EBOLA/EVD [to 3 January 2014]

EBOLA/EVD [to 3 January 2014]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

Editor’s Note:
Our extensive coverage of Ebola/EVD activity continues – including detailed coverage of UNMEER and other INGO/agency activity now available at the end of this digest. Please also note that many of the organizations and journals we cover continue to publish important EVD content which is threaded throughout this edition.
We note that the WHO Situation Report just below references the “100% goals” re-affirmed at the 60-day mark (see bolded text, second paragraph), but we have not encountered any update from UNMEER on performance against these goals.

WHO: Ebola response roadmap – Situation report 31 December 2014
Summary [Excerpt]
A total of 20,206 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in four affected countries (Guinea, Liberia, Mali and Sierra Leone) and four previously affected countries (Nigeria, Senegal, Spain and the United States of America) in the seven days to 28 December (week 52). There have been 7,905 reported deaths (case definitions are provided in Annex 1). On 29 December, the United Kingdom reported its first confirmed EVD case. Reported case incidence has fluctuated between 70 and 160 confirmed cases in Guinea over the past 15 weeks. In Liberia, case incidence has mostly declined in the past six weeks. In Sierra Leone, there are signs that the increase in incidence has slowed, although the country’s west is now experiencing the most intense transmission of all the affected countries. The reported case fatality rate in the three intense-transmission countries among all cases for whom a definitive outcome is known is 71%.

Interventions in the three countries continue to progress in line with the UN Mission for Ebola Emergency Response aim to conduct 100% of burials safely and with dignity, and to isolate and treat 100% of EVD cases by 1 January, 2015. Every country has sufficient capacity to isolate patients, but the uneven geographical distribution of beds and cases means shortfalls persist in some districts. In the past month, the average number of beds per reported patient has grown from 6.6 to 13.9 in Liberia, and 1.4 to 3.6 in Sierra Leone. In Guinea, it has fallen slightly from 2.3 to 1.9 beds per patient, reflecting a small increase in probable and confirmed cases. Each country has sufficient capacity to bury all people known to have died from Ebola, yet the under-reporting of deaths is a persistent challenge. The number of trained safe burial teams has significantly grown in the past month – from 34 to 64 in Guinea, 56 to 89 in Liberia, and 50 to 101 in Sierra Leone. This is close to the capacity needed in each country. All three countries report that more than 90% of registered contacts associated with known cases of EVD are being traced, although the number of contacts traced per EVD case remains low in many districts. Social mobilization is a vital component of an effective response. Engaging communities promotes burial practices that are safe and culturally acceptable, and the isolation and appropriate treatment of patients with symptoms of EVD.

Stories from the Field
Sierra Leone: How Kailahun district kicked Ebola out
29 December 2014
Sierra Leone communities organize Ebola response
24 December 2014
Cured of Ebola, Rebecca returns to cure others
22 December 2014

UNMEER Watch [to 3 January 2014]
:: Ould Cheikh Ahmed Arrived in Accra to Officially Take Over as Head of UN Ebola Mission
03 Jan 2015

:: Outgoing UNMEER Chief: Zero Ebola Cases is “only acceptable outcome”
[Full text]
Accra, 2 January 2015 – Anthony Banbury, Head of the United Nations Mission for Ebola
Emergency Response (UNMEER), gave a final review of progress in the fight against Ebola today as he prepares to hand over the role to his successor, Ismail Ould Cheikh Ahmed of Mauritania on Saturday.
“It’s important to remember where we were when we started,” Banbury told journalists during a press conference in Accra. “At the time, there were predictions of up to 1.4 million cases of Ebola by the start of the year…Here we are in January and we have a total of around 20,000 cases instead of 1.4 million. That’s 1.4% of what was being projected as a possibility by credible scientists back in September.”
According to the latest World Health Organization report, there are 20,206 confirmed, probable or suspected cases of Ebola and 7,905 reported deaths.
“We are engaged in a big battle with this disease,” he said. “It’s an insidious, invasive disease that attacks people through acts of caring and kindness…It’s going to be extremely hard for us to bring it down to zero but that is what we will do. That is the only acceptable outcome.”
Returning from a final review mission in Guinea, Liberia and Sierra Leone, Banbury, who was
appointed in September, says there has been significant progress in the fight against Ebola over
the past 90 days. Banbury pointed, for instance, to the increased number of isolation beds in each country, which stands at two beds per patient in Guinea, 3.5 in Sierra Leone, and 14 in Liberia.
With support from UNMEER and other partners, the three countries now also have sufficient
capacity to isolate and treat 100 percent of confirmed Ebola patients and enough burial teams to ensure safe and dignified burials for 100 percent of all deaths due to Ebola.
Banbury, however, said several challenges remain, including the geographical dispersion of
Ebola. He also cited behavior change and community resistance as major obstacles in some areas despite massive interventions.
“It’s a bit like putting seatbelts in cars,” said Banbury. “If you have seatbelts in cars you can save a lot of lives, but only if people use those seatbelts.”
The key to success, according to Banbury, is to effectively engage with communities, and also to maintain vigilance and commitment as the number of cases continues to drop.
“It’s an obligation to set very ambitious targets so we can bring this crisis to an end as quickly as possible,” he said. “For the UN, it’s a very heavy responsibility. But it’s also a privilege to work with these communities and these people. We will succeed together.”
Banbury is succeeded by Ismail Ould Cheikh Ahmed of Mauritania, who will himself be visiting
the affected countries next week to reinforce UNMEER’s strategic priorities. Before his new
appointment, Ould Cheikh Ahmed was appointed Deputy Special Representative and Deputy
Head of the United Nations Support Mission in Libya (UNSMIL).

:: Secretary-General’s press encounter on Ebola (full transcript)
22 Dec 2014

UNICEF Watch [to 3 January 2014]
:: UNICEF Ebola response: 400+ survivors receive psycho-social support and kits to restart their lives
KENEMA, Sierra Leone, 24 December 2014 – More than 400 Ebola survivors have taken part in four separate survivor conferences over the past few days in the districts of Kailahun, Kenema and Bo, where they learned more about protecting their communities, were informed as to how their bodies defeated the disease, and received psycho-social support.

CDC/MMWR Watch [to 3 January 2014]
:: Ebola epidemic continues to spread, requiring intensified effort – Press Release
December 22, 2014
After more than a year of Ebola transmission in Guinea and more than 7 months of transmission in Liberia and Sierra Leone, there is still much to be done to stop the world’s first Ebola epidemic, CDC director Tom Frieden, M.D., M.P.H reported from his second visit to the three affected nations.
Dr. Frieden yesterday returned from West Africa, where he spoke with patients and staff; met with many of CDC’s 170 staff working in each of the countries; and met with the presidents, health ministers, and Ebola leadership of each country. He described the situation as both inspiring and sobering.
“It is inspiring to see how much better the response has become in the past two months, how much international commitment there is, and, most importantly, how hard people from each of the three countries are working to stop Ebola,” Dr. Frieden said. “But it is sobering that Ebola continues to spread rapidly in Sierra Leone and that in parts of Monrovia and Conakry Ebola is spreading unabated. Improvements in contact tracing are urgently needed.”
At a telebriefing held to discuss the results of his trip to Guinea, Liberia, and Sierra Leone, Dr. Frieden described progress in some areas but continued growth in Ebola cases in other areas. Lingering unmet needs throughout the region continue to challenge response efforts.
“In Liberia, the outbreak has slowed dramatically and at the moment the country has the upper hand against the virus, in part due to improvements in access to Ebola Treatment Units and Community Care Centers, safe burials, and community engagement,” Dr. Frieden said. “But the outbreak continues to surge in Sierra Leone, and there has been a troubling spread in Guinea’s capitol city. We’ve got a long way to go and this is no time to relax our grip on the response.”…

:: MMWR Weekly, January 2, 2014 / Vol. 63 / Nos. 51 & 52
– Perceptions of the Risk for Ebola and Health Facility Use Among Health Workers and Pregnant and Lactating Women — Kenema District, Sierra Leone, September 2014

MSF/Médecins Sans Frontières [to 3 January 2014]
:: A Mixed Welcome for Homecoming Ebola Survivors
December 31, 2014
Moses’s family has been hard hit by Ebola. Four of them were infected with the virus—his father and brother died, but Moses and his sister both survived. Moses was recently discharged from the Doctors Without Borders/Médecins Sans Frontières (MSF) Ebola management center in Bo, Sierra Leone, and made the journey back to his home village, accompanied by MSF health promoter Esmee de Jong.

:: Clinical Trial for Potential Ebola Treatment Starts in MSF Clinic in Guinea
December 29, 2014
A clinical trial for a possible treatment for Ebola started in Guinea on December 17. The trial is led by the French medical research institute INSERM and is taking place at the Doctors Without Borders/Médecins Sans Frontières (MSF) Ebola treatment center in Guéckédou, in the east of the country. Although every experimental treatment for Ebola patients offers hope, MSF remains prudent. There’s no guarantee that the drug will be effective and safe, and, even if it is, it will not mean the end of the epidemic which continues to spread in the three most affected countries of West Africa.
The trial aims to include as many Ebola-positive patients presenting at the MSF treatment center as possible. There will be no control group (group of patients who do not receive the treatment) in this study, as it is considered unethical to deny a group of patients the higher chance of survival that may come with the new treatment, especially given the high mortality rate of Ebola. Instead, the outcomes of the patients will be measured against those of MSF patients admitted earlier this year, before the trial began. The first conclusive results are not expected before the first trimester of 2015.
All new patients arriving at the MSF Ebola treatment center in Guéckédou are informed about the possibility of receiving the experimental treatment and can elect to participate in the study or not. Those who do not wish to be given the new treatment will receive the same supportive care as those who do, but without the administration of the trial drug.
The drug being used in Guéckédou is favipiravir, an antiviral drug produced by the Japanese company Toyama/FujiFilm. This drug has had good results against Ebola in animal studies and good safety results in humans when used as treatment for another viral infection. But, as the drug has never been studied in humans with Ebola, it is important to wait for the results of the trial before declaring favipiravir a treatment for the disease.
If favipiravir is shown to be safe and effective, it will be made accessible to Ebola patients in other Ebola treatment centers through advancing the trial to the next phase. This means that after approval from national authorities and independent ethics committees more Ebola-positive patients in West Africa will be started on the treatment.
A safe and effective treatment for Ebola will prevent many patients from dying, but it will not change the course of the epidemic. Interventions like early admission of patients in specialized centers, thorough and accurate contact tracing, tailored health promotion, and necessary hygiene and sanitation measures will continue to be the most important strategies in ending the outbreak. Research into other treatments including vaccines and new diagnostics will also remain important.

Press Release [Full text]
December 30, 2014
On the 28th December, the first Ebola patient treated in Africa with the experimental drug ZMAb has been discharged from the Ebola Treatment Centre run by EMERGENCY NGO in Goderich, Sierra Leone.
A.M., 72 years old, had been admitted 2 weeks ago in very critical conditions.
The ZMAb used for A. M. had been requested by the Ministry of Health of Sierra Leone to treat Dr. Victor Willoughby, a leading doctor in the country. Dr. Willoughby, unfortunately died as soon as the drug arrived in country.
The Ministry of Health asked EMERGENCY to give the ZMAb to A.M., wife and mother of two of the patients of Dr Willoughby, both died of Ebola few days before.
The high standard Ebola Treatment Centre run by EMERGENCY NGO is the only centre in Africa that has used ZMAb so far. It opened on 14th of December in collaboration with DFID, the Department for International Development of the British Government.

Save The Children [to 3 January 2014]
Save the Children’s Sierra Leone Ebola Center Discharges its 60th Survivor
December 24, 2014

Plan International [to 3 January 2014]
Children’s futures impacted due to Ebola school closures
29 December 2014:
Children in Ebola-stricken Liberia are playing, working or begging to fill their time while schools are closed, according to Plan International.
The virus has kept schools shut for more than five months, in a country which already suffered from limited learning facilities and trained teachers, as well as a high illiteracy rate.
New research from Plan shows that a cohort of children and youth will lose half a year or more of education, which is expected to affect their prospects in life, as well as dent their confidence and self-esteem.
The report, entitled Young Lives on Lockdown: The impact of Ebola on children and communities in Liberia, says that while teachers and older children are continuing to teach their children and sibling at home, the majority of parents are themselves uneducated and thus cannot give their children home schooling.
“Most parents cannot read or write so they cannot help their children at home, and at the same time they don’t let other people come to their houses to conduct lessons for them or let their children out for even 30 minutes,” said one community leader interviewed for the research.
Once schools do re-open, parents worry they will not have the money to pay their children’s fees. “Schools will reopen but there’s no money to put kids in school,” said another community leader, speaking to researchers…

European Vaccine Initiative Watch [to 3 January 2014]
Senior Project Manager position open at GAVI The Vaccine Alliance
24 December 2014
GAVI is currently looking for a Senior Project Manager, Ebola Vaccine.