Tag: Ebola

Ebola: Where are we now?

A medical worker checks his protective clothing at an MSF facility in Kailahun, Sierra Leone. (Pic: AFP)

For the first time in more than a year, no one in either Sierra Leone or Liberia is being treated for Ebola, raising hopes that after more than 11 000 deaths and 28 000 infections throughout West Africa, the epidemic could finally be winding down.

But 18 months after the World Health Organisation (WHO) formally announced the beginning of the Ebola outbreak in March 2014, the last thing the region needs is another false dawn. Three months ago, Liberia was declared free of the virus only for new cases to emerge.

See: Bush meat trade roaring again despite Ebola ban

Although there are just three known cases left in the region and just 629 potential contacts still under observation, the epidemic isn’t yet over.

Here is where things stand:

Guinea
Cases: 3,792
Deaths: 2,527

Guinea is where the outbreak started in December 2013 with the death of a two-year-old boy. Now, 20 months on, much of the country is Ebola-free, including the southeastern forest region where the index case originated. But there remain a few pockets of resistance, particularly in and around the capital Conakry, where the only three current cases in the entire region were recorded during the week ending 23 August. Approximately 600 people are still under observation in Guinea and WHO warns that “there remains a significant risk of further transmission,” particularly because one of the positive cases – a taxi driver who was not previously on any contact lists – could have spread the virus to his passengers. Guinea is also the site of the first health worker infection in more than one month.

Liberia
Cases: 10 672
Deaths: 4 808

Last month, Liberia began a 42-day countdown to being Ebola-free, but not for the first time. The outbreak was previously declared over in the country on 9 May. But on 30 June, the Ministry of Health announced that a teenaged boy had tested positive in a small town on the outskirts of Monrovia. Over the next two weeks, five more cases were confirmed. The source of the second outbreak is still unknown, but Ebola response teams were able to quickly contain the flare-up. The last patient was discharged on 23 July and all potential contacts have since passed the 21-day incubation period. Liberia could once again be declared Ebola-free on 3 September.

Sierra Leone
Cases: 13 541
Deaths: 3 952

Sierra Leone has now gone two consecutive weeks without any new cases being reported. The last patients were sent home as survivors on 24 August. Just 29 contacts are still under a 21-day surveillance period, which is set to end on Saturday. If no new cases surface, Sierra Leone will be declared free of Ebola on 5 October.

9 years ago

Ebola’s victims of the future: pregnant women

A volunteer in protective suit in the capital Freetown. (Pic: AFP)

For the last 13 years, Sierra Leone has seen a dramatic decrease in its maternal mortality rate, due in large part to the introduction of free health care for pregnant women. One of the most devastating and yet rarely acknowledged impacts of the Ebola epidemic is that it threatens to undo all this good work.

It’s not just the loss of more than 220 health workers, including many midwives, to the virus, with little training or wiggle-room in the fragile health system to replace those skills. It’s also the lingering fear of hospitals and doctors among the local population, which remains traumatised by an outbreak that has claimed almost 4 000 lives and still sees new infections each week, albeit small numbers.

A World Bank report in July – Healthcare Worker Mortality and the Legacy of the Ebola Epidemic – estimated that Sierra Leone’s maternity mortality rate could increase because of the current crisis by 74 percent, to levels not seen since the end of the civil war in 2002.

“During the Ebola outbreak, there were many challenges that we encountered that led to many pregnant women not coming to the hospital and this may have led to the [recent] increase in death rates [among pregnant women],” A.P. Koroma, medical superintendent at the PCMH (Cottage) Hospital in Freetown, told IRIN.

The hospital has lost 85 mothers since the outbreak was first reported in May 2014, which Koroma said is “definitely a sharp increase compared to previous years.”

“People were, and are [still], afraid,” he added.

Before Ebola came, an average of 10 700 women each year gave birth at Cottage Hospital. Since the outbreak, this number has dropped to 6 723.

The most recent maternal mortality rate is not yet available at the national level, but given the hospital attendance records and the risks of at-home childbirth in Sierra Leone, it is expected to rise.

“During the Ebola outbreak, people had the impression that when they come to the hospital, they may be infected,” Koroma explained. “For those coming to the hospital, we did our best… but some of them came to the hospital late because they were told that if you have bleeding, which is one of the symptoms of Ebola, no nurse or doctor will want to touch a patient until an Ebola test is done, which can take up to three days.”

Others, who did come, died while waiting for the Ebola test results.

The hospital now has access to a rapid diagnostic test, which can give results in less than three hours.

Despite this, and better safety measures generally, many hospital staff are still afraid to tend to pregnant women, given the fact that childbirth puts them in direct contact with bodily fluids.

“When we started hearing of our colleagues dying, everybody was afraid and nobody wanted to even touch a patient,” Koroma explained.

But not all women are staying away.

“Some of my friends said that if I came to the hospital I would get Ebola… so I became afraid,” said 22-year-old Mary Conteh, from Freetown, who gave birth earlier this month. “But later I decided to come to Cottage Hospital…. I thank God I had a safe delivery.”

Shortage of health workers

Sierra Leone lost an estimated seven percent of its nurses and midwives to Ebola, according to the World Bank report – a devastating loss for a country that had just over 1 000 to begin with.

“This is just a terrible shock to an already weak healthcare system,” said David Evans, Senior Economist at the World Bank Group. “And if one were to put this [loss of health care workers] into actual numbers, that’s an additional 1,850 women dying per year [in Sierra Leone] just as a result that we’ve lost health care workers due to the Ebola epidemic.”

If Sierra Leone is to prevent its maternal mortality rate rising further, experts say more investment is drastically needed to plug the gap in maternal healthcare.

“In terms of response, it’s not rocket science,” Evans said. “These countries and the international communities supporting them need to hire more health workers and provide resources so they are well paid and want to be in Sierra Leone working there. And, as the Ebola epidemic wanes, as it continues, making sure they have protective equipment.”

In the short-term, to avoid a further increase in maternal mortality, Evans suggested a “stop-gap measure” of employing foreign healthcare workers and birth attendants, allowing local capacity to be built up over the longer term.

Women in Sierra Leone say they are praying for just that.

“All I want is to have a healthy baby,” said 25-year-old Frances Tucker, who is five months pregnant. “I don’t want to have problems like other pregnant women have had by staying at home, afraid of coming to the hospital… putting you and your baby’s life at risk.”

Jennifer Lazuta and John Sahr Sahid for IRIN

9 years ago

Two new trials of Ebola vaccines begin in Africa and Europe

Healthcare workers, wearing protective suits, leave a high-risk area at the French NGO Médecins Sans Frontières Elwa hospital in Monrovia, Liberia. Pic: Dominique Faget/AFP

Two new Ebola vaccine trials began on Wednesday with volunteers in Britain, France and Senegal getting “prime-boost” immunisations developed by Bavarian Nordic, GlaxoSmithKline and Johnson & Johnson.

The mid-stage, or Phase II, trials are designed primarily to test the vaccines’ safety, but will also assess whether they provoke an immune response against the deadly virus.

The development of the prime-boost and other vaccines was accelerated in response to vast outbreaks of Ebola in West Africa, where at least 11,200 people have died so far in Guinea, Sierra Leone and Liberia.

“The current Ebola outbreak has reinforced that speed of response is crucial,” said Egeruan Babatunde Imoukhuede, who is coordinating one of the trials in Senegal.

“Outbreak diseases spread quickly, so any vaccination approach must be able to keep up.”

Data from the World Health Organisation show there were 30 confirmed cases of Ebola in West Africa in the week to July 5.

In Liberia, which was declared Ebola-free in May, a sixth new case was confirmed on Tuesday in what health officials fear is a new wave of the outbreak.

While the number of Ebola cases has dropped sharply in recent months, researchers said the flare-up in Liberia underlines the need to push ahead with developing potential vaccines that may help control this and future outbreaks.

The trial of the Bavarian Nordic and J&J prime-boost combination initially aims to recruit more than 600 healthy adult volunteers in Britain and France.

Bavarian said it hoped to launch another phase of this trial in Africa later this year involving 1,200 volunteers, but other large clinical trials have recently been thwarted by the drop in case numbers.

Previously planned trials of GSK, Merck and J&J shots in West Africa have been struggling to recruit volunteers with enough exposure to Ebola to prove whether their vaccines are doing the job and preventing infection.

The second trial will be conducted in Senegal and uses two vaccines tested first in people at Oxford University’s Jenner Institute and being developed in a partnership with GSK. The first, based on a chimpanzee adenovirus, is designed to stimulate, or prime, an initial immune response, while the second is designed to boost that response.

Each vaccine is based on genetically modifying safe viruses to carry just one part of the Ebola virus that will stimulate the body’s immune system. Researchers stressed that none of the shots contains any live Ebola virus.

Kate Kelland for Reuters

9 years ago

Ebola: Getting to zero cases

The Ebola outbreak has slowed across West Africa but every new infection continues to threaten millions of lives. This fatal disease claimed 7 000 lives by the end of 2014 in just Guinea, Liberia and Sierra Lione. Overcoming this complex emergency challenged governments and international aid organisations and brought fear to the rest of the world.

This inspiring story of a girl in Sierra Leone who loses her parents to Ebola visualises the truly devastating effect of the disease, but also the courage of everyday heroes who help fight the outbreak.

Last month, Liberia was finally declared Ebola-free. However, the deadly virus will not truly disappear until there is no longer active transmission in affected neighbouring countries.

Sheldon Yett, Unicef‘s representative in Liberia, cautioned that the region could not afford to let its guard down. “Having achieved zero cases is the first step, now the challenge is to remain at zero. The threat won’t be over until there are no more cases in neighboring Sierra Leone and Guinea.” He also added, “In the longer-run there is a need to rebuild a better health system, with the capacity to identify and respond to any future outbreaks, be it Ebola, measles or pertussis,” said Yett.

Getting to zero is now a reality as long as we see a sustained commitment throughout 2015 in the fight against Ebola. Liberia is now clear. Now it’s time for Guinea and Sierra Leone to #GetToZero.

9 years ago

WHO declares Liberia Ebola-free

A man walks past an Ebola campaign banner in Monrovia. (Pic: AFP)

The UN health agency on Saturday declared Liberia Ebola-free, hailing the “monumental” achievement in the west African country where the virus has killed more than 4 700 people.

“The outbreak of Ebola virus disease in Liberia is over,” the World Health Organisation (WHO) said in a statement, adding that 42 days had passed since the last confirmed case was buried.

That period is double the number of days the virus requires to incubate, and WHO hailed its eradication as an enormous development in the long crisis.

“Interruption of transmission is a monumental achievement for a country that reported the highest number of deaths in the largest, longest, and most complex outbreak since Ebola first emerged in 1976,” it said.

The declaration was a source of both great pride to Liberians who had been stalked by the deadly virus they simultaneously sought to battle.

“We are out of the woods. We are Ebola free. Thanks to our partners for standing with us in the fight against Ebola. We are Liberians,” tweeted Liberian Information Minister Lewis Brown.

The news was also cheered by international organisations like the Red Cross, Unicef and Doctors Without Borders (MSF), as well as officials from the US and European Union.

However whailing the “important marker” White House spokesman Josh Earnest, in a statement, said: “The world must not forget that the Ebola outbreak still persists in neighbouring Sierra Leone and Guinea.

“We must not let down our guard until the entire region reaches and stays at zero Ebola cases.”

Relief and sorrow

The WHO warned that because the Ebola outbreaks were continuing in neighbouring Guinea and Sierra Leone, the risk remained high that infected people could re-enter the country.

Because of that risk, MSF also tempered its applause of the declaration with reminders that the crisis will not be over for any one nation until the virus has been eradicated everywhere.

For average Liberians, the development was a source of both relief and sorrow.

“I lost a brother in the Ebola crisis so I am happy and sad,” said 40 year-old Monrovia taxi driver Nyaningo Kollie.

During the two months of peak transmission last August and September the capital Monrovia was the setting for “some of the most tragic scenes from West Africa’s outbreak: gates locked at overflowing treatment centres, patients dying on the hospital grounds, and bodies that were sometimes not collected for day,” noted WHO official Alex Gasasira, who read the organisation’s statement Saturday.

At the height of the crisis in late September Liberia was suffering more than 400 new cases a week, with uncollected and highly infectious bodies piling up in the streets of Monrovia, a sprawling, chaotic city at the best of times.

The health system – embryonic before the crisis, with some 50 doctors and 1 000 nurses for 4.3 million people – was devastated, losing 189 health workers out of 275 infected.

“At one point, virtually no treatment beds for Ebola patients were available anywhere in the country,” Gasasira recalled.

Schools remained shut after the summer holidays, unemployment soared as the formal and black-market economies collapsed and clinics closed as staff died and non-emergency healthcare ground to a halt.

And then, as suddenly as it had spread, Ebola retreated.

‘Thank all Liberians’

Liberia, which had recorded 389 deaths in one week in October alone, saw fatality counts dropping below 100 within weeks, and into single figures by the start of 2015.

During a WHO-hosted ceremony Saturday in the Ebola crisis cell in Monrovia, Liberian President Ellen Johnson Sirleaf saluted her fellow citizens and health workers for rising to the crisis.

“I thank all Liberians for the effort. When Ebola came, we were confused. We called on our professionals. They put their best in the fight, this is the result I have sent a message to the international community to thank them,” she said.

In the coming years there will be a reckoning on the response to the greatest ever Ebola outbreak, which left 11 000 dead.

The West was initially accused of ignoring the crisis and then treating Liberia and its neighbours as pariahs, blocking flights and quarantining returning health workers after the first-ever domestic infections outside of Africa, in the US and Spain.

The WHO, at times seen as overly bureaucratic and politicised, was berated for waiting until August – almost five months after the outbreak was identified – to declare it a “public health emergency of international concern.”

“Quite simply, we were all too late. The world – including MSF – was slow to start the response from the beginning,” said MSF’s head of Ebola operations in Brussels, Henry Gray, in a statement.