Jorge Dirkx
Because Ebola is highly contagious, staff treating patients suffering from the disease must wear protective equipment to prevent transmission.
MSF’s West Africa Ebola response started in March 2014 and now counts activities in three countries: Guinea, Liberia, and Sierra Leone. MSF currently employs 276 international and around 2,977 locally hired staff in the region. The organisation operates six Ebola case management centers (CMCs), providing nearly 600 beds in isolation. Since the beginning of the outbreak, MSF has admitted more than 4,500 patients, among whom more than 2,700 were confirmed as having Ebola. Around 1,000 have survived. More than 807 tonnes of supplies have been shipped to the affected countries since March. As of 10 October, the estimated budget for MSF’s activities on the West Africa Ebola outbreak until the end of 2014 is 46.2 million euros.
Ebola first appeared in 1976 in simultaneous outbreaks in Nzara, Sudan, and in Yambuku, DRC
The latter was in a village situated near the Ebola River, from which the disease takes its name
Fruit bats are considered to be the natural host of the Ebola virus
The case-fatality rate varies from 25 to 90 percent, depending on the strain
If contracted, Ebola is one of the world’s most deadly diseases. It is a highly infectious virus that can kill up to 90 percent of the people who catch it, causing terror among infected communities.
Doctors Without Borders/Médecins Sans Frontières (MSF) has treated hundreds of people with the disease and helped to contain numerous life-threatening epidemics.

Latest News from the West Africa Outbreak

Ebola: Latest MSF Updates


WHO: A Deteriorating Situation (as of October 16, 2014)
Cases
Deaths
Guinea
1,472
843
Liberia
4,249
2,458
Nigeria
20
8
Sierra Leone
3,252
1,183
Senegal
1
0
Total
8,994
4,492
Data are based on official information reported by Ministries of Health. These numbers are subject to change due to ongoing reclassification, retrospective investigation, and availability of laboratory results. The figures are underestimated.

MSF Case Numbers
Date of info
Admissions since start of activities*
Confirmed
Recovered
GUINEA
Conakry
13 October
703
255
123
Guéckédou
13 October
1,024
611
219
SIERRA LEONE
Kailahun
13 October
736
505
205
Bo 13 October 78 63 22
LIBERIA
Foya
13 October
671
381
138
Monrovia (ELWA 3)
13 October
1,299
891
274
TOTAL

4,511
2,706
981
* Admissions include all suspected, probable and confirmed cases. Anyone who is admitted is lab tested which can take 1-2 days for results to come back. If they are negative, they are discharged. So the total admissions includes people who are currently waiting for lab confirmation and people who never had Ebola but had symptoms and were therefore admitted to the suspected ward.

MSF Staff on the Ground (as of October 13, 2014)

  • Guinea: 60 international, approximately 360 national (+48 from Ministry of Health)
  • Liberia: 109 international, around 1,241 national
  • Sierra Leone: 107 international, around 1,376 national
  • Total: 276 international, around 2,977 national
Since the Ebola outbreak in West Africa was officially declared on March 22 in Guinea it has claimed 4,492 lives. The outbreak is the largest ever, and is currently affecting three countries in West Africa: Guinea, Liberia and Sierra Leone. Two countries in West Africa are in the period of counting days because there are no more active cases: Senegal and Nigeria. Two people in the United States of America (USA) and one person in Spain are currently being treated for Ebola.
Simultaneously, there is an unrelated outbreak of Ebola in DRC. Sixty-seven MSF staff are working on this outbreak and two case management centres have been established: one in Lokolia (40 beds) and one in Boende (10 beds). There has also been a confirmed case of Marburg fever in Uganda. MSF teams are supporting the response by reinforcing local capacities on infection control and treatment.
Following announcements made in the last weeks, deployment of international aid is slowly taking place in the three main countries affected. However, there is little indication that current efforts to increase capacity to isolate and take care of suspected and confirmed Ebola cases will address needs sufficiently.
The United Nations Mission for Ebola Emergency Response (UNMEER) has been set up and will be based in Ghana to pursue five strategic priorities: stop the spread of the disease; treat the infected; ensure essential services; preserve stability; and prevent the spread of the disease to countries currently unaffected.
MSF teams in West Africa are still seeing critical gaps in all aspects of the response, including medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems, community education and mobilisation.
MSF has been responding to the outbreak since March, and currently has a total of 3,253 staff working in Guinea, Liberia and Sierra Leone, treating a rapidly increasing number of patients. Twenty-one MSF staff have been infected with Ebola since March, six of whom have recovered. The vast majority of these infections were found to have occurred in the community.
Video of Medical workers use education to combat Ebola outbreak

Sierra Leone

Update: October 16, 2014
Every district in Sierra Leone is now affected by the epidemic. New hotspots for the disease include the capital, Freetown, and the areas of Port Loko, Bombali, and Moyamba. The government has put five of the worst-affected districts under quarantine, setting up checkpoints on roads to prevent people leaving the area—measures that affect between one and two million people.
The government’s response is hampered by a lack of resources and coordination at both national and district level. There is no strong surveillance system in place, while up to 85 percent of calls to the national telephone helpline get no response. Transit centers are full and management is an issue, creating the risk of cross-contamination. As a result of overcrowding, delays in lab testing, and too few ambulances, staff in transit centers are obliged to send people untested to CMCs, risking that positive cases infect those who are negative. As there are few CMCs, and these are often far away, people often die on the long journey there. Dead bodies have the highest viral load possible, putting other passengers at risk.
With so many deaths from Ebola, we are seeing an increasing number of orphaned children in our centers, and a lack of caregivers.
The international response is beginning to get underway, but it is slow and uncoordinated. Governments (including the UK and China) and various NGOs have sent teams to construct new centers at different locations around the country, including Jiu, Port Loko, and Freetown. Getting these new centers up and running is a matter of urgency.

Liberia

Update: October 16, 2014
On Monday, October 13, a health worker strike at Ministry of Health structures over pay disputes and labor safety was averted and did not have an impact on MSF’s activities in Monrovia.
The MSF team is trying to understand the situation in local communities, as well as working with others to see the possibility of offering safe burials in addition to cremations. The perception of Ebola case management centers in Monrovia is poor—community understanding of what happens inside them is shrouded in mystery and fear, as well as widespread aversion to the enforced cremation practice which is not culturally well-accepted.
Monrovia
Over the past weeks, the number of admissions in Elwa 3 has stayed stable at around 130 patients admitted at any one time. Despite having increased to 250 beds, we do not see the expected rise in admissions in the case management center. More and more reports suggest that families are choosing to keep suspect cases at home and are also practicing burials through various means, to circumvent the mandatory cremation policy enacted by the government.
A second round of mass distribution of home protection and disinfection kits in Monrovia has begun this week, with more than 800 kits distributed on the first day, October 14. A mass distribution campaign of anti-malarial kits is due to start in Monrovia this week. This will take place in the same locations as the first round of home protection and disinfection kits distributed in past weeks.
Foya
The number of admissions in Foya have been low for the past few weeks, with only seven patients currently admitted. During the last 21 days, there has only been one confirmed case in the western districts of Foya, Kolahun and Vahun, and this patient was infected outside of Lofa county. Most patients are coming from the east of the county, near the border of Guinea and increasingly further afield, from Zorzor, Saleya, and close to Bong county.
MSF activities in Voinjama and Quardu Bondi are increasing accordingly. A health promotion team visited the villages of Barkedu and Gbegbedu in Quardu Bondi district near the Guinean border at the weekend, as a number of Ebola cases have come from there in the last two weeks. MSF continues to support the referral system for patients from these districts to the Foya CMC. MSF will soon open a transit unit to accommodate patients identified late in the day. They will spend the night at the unit and be transferred the next morning to the centre in Foya. Triage stations in the OPD and General Hospital of Voinjama are also being established.
As local health centers are starting to reopen, MSF is making donations of protective equipment and providing training to the staff working in these centers for the safe use of this equipment. The decline in admissions has also allowed MSF to reorganize its outreach activities. In Foya, MSF has expanded health promotion activities to villages where outbreaks have not yet occurred. In Voinjama the health promotion team is educating trainers in other NGOs and organizations to ensure best practices are passed on.
The lower number of cases, particularly in the west of the county, is leading to a concerning perception among the community that Ebola may soon be over. MSF is remaining vigilant however, and is reinforcing health promotion messages with twice weekly radio shows in Foya and Kalahun and has recorded health promotion radio messages to be broadcast several times daily in Foya. Translation of these messages and recording in Bandi, Mandingo and Loma will take place next week.

Guinea

Update: October 16, 2014
There are still huge challenges in controlling the Ebola outbreak in Guinea, with of the number of positive cases stabilizing and then rising a few days later on two occasions. Each MSF Ebola case management center in the country has reached its capacity. In order for the response to be more effective, a number of things are needed, including support and reinforcement in contact tracing and in the surveillance system, an adapted community awareness approach, and better referral of suspected cases to health structures.
On October 12, MSF began construction on a new CMC in Macenta which should be fully functional with 30 beds by mid-November. MSF will manage the CMC and simultaneously train Red Cross staff in order for them to take it over.
In Conakry, after several days of having empty beds, MSF’s CMC is close to capacity. The Conakry CMC received 38 new confirmed cases last week. MSF has permission to build a new CMC in the centre of Conakry, and this has been welcomed given that three quarters of patients received at Conakry CMC are from the city.
MSF’s Guéckédou CMC has seen more patients in the last month than in the first eight months of operation. More and more cases arrive every day and the team expect to see another rise next week. As a result an extension of 15 beds is close to completion.

Nigeria

Update: October 16, 2014
International MSF teams left Nigeria on October 5. The implementation of a transition plan is ongoing and focuses on various health education programs and trainings. The outbreak will be declared officially over if there are no new cases by October 20. MSF will keep in contact with the authorities for follow up until that date.

Senegal

Update: September 24, 2014
MSF teams have now finished their intervention programme in Senegal. If the active surveillance for new cases that is currently in place continues, and no new cases are detected, WHO will declare the end of the outbreak in Senegal on October 17. Teams will keep in touch with the government as part of routine follow up.

Democratic Republic of Congo (DRC)

Update: October 16, 2014
The current outbreak in DRC’s Equateur province is unrelated to the one in West Africa. Around 60 MSF staff have been deployed to Lokolia and Boende in response to the outbreak, and teams are running two case management centers, one with 40 beds and the other with 10 beds. As of October 14, 59 people have been admitted at the two facilities. So far 12 deaths have been reported, infection has been confirmed in 25 cases, and 12 people have recovered. The outbreak is not controlled yet with one new confirmed case from October 4.

Uganda

There has also been a confirmed case of Marburg fever in Uganda. MSF has helped reinforce local capacities for the treatment of confirmed cases (ward rehabilitation, staff training) and is currently involved in the reinforcement of infection control capacities (contact tracing, follow-up and management of suspect cases, isolation capacities in primary health structures).

What causes Ebola?

Ebola can be caught from both humans and animals. It is transmitted through close contact with blood, secretions, or other bodily fluids.
Health care workers have frequently been infected while treating Ebola patients. This has occurred through close contact without the use of gloves, masks, or protective goggles.
In areas of Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope, and porcupines found dead or ill in the rainforest.
Burials where mourners have direct contact with the deceased can also transmit the virus, whereas transmission through infected semen can occur up to seven weeks after clinical recovery.

No specific treatment or vaccine is yet available for Ebola.

Symptoms of Ebola

Early on, symptoms are nonspecific, making it difficult to diagnose.
The disease is often characterised by the sudden onset of fever, feeling weak, muscle pain, headaches, and a sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function, and, in some cases, internal and external bleeding.
Symptoms can appear from two to 21 days after exposure. Some patients may go on to experience rashes, red eyes, hiccups, chest pains, difficulty breathing, and swallowing.

Diagnosing Ebola

Diagnosing Ebola is difficult because the early symptoms, such as red eyes and rashes, are common.
Ebola infections can only be diagnosed definitively in the laboratory by five different tests.
Such tests are an extreme biohazard risk and should be conducted under maximum biological containment conditions. A number of human-to-human transmissions have occurred due to a lack of protective clothing.
“Health workers are particularly susceptible to catching it so, along with treating patients, one of our main priorities is training health staff to reduce the risk of them catching the disease while caring for patients,” said Henry Gray, MSF’s emergency coordinator, during an outbreak of Ebola in Uganda in 2012.
“We have to put in place extremely rigorous safety procedures to ensure that no health workers are exposed to the virus—through contaminated material from patients or medical waste infected with Ebola.”

Treating Ebola


MSF
No specific treatment or vaccine is yet available for Ebola.
Standard treatment for Ebola is limited to supportive therapy. This consists of hydrating the patient, maintaining their oxygen status and blood pressure, and treating him or her for any complicating infections.
Despite the difficulty of diagnosing Ebola in its early stages, those who display its symptoms should be isolated and public health professionals notified. Supportive therapy can continue with proper protective clothing until samples from the patient are tested to confirm infection.
MSF contained an outbreak of Ebola in Uganda in 2012 by placing a control area around the treatment center.
An Ebola outbreak is officially considered at an end once 42 days have elapsed without any new confirmed cases.

Risk of Ebola Spreading

The risk of Ebola spreading to the US is minimal, but to minimize it even further we need more resources to bring the outbreak under control in West Africa.
Before this outbreak, MSF has treated hundreds of people affected by Ebola in Uganda, Republic of Congo, the Democratic Republic of Congo (DRC), Sudan, Gabon, and Guinea. In 2007, MSF entirely contained an epidemic of Ebola in Uganda.
"I was collecting blood samples from patients. We did not have enough protective equipment to use [and] I developed the same symptoms,” says Kiiza Isaac, a nurse from Uganda.
On November 19, 2007, I received laboratory confirmation—I had contracted Ebola.
"MSF came to Bundibugyo and they ran a treatment center. Many patients were cared for. Thank God, I survived. After my recovery, I joined MSF."
It is estimated there have been over 1,800 cases of Ebola, with nearly 1,300 deaths.
The Ebola virus was first associated with an outbreak of 318 cases of a hemorrhagic disease in Zaire (now the Democratic Republic of Congo) in 1976. Of the 318 cases, 280 died—and died quickly. That same year, 284 people in Sudan also became infected with the virus, killing 156.
The Ebola virus is made up of five species: Bundibugyo, Ivory Coast, Reston, Sudan, and Zaire, named after their places of origin. Four of these five have caused disease in humans. While the Reston virus can infect humans, no illnesses or deaths have been reported.
MSF has treated hundreds of people affected by Ebola in Uganda, Republic of Congo, the Democratic Republic of Congo (DRC), Sudan, Gabon and Guinea. In 2007, MSF entirely contained an epidemic of Ebola in Uganda.

 

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