kitaifa 1,760 waliokodishwa ndani ya mkoa. Tangu mwanzo wa janga hilo, wagonjwa 9,626 wamelazwa katika vituo vya usimamizi wa Ebola vya MSF, wagonjwa 5,149 wamethibitishwa kuwa na Ebola, wagonjwa 2,425 wamepona kutoka kwa Ebola katika vituo vyetu, na wagonjwa 18,725 wameripotiwa katika wiki ya 27 nchini Guinea. Katika wiki ya 28, kulikuwa na visa 13 na wagonjwa 12 walipokelewa katika vituo vya MSF. Hadi sasa katika Julai viwango vya maambukizi ni sawa na Juni. Matukio tisa kutoka Conakry yote yanahusiana na minyororo inayojulikana ya maambukizi. Kwa jumla, wagonjwa 30 katika vituo vyote vya matibabu ya Ebola (ETCs) - 20 wamethibitishwa na 10 wanashukiwa. Utafiti wa eneo la Donetsk ulifungwa Julai 5, na kazi ya kuondoa uchafuzi itaendelea wiki hii. Conakry: Shughuli za ufikiaji - Kuendelea na kukuza afya na timu katika manispaa zote za Conakry. - Kuendelea kwa huduma ya ambulansi kwa ajili ya tahadhari kwa ajili ya kesi ya tuhuma Ebola katika hali kali ya matibabu, na watoto. - Wasimamizi saba wa MSF bado wanafanya kazi katika ufuatiliaji. Nongo ETC - Kituo cha matibabu cha watoto kilichofunguliwa Julai 5, kitanda cha 15 kinapatikana rasmi hadi 70 ikiwa inahitajika. Wagonjwa 32 wamepelekwa hospitalini Nongolo - Ushirikiano wa kukuza afya ya jamii unaendelea. Katika wiki ya 27, kesi 11 zilitolewa, mbili kati ya hizo hazikuwa kwenye orodha ya mawasiliano na hazikuwa na uhusiano wa kudumu. - 3 (kumi) wiki - Shughuli za MSF: ufikiaji na ufahamu unaendelea. - ilifunguliwa tarehe 3 Julai na uwezo wa kitanda 15-20. - wagonjwa wanne (4) waliopatikana hadi 10/7, mmoja (1) alithibitishwa. "Msaada wa chanjo ya MSF kwa wafanyakazi wa huduma za afya wa mstari wa mbele unaendelea bila athari mbaya zilizogunduliwa hadi sasa. """ Zaidi ya watu 900 wamepokea chanjo. Baada ya kutangazwa kuwa hakuna ugonjwa wa Ebola mnamo Mei 9, mvulana wa miaka 17 alikufa mnamo Juni 29. MSF haishiriki moja kwa moja katika utunzaji wa wagonjwa wa kesi mpya, katika uchunguzi au katika ufuatiliaji wa mawasiliano, lakini iko tayari kutoa msaada kwa mamlaka ya Liberia na washirika wao, ikiwa watahitaji. Kwa kuwa mfumo wa afya wa taifa umeharibiwa na mlipuko huo na mamia ya wafanyakazi wa afya wa Liberia wanafariki kutokana na Ebola, MSF inazingatia kusaidia kurejesha vifaa vya afya. "Tunataka kuwachochea watu wa Liberia kuwa na uhakika kwamba wanaweza kwenda hospitali tena na kuwa na mahitaji yao ya huduma za afya yakitunzwa.""" Katika mji wa Monrovia, shirika la MSF linaendesha hospitali ya watoto yenye vitanda 69, na lengo lake ni kusaidia kuimarisha huduma za afya baada ya mlipuko wa Ebola. 44% ya wagonjwa hao wana umri wa chini ya mwaka mmoja. MSF pia inaendesha kliniki kwa ajili ya waokokaji wa Ebola katika majengo ya hospitali. Wagonjwa wa zamani wanakabiliwa na uchambuzi na ubaguzi wakati wa kupata huduma, pamoja na matatizo ya kijamii na kiuchumi (kupoteza kazi, kupoteza makazi, nk). MSF hutoa mashauriano ya jumla ya wagonjwa wa nje, na inashughulikia mahitaji ya afya ya akili. Mashtaka ya kawaida ni maumivu ya viungo na masuala ya macho, ambayo MSF inahakikisha kuelekezwa kwa wataalamu wa nje. Kwa ujumla, visa 14 vipya vilithibitishwa nchini Sierra Leone katika wiki ya 12-07 ikilinganishwa na tisa katika wiki ya 5-07-07. Mlipuko wa virusi vya corona umeenea katika wilaya tatu za eneo la Magharibi la Freetown, Port Loko na Kambia, kama ilivyokuwa wiki zilizopita. Katika mji wa Freetown, kesi 10 mpya zilithibitishwa katika wiki ya 12-07 ikilinganishwa na kesi tatu katika wiki ya 5-07-07. Hii ni kiwango cha juu zaidi tangu wiki ya 13 (23-29 Machi 2015). Matokeo ya uchunguzi huo ni kwamba, watu watatu wametambuliwa katika wilaya ya Kambia na mmoja katika wilaya ya Port Loko. Kituo cha ETC cha Bo katika Bo kinapokea wagonjwa wote wa tuhuma kutoka kusini mwa Sierra Leone, na uwezo wa kutibu visa 12 vilivyothibitishwa na visa 12 vya tuhuma. Leo kituo hicho kinapokea watuhumiwa 5 hadi 10 kwa wiki hasa kutoka wilaya ya Bo. Kwa kuwa hakuna wagonjwa katika wiki zilizopita, Kitengo cha Matibabu ya Ebola cha Magburaka (ETU) kimefungwa. Kliniki ya waokokaji ili kukidhi mahitaji ya wagonjwa waliopona itaanza hivi karibuni. Timu za MSF pia ziliunga mkono wilaya ya Tonkili katika kampeni ya chanjo ya surua. Freetown - Hastings (kubadilisha Kissy) Freetown imeona mwangaza wa hivi karibuni wa Ebola na kesi 10 zilizothibitishwa zilizorekodiwa katika Eneo la Magharibi wiki iliyopita, jumla ya kila wiki ya juu zaidi tangu Machi. MSF imekuwa ikiendesha Kituo cha Uzazi cha Ebola huko Hastings, na huduma maalum za uzazi kwa wanawake wajawazito walio na ugonjwa wa Ebola wanaohitaji huduma maalum. Hata hivyo, wakati vituo vingine vya usimamizi wa Ebola katika mji huo vinapofikia uwezo wao, kituo cha usimamizi wa ugonjwa wa Ebola cha uzazi cha MSF huko Hastings sasa pia kinachukua wagonjwa wasio wajawazito na wagonjwa waliothibitishwa wa Ebola, na wagonjwa sita kwa sasa wamelazwa. "Mashirika ya afya ya kimataifa yanafanya kazi kwa ushirikiano na Kamati ya Msaada wa Ebola ya Wilaya (DERC) kutambua na kukabiliana na kesi mpya za Ebola huko Freetown."""