Tag: Liberia

Ebola: Where are we now?

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

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
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

WHO declares Liberia Ebola-free

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

Liberia emerges from the nightmare of Ebola

Staff and volunteers at the ELWA hospital in the Liberian capital Monrovia wearing protective gear. (Pic: AFP)
Staff and volunteers at the ELWA hospital in the Liberian capital Monrovia wearing protective gear. (Pic: AFP)

Heavily pregnant when she died, Fatimah Jakemah was bagged, bleached and carted off for cremation, one of dozens of new cases in the capital that week as Ebola tightened its grip on Liberia.

It was early September and the outbreak was about to mushroom into an emergency of historic proportions that would eventually see 4 700 deaths throughout the country.

Across town, Olivia Clark found herself handing another collection team her 18-month-old son, Aaron, who had slipped away a few hours earlier, too young to fight the deadly virus amplifying inside his tiny body.

Her husband was already dead and Red Cross trucks piled with bodies were becoming a familiar sight as Ebola stalked the capital’s poorest neighbourhoods, terrorising families crammed into squalid slum housing.

Amid the horror, one case stood out as uniquely cruel.

In the quarantined hamlet of Ballajah, 150 kilometres away, 12-year-old Fatu Sherrif was locked into her home with her dead mother as panicked neighbours fled to the forest.

Her cries could be heard for several days by the few who had stayed in the abandoned village before she died alone, without food or water.

By October the situation was so bad that besieged Red Cross disposal teams had given up trying to separate Ebola victims from those who might have met other ends, following a government directive to “burn them all”.

As Ebola set out on its murderous path through Liberia and its neighbours Guinea and Sierra Leone, credible medical experts were predicting worst case scenarios of more than a million cases and tens of thousands dead.

‘Ebola-free’

Yet treatment units are now lying empty and life is returning to normal as Liberians emerge from the nightmare which enveloped them in the summer and autumn of 2014.

If there are no new infections in the next 48 hours, the World Health Organisation (WHO) will declare Liberia “Ebola-free” on Saturday, 42 days – or twice the incubation period of the virus – after the last case.

At the height of the crisis in late September it was seeing 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.

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 crept in, Ebola retreated.

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

The last person to die was Ruth Tugbah, a 44-year old fruit seller who contracted the virus in mid-March, probably through having sex with her boyfriend, an Ebola survivor.

In the coming years there will be a reckoning on the response to the greatest ever Ebola outbreak, which has left 11,000 dead and is still simmering in Guinea and Sierra Leone.

The West was accused of ignoring the crisis early on 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”.

‘Morale transformed’

With the outbreak nearing its peak and facing criticism over US inertia, President Barack Obama ordered the largest ever US deployment to the region in September, sending 2,800 troops to build 11 Ebola treatment units across Liberia.

Critics pointed out that cases had already begun to fall before they were set up and most remained empty.

The US Agency for International Development (USAID) has pointed out, however, that the military activity was just a small proportion of the full American response which included – among numerous projects – funding 10 000 civilian responders and 70 safe burial teams.

An official told AFP that clinics it funded had treated 943 patients, 190 of whom had Ebola.

In any case, David Nabarro, the UN’s special envoy on Ebola, argues that the appearance of the Americans and their military clinics gave people hope.

“I watched in September and October as the arrival of the Americans in Liberia completely transformed the morale of people and the government and, I believe, contributed to a much more widespread change in behaviour than any of us imagined would be possible,” he told reporters this week in Dakar.

“Virtually the whole country in the space of a couple of weeks in the beginning of October adopted different ways of living and reduced their risk of infection.”

When – if – the WHO declares Liberia “Ebola-free” on Saturday there will be no bunting, no ticker tape parades, just the repeated reminder on the airwaves to guard against complacency.

Liberia will remain alert to two threats – the possibility that someone with Ebola might get into the country under the radar, and that “small flare-ups” seen in other outbreaks are a possibility over the coming months.

“My colleagues in Liberia told me that they expect to be keeping extensive surveillance and practising precautions for probably as long as one year,” Nabarro said.

Ebola vaccine trials begin in Liberia

An adhesive bandage is placed on the arm of a volunteer after she was administered an experimental Ebola vaccine at Redemption Hospital in New Kru Town, a suburb of Monrovia, on February 2. (Pic: AFP)
An adhesive bandage is placed on the arm of a volunteer after she was administered an experimental Ebola vaccine at Redemption Hospital in New Kru Town, a suburb of Monrovia, on February 2. (Pic: AFP)

The first large-scale trials of two Ebola vaccines began in Liberia on Monday, the hospital hosting the research said.

The vaccines, which contain harmless elements of the killer virus that trigger an immune response, were administered to 12 volunteers at the start of a trial which will eventually involve up to 27 000 adults.

“We received 20 persons who came voluntarily to take the vaccine but we are taking only 12 per day,” said Melvin Johnson, head of the trial centre at the Redemption Hospital in the capital Monrovia.

“The first 12 were given the vaccine and the balance will receive theirs on Tuesday.”

The Partnership for Research on Ebola Vaccines in Liberia (Prevail), a collaboration between the United States and Liberia, said trials would begin at other hospitals around Monrovia after the first 600 participants join the study.

The candidate vaccines – GlaxoSmithKline’s Chad3-EBO-Z and rVSV-ZEBOV, manufactured by Merck and Newlink – have been determined as safe for use on humans in smaller trials in several countries.

Prevail said the drugs could cause pain, redness or swelling in the injected arm, as well as fever, headaches and tiredness, but added that the side-effects “typically have been mild to moderate and have gone away on their own”.

The study, led by the US National Institutes of Health, was launched at the Redemption Hospital on Sunday at an event attended by Liberian Vice-President Joseph Boaikai.

“We hope that this scientific undertaking we launch here today will get answers for the mystery surrounding this disease,” he said.

‘Need for speed’
There is currently no vaccine to guard against Ebola on the world market, and no specific drug approved to treat it, even though the virus first emerged in the 1970s.

Researchers have said that it remains unknown what level of immune response is needed to protect humans from Ebola, which causes often fatal haemorrhaging, organ failure and severe diarrhoea.

Liberia, Sierra Leone and Guinea have registered almost 9 000 deaths since the beginning of the worst outbreak on record in December 2013, although experts believe the real toll could be significantly higher.

The World Health Organisation (WHO) said last week however that the countries reported fewer than 100 new lab-confirmed cases in the past week for the first time since last June.

“It’s fantastic that large-scale trials of the first candidate Ebola vaccine are getting underway in Liberia, a country that has suffered enormously at the hands of this disease,” said Jeremy Farrar, director of the Wellcome Trust.

“The WHO confirmed last week that infection rates there continue to fall, which emphasises the need to complete these crucial trials as quickly as possible,” Farrar said.

“The international response that has got us this point has been phenomenal and we must keep on course until the infection rate is brought down to, and remains at, zero.”

Wellcome is funding tests on the GSK candidate vaccine in Britain and Mali and parallel studies of other vaccines in Geneva, Gabon, Kenya and Guinea.