EBOLA/EVD [to 14 March 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

WHO: Ebola Situation Report – 11 March 2015
SUMMARY
:: A total of 116 new confirmed cases of Ebola virus disease (EVD) were reported in the week to 8 March, compared with 132 the previous week. Liberia reported no new confirmed cases for the second consecutive week. New cases in Guinea and Sierra Leone occurred in a geographically contiguous arc around the coastal capital cities of Conakry and Freetown, with a total of 11 districts reporting cases. Although there has been no significant decline in overall case incidence since late January, the recent contraction in the geographical distribution of cases is a positive development, enabling response efforts to be focused on a smaller area.

:: Guinea reported 58 new confirmed cases in the week to 8 March, compared with 51 cases the previous week. Cases were clustered in an area around and including the capital Conakry (13 cases), with the nearby prefectures of Boffa (2 cases), Coyah (8 cases), Dubreka (5 cases), Forecariah (28 cases), and Kindia (2 cases) the only other prefectures to report cases.

:: Sierra Leone reported 58 new confirmed cases in the week to 8 March; the first time since June 2014 that weekly incidence has not exceeded that of Guinea. Cases were reported from 5 north and western districts clustered around the capital Freetown, which reported 27 new confirmed cases. The neighbouring districts of Bombali (6 cases), Kambia (7 cases), Port Loko (12 cases) and Western Rural (6 cases) also reported cases.

:: In the 4 days to 5 March there were 90 reported suspected cases in Liberia, none of whom tested positive for EVD, indicating that vigilance is being maintained. A total of 102 contacts were being followed up.

:: The number of confirmed EVD deaths occurring in the community has risen for the past 3 weeks in Guinea, suggesting that there are still significant challenges in terms of contact tracing and community engagement. Of a total of 40 EVD-positive deaths reported in the week to 8 March, 24 occurred in the community. By contrast, a far smaller proportion of EVD-positive deaths occurred in the community in Sierra Leone: 11 of 83. A total of 13 unsafe burials were reported from Guinea and 2 from Sierra Leone over the same period.

:: In the week to 1 March, 7 of 51 (14%) confirmed cases of EVD reported from Guinea arose among known contacts of previous cases, indicating that there are a large number of untraced contacts associated with known chains of transmission, and that unknown chains of transmission persist. In Sierra Leone, by contrast, 52 of 81 (64%) of confirmed EVD cases arose among known contacts over the same period. The average daily number of contacts traced in the week to 8 March was 1433 in Guinea, compared with 7934 in Sierra Leone.

:: The relatively low proportion of cases arising among known contacts, the relatively high proportion of EVD-positive deaths that occur in the community, and the continued occurrence of unsafe burials in Guinea are all indicative of continued difficulties engaging effectively with affected communities. A total of 7 Guinean prefectures reported at least one security incident in the week to 8 March.

:: During the week to 1 March, five cross-border meetings took place, including a coordination meeting in Kambia and Forecariah to facilitate communication, share best practices, and align strategies.

:: In the week to 8 March, 1 new health worker infection was reported in Guinea, bringing the total number of health worker infections reported across the three most-affected countries since the start of the outbreak to 840, with 491 deaths.

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
:: There have been over 24,000 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (table 1), with almost 10,000 reported deaths (outcomes for many cases are unknown). A total of 58 new confirmed cases were reported in Guinea, 0 in Liberia, and 58 in Sierra Leone in the 7 days to 8 March (4 days to 5 March for Liberia).

:: The total number of confirmed and probable cases is similar in males and females (table 2). Compared with children (people aged 14 years and under), people aged 15 to 44 are approximately three times more likely to be affected. People aged 45 and over are nearly four times more likely to be affected than children.

:: A total of 840 confirmed health worker infections have been reported in the 3 intense-transmission countries; there have been 491 reported deaths…

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Speech: From crisis to sustainable development: lessons from the Ebola outbreak
Dr Margaret Chan, Director-General of the World Health Organization
London School of Hygiene and Tropical Medicine. Women in Science Lecture Series
10 March 2015
[Full text: http://www.who.int/dg/speeches/2015/ebola-lessons-lecture/en/ ]