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[stem-ebola] PRO/AH/EDR> Ebola virus disease - West Africa (189): Sierra Leone, Liberia, OIE

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

In this update:

STOP PRESS: Liberian case in Texas has died (CNN)

[1] Sierra Leone: medical supplies blocked at docks for 2 months
[2] Liberia: home disinfection kits for Monrovia
[3] Liberia: journalists need written permission for Ebola interviews
[4] Liberia: US military will have 7 Ebola testing labs throughout
[5] Liberia: cremation brings problems
[6] Liberia: anti-corruption program
[7] Sex after Ebola
[8] OIE experts review current knowledge on Ebola reservoir

STOP PRESS: Liberian case in Texas has died (CNN)
[Heard by me on TV at 11:30 8 Oct 2014. More to follow in next update.
- Mod.JW]

[1] Sierra Leone: medical supplies blocked at docks for 2 months
Date: Sun 5 Oct 2014
Source: The New York Times [edited]

It has been sitting idly on the docks for nearly 2 months: a shipping
container packed with protective gowns, gloves, stretchers,
mattresses, and other medical supplies needed to help fight Sierra
Leone's exploding Ebola epidemic. There are 100 bags and boxes of
hospital linens, 100 cases of protective suits, 80 cases of face
masks, and other items -- in all, more than USD 140 000 worth of
medical equipment locked inside a dented container at the port since 9
Aug 2014. Hundreds of people have died of Ebola in Sierra Leone since
then, and health workers have endured grave shortages of lifesaving
supplies, putting them at even greater risk in a country reeling from
the virus.

"We are still just hoping (!!!) -- which sounds like begging -- that
this container should be cleared," one government official wrote in a
frantic email to his superiors, weeks after the container arrived. In
many ways, the delay reflects what some in the growing ranks of
international officials pouring into this nation to fight Ebola
describe as a chaotic, disorganized government response to the

Many health care workers in Sierra Leone have died of Ebola. "It's a
mess," said one foreign official working alongside the Sierra Leone
government agency set up to deal with the crisis. The official, who
spoke on condition of anonymity to maintain vital relations with the
government, said that nobody appeared to be in charge at the agency,
known as the "emergency operations center," and that different
factions made decisions independently. "It's the only body
responsible," the official said. "What is it doing?"

In the case of the shipping container, the desperately needed supplies
seem to have been caught, at least in part, in a trap that is common
the world over: politics, money, and power. The supplies were donated
by individuals and institutions in the United States, according to
Chernoh Alpha Bah, who organized the shipment. But Mr Bah wears
another hat, as well. He is an opposition politician from President
Ernest Bai Koroma's hometown, Makeni -- a place that clearly showed
the government's inability to contain Ebola.

Mr Bah said he thought the equipment would be welcomed by the
struggling authorities, and he said he expected the shipping fee of
USD 6500 would be a small detail for Sierra Leone. According to the
official, the government has already received well over USD 40 million
in cash from international donors to fight Ebola. The shipping
company, as a good-will gesture in a moment of crisis, had agreed to
send the goods without being paid first, Mr Bah said. But no more. 3
other containers of similar value await shipment from the United
States, he said, halted by the government's long refusal to pay... --

[Byline: Adam Nossiter]

Communicated by:

[2] Liberia: home disinfection kits for Monrovia
Date: Thu 2 Oct 2014
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA),
ReliefWeb, Medecins Sans Frontieres (MSF) report [edited]

Teams from Doctors Without Borders/Medecins Sans Frontieres (MSF) have
begun distributing more than 50 000 family protection and home
disinfection kits in Monrovia, Liberia, as part of the organization's
Ebola response. The kits are designed to give people some protection
should a family member become ill and also allow them to disinfect
their homes, reducing the chance that others in the household could
become infected.

"We know these kits are not the solution to the Ebola crisis in
Monrovia," said Anna Halford, coordinator for the distribution. "But
the scale of the epidemic, and the inadequacy of the response so far,
means that we are forced to take unprecedented and imperfect

"In order to get the epidemic under control, all infected people must
be able to have a bed in a treatment center, but until the facilities
that have been promised materialize, this will be impossible. In the
meantime, these kits offer people some protection from an infected
family member until they can get the medical care they need in an
Ebola management center."

The kits, which are distributed in 2 buckets, contain chlorine, soap,
gloves, a gown, plastic bags, a spray bottle, and masks. The kits also
contain health promotion messages and instructions for their safe use.
MSF started the distribution by giving the kits to people who were
turned away from MSF's treatment center when it was full, to contacts
of patients at the center, to those working at the center, and to
those living nearby.

"Our kits are not designed to allow people to care for an Ebola
patient in their homes," said Laurence Sailly, MSF head of mission in
Monrovia. "To do this safely, people need intensive training and
support, but it will allow people to protect themselves from a sick
family member for a short time until they can be admitted to a
treatment center."... -- more

Communicated by:

[The kits are "not designed to allow people to care for an Ebola
patient in their homes" but "will allow people to protect themselves
from a sick family member for a short time until they can be admitted
to a treatment center" -- after many more are built and staffed. But
since that will take much more than a week, people will inevitably end
up caring for Ebola patients in their homes. - Mod.JW]

[3] Liberia: journalists need written permission for Ebola interviews
Date: Mon 6 Oct 2014
Source: Voice of America [edited]

The Ministry of Health and Social Welfare has released a new media
order requiring journalists wanting to photograph, conduct interviews,
or do video recordings at an Ebola health care facility to first get
written permission from the health ministry.

Assistant Health Minister and head of the Ebola incident management
team Tolbert Nyenswah told journalists the new media access policy
aims to protect the privacy of patients and healthcare workers as well
as the health and safety of Liberian and international journalists...
-- more

[Byline James Butty]

Communicated by:

[I wonder how many days it takes to get an answer from an already
overstretched ministry? - Mod.JW]

[4] Liberia: US military will have 7 Ebola testing labs throughout
Date: Tue 7 Oct 2014
Source: Stars and Stripes [edited]

The US Defense Department [DOD] will operate 7 mobile testing labs in
Liberia to fight the spread of Ebola, the head of US Africa Command
said Tue [7 Oct 2014] at the Pentagon. Hundreds of DOD personnel are
in Liberia laying the groundwork for a US military mission to fight
the outbreak that the World Health Organization estimates has killed
more than 3400 people. Thousands of US soldiers are scheduled to
arrive this month [October 2014] to build treatment centers and
oversee logistics. The humanitarian mission is likely to cost about
USD 750 million over the coming 6 months, Gen. David Rodriguez said.

Defense officials have repeatedly said troops have no contact with
disease sufferers, but Rodriguez said Tue [7 Oct 2014] that a few
military infectious disease specialists would be working with
contaminated blood samples in the mobile labs. "This is not just
medical guys trained to do this [particular task], this is what they
do for a living," he said. One such lab has been operational in
Liberia for years, while 2 more were recently deployed. DOD now is
working to send 4 more labs, he said -- each operated by 3 or 4
technicians -- needed because Ebola symptoms can mimic other tropical
diseases, such as malaria. "The testing really focuses on whom you
need to treat and whom you don't need to treat, because malaria shows
a similar problem with the symptoms," he said.

Making sure US personnel don't catch Ebola is priority no. 1,
Rodriguez said. "By providing pre-deployment training, adhering to
strict medical protocols while deployed, and carrying out carefully
planned reintegration measures based on risk and exposure, I am
confident that we can ensure our service members' safety, and the
safety of their families and the American people," he said.

While deployed, troops will use safety clothing and equipment and wash
constantly to prevent the virus spreading. They'll also be checked for
symptoms throughout the day, Rodriguez promised. Should anyone come
down with the virus, they'll be evacuated to the United States for
treatment on a specially equipped medical transport plane.

Communicated by
Ryan McGinnis

[Photo of US military field hot lab in action:
(US Army Africa photo by US Navy Chief Petty Officer Jerrold

US Navy Lt Jose Garcia inactivates the Ebola virus in each specimen in
a process that renders the virus safe for further analysis at a Naval
Medical Research Center mobile laboratory at Bushrod Island, Liberia,
6 Oct 2014. The center sent 2 mobile testing labs to Liberia to
support Operation United Assistance. Each 2-person lab is capable of
testing up to 80 samples per day. - Mod.JW]

[5] Liberia: cremation brings problems
Date: Tue 7 Oct 2014
Source: Time [edited]

Overwhelmed by the increasing number of dead, and faced with community
fears that the buried bodies may also transmit the disease -- which,
if interred properly, they won't -- Liberia's government declared in
August [2014] that all those who died of Ebola should be cremated.

With international help and advice, the government established a Dead
Body Management program to pick up Ebola's victims and dispose of them
safely. But testing for Ebola is difficult and time consuming. What
little testing resources do exist are reserved for the living, says
assistant health minister, Tolbert Nyenswah. With hospitals closed and
doctors overwhelmed, it is almost impossible to prove that the cause
of death is anything but the deadly virus. "These days, if someone
dies, it's Ebola," says [a coffin-maker]. "There is no testing, no
questions. Just Ebola, and they take the body away. No one has time
for coffins." He hasn't sold a coffin in 2 months, ever since the
Liberian government declared, in an effort to tackle the Ebola crisis,
that all of the country's dead should be burned and not buried.

The government directive, while logical from an epidemiological
aspect, has taken a toll on a society already traumatized by Ebola's
sweep. It denies communities a final farewell, and has led to
standoffs with the Dead Body Management teams who must pick up the
dead even as the living insist that the cause of death was measles, or
stroke, or malaria -- anything but Ebola. "We take every body, and
burn it," says Nelson Sayon, who works on one of the teams. Dealing
with the living is one of the most difficult aspects of his job, he
says, because he knows how important grieving can be. "No one gets
their body back, not even the ashes, so there is nothing physical left
to mourn."

Monrovia's mass cremations, which take place in a rural area far in
the outskirts of town, happen at night, to minimize the impact on
neighboring communities. For a while the bodies were simply burned in
a pile; now they are placed in incinerators donated by an
international NGO. There are so many that it can sometimes take all
night, says Sayon.

In a country where distrust between the people and the government runs
deep, the mass cremations have caused a deeper rift, says Kenneth
Martu, a community organizer from the Westpoint area of Monrovia. "In
west Africa we don't cremate bodies at all. So when the government
takes away our bodies, and can't even tell us if they died of Ebola or
not, it breeds resentment." Liberians, he points out, are no strangers
to mass casualties: 2 civil wars, from 1989 to 1996 and 1999 to 2003,
saw nearly half a million die. "Even with mass graves, people can
bring flowers. They know where to find the dead. But here we don't
even know where the ashes are." [It seems insensitive not to identify
the burial places of the ashes. - Mod.JW]

There are exceptions to the cremation directive. If a family can get a
signed death certificate from the Ministry of Health stating that the
cause of death was not Ebola, they can take the body to a funeral
parlor for embalming and eventual burial. There are even dispensations
for those who do die of Ebola; under certain circumstances the dead
can be buried in a cemetery, if the Dead Body Management team conducts
the preliminary steps of laying the body 6 feet [2 m] deep and soaking
the next 4 feet [1.2 m] of earth with chlorine solution. But those
dispensations are impossible to get without connections. One recent
Saturday, a funeral cortege down one of Monrovia's main thoroughfares
drew questioning comments and glares of resentment from bystanders.
"Haven't seen that in a while," exclaimed one woman. "Must be related
to a minister," muttered a man... -- more

[Byline: Aryn Baker]

Communicated by:

[6] Liberia: anti-corruption program
Date: Tue 7 Oct 2014
Source: AllAfrica, Heritage (Monrovia) report [edited]

In an effort to ensure transparency, accountability and integrity in
the management of Ebola resources, the Liberia Anti-Corruption
Commission (LACC) has embarked on a program to monitor and make sure
that adequate internal controls and systems are instituted in the
administration of said resources.

The LACC has therefore requested the National Ebola Taskforce to
furnish the list of all monetary contributions and payments made to
the National Ebola Trust Fund, along with information of all other
related resources. Additionally, the Commission has entreated the
National Ebola Taskforce to provide a full list of all administrators
of Ebola resources.

7 Oct 2014: (Heritage) The Government of Liberia (GoL) through the
Ministry of Finance and Development Planning (MFDP) has commenced the
process for the selection and appointment of an independent "Fiduciary
Agent" to assist the government with the financial management of the
Ebola Trust Fund. An MFDP release says the decision to contract an
independent financial management firm was intended to uphold
government's commitment to full transparency and accountability as
announced recently by Liberia's Minister of Finance and Development
Planning, Amara M Konneh.

According to Minister Konneh, the firm selected to provide the
fiduciary service would manage the fund and supervise accounting
related services, under the direction of the Minister of Finance and
Development Planning, under the multi-donor governance structure. The
release says it would be required to set up a sound financial
management system to accurately record and report on all funds
received and disbursed from the Trust Fund and providing regular fund
management report.

The Firm would also provide oversight of all procurement functions to
ensure compliance with established guidelines of the government as
well as those of development partners ... The GoL in response to the
Ebola Virus epidemic established the Ebola Trust Fund (ETF) at the
Central of Bank of Liberia (CBL) in a bid to attract resources from
the government, private citizens and international donors. The Fund
was created with an initial USD 5 million injection through a loan
facility from the Central Bank of Liberia. To date, the fund has
raised over USD 10 million, with more donations expected from foreign
partners and friendly governments in coming weeks. Recently, the
Liberian government announced it needed USD 375 million to effectively
fund its National Ebola Response and Restoration of Basic Health
Services strategy.

Communicated by:

[7] Sex after Ebola
Date: Tue 7 Oct 2014
Source: Reuters [edited]

Sex could keep the Ebola epidemic alive even after the World Health
Organization (WHO) declares an area free of the disease, one of the
discoverers of the deadly virus said on Tue [7 Oct 2014].

The WHO is hoping to announce later this week that Nigeria and Senegal
are free of Ebola after 42 days with no infections -- the standard
period for declaring an outbreak over, twice the maximum 21-day
incubation period of the virus. However, it appears the disease can
last much longer in semen.

"In a convalescent male, the virus can persist in semen for at least
70 days; one study suggests persistence for more than 90 days," the
WHO said in an information note on Mon [6 Oct 2014] [see item [1] WHO
Ebola situation assessment - 6 Oct 2014 in ProMED-mail posting Ebola
virus disease - West Africa (188): international cases, Liberia,
clinical 20141007.2837773 - Mod.JW]

"Certainly, the advice has to be for survivors to use a condom, to not
have unprotected sex, for 90 days," said Peter Piot, a professor at
the London School of Hygiene and Tropical Medicine and a discoverer of
Ebola in 1976. "If we would apply the rule for double the time, that
would be 180 days -- 6 months. I think it (90 days) is probably a
compromise, for practicality," he told a news conference in Geneva.

Communicated by:

[It didn't keep Ebola going in the Congo after the original outbreak
in 1976, or after the Kikwit outbreak in 1995, or after any other
outbreak in the Congo or Uganda between 1976 and now.

Rowe AK, Bertolli J, Khan AS, et al: Clinical, virologic, and
immunologic follow-up of convalescent Ebola hemorrhagic fever patients
and their household contacts, Kikwit, Democratic Republic of the
Congo. J Infect Dis. 1999; 179 Suppl 1: S28-35; available at

"Evidence of Ebola virus was detected by reverse transcription --
polymerase chain reaction in semen specimens up to 91 days after
disease onset; however, these and all other non-blood body fluids
tested negative by virus isolation. Among 81 initially antibody
negative HHCs [household contacts] , none became antibody positive."

Also note:
"Blood specimens of 5 HHCs not identified as EHF [Ebola hemorrhagic
fever; now Ebola virus disease] patients were initially antibody
positive. No direct evidence of convalescent-to-HHC transmission of
EHF was found, although the semen of convalescents may be infectious.
The existence of initially antibody-positive HHCs suggests that mild
cases of Ebola virus infection occurred and that the full extent of
the EHF epidemic was probably underestimated."
- Mod.JW]

[8] OIE experts review current knowledge on Ebola reservoir
Date: Mon 6 Oct 2014
Source: OIE (World Organisation for Animal Health) press releases

The World Organisation for Animal Health (OIE) has issued a technical
information sheet on Ebola virus disease outlining epidemiological
observations and scientific knowledge of the disease including the
animal reservoir.

The OIE technical information sheet on Ebola virus disease has been
prepared and reviewed by internationally regarded scientific experts,
including experts from OIE global Reference Centres and Working Group
on wildlife, and was subsequently endorsed by the OIE Scientific
Commission on Animal Diseases.

Ebola virus disease (EVD), also known as Ebola haemorrhagic fever is a
severe contagious disease affecting humans and non-human primates,
such as gorillas, chimpanzees and some other monkeys. It mainly occurs
in the Central and West African regions and can be transmitted to
humans from an infected animal or human. Hence, Ebola virus disease is
a zoonosis and poses significant threats to public health by causing
hemorrhagic fever outbreaks in humans with a high case fatality rate.
At present, there is no licensed therapeutic or vaccine for humans.
Experimental drugs and vaccines are being developed.

The virus was reported again in humans at the beginning of 2014 in
Guinea and then Liberia. It has since then spread to Sierra Leone and
most recently to Nigeria to become the largest Ebola outbreak in
history and the 1st in West Africa. In August 2014, the WHO declared
the outbreak as an international health emergency. An unrelated
outbreak was also reported in Democratic Republic of Congo (DRC).

Although the strain causing the current outbreak has resulted in an
unprecedented number of fatalities, the initial source of the virus
remains unclear. However it is likely that the initial introduction to
the human population was from a wild animal source to a single person.
The disease is now being transmitted between humans and there is no
evidence that animals continue to play a role in spreading the virus.

Field studies and epidemiological surveys demonstrate that the natural
reservoir hosts for this virus may be fruit bats, without showing
clinical signs. These results still need to be further investigated.

Ebola is most likely initially transmitted from animals such as bats
and non-human primates to humans through hunting and collection of
sick or dead wild animals and handling or consumption of uncooked bush
meat. In rural areas fruit bats are a popular source of forest meat
for humans and are prepared by hand to be dried, smoked, and/or
cooked. Infection could also be transmitted to humans by handling or
consumption of forest fruits contaminated with bat saliva or faeces in
affected areas.

Therefore the OIE is in full accordance with World Health Organization
(WHO) recommendations to avoid contact with wild animals, including
bats, monkeys, and rodents, in affected areas.

The OIE encourages the national Veterinary Services of the countries
affected to remain vigilant and develop their involvement towards
wildlife. In collaboration with OIE experts, it will continue to work
and regularly update guidance to its Members and the public on this

Related links:
WHO fact sheet on Ebola virus

Link to OIE Information Sheet

Communicated by:


A HealthMap/ProMED-mail map can be accessed at:

[See Also:
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clinical 20141007.2837773
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Liberia 20141005.2834551
Ebola virus disease - West Africa (186): WHO, Cuban HCWs arrive,
prevention 20141004.2832637
Ebola virus disease - West Africa (185): WHO, CDC, Liberia, vaccine
Ebola virus disease - West Africa (184): USA (TX) first case ex
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Ebola virus disease - West Africa (183): great apes as sentinels
Ebola virus disease - West Africa (182): vaccine, orphans, S.Leone,
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Ebola virus disease - West Africa (181): Liberia, Europe, Senegal, sea
law 20140929.2816072
Ebola virus disease - West Africa (180): S. Leone, Liberia, USA,
drugs, Guinea 20140928.2813292
Ebola virus disease - West Africa (179): Liberia, protection, aerosol,
prevention 20140927.2811394
Ebola virus disease - West Africa (178): WHO Roadmap Update
Ebola virus disease - West Africa (177): WHO, quarantine, vaccine,
Liberia, surv. 20140926.2808526
Ebola virus disease - West Africa (176): Sierra Leone, USA, Nigeria
Ebola virus disease - West Africa (175): CDC, Sierra Leone, drugs,
survivors RFI 20140924.2802601
Ebola virus disease - West Africa (174): WHO, UNMEER, AU, Sierra
Leone, Liberia 20140924.2799482
Ebola virus disease - West Africa (173): WHO, Sierra Leone,
respirators, aid 20140922.2792415
Ebola virus disease - West Africa (172): Sierra Leone, volunteers,
Senegal free 20140921.2790986
Ebola virus disease - West Africa (171): lockdown, serum, aerosol,
team killed 20140920.278947
Ebola virus disease - West Africa (170): WHO, volunteers, risk,
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Ebola virus disease - West Africa (169): MSF, aircraft, blood donation
Ebola virus disease - West Africa (168): MSF, volunteers, hiccups,
vaccine 20140917.2780781
Ebola virus disease - West Africa (167): WHO, UN, UNICEF volunteers,
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Ebola virus disease - West Africa (166): USA aid, hospitals, donations
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control, susp. 20140914.2773490
Ebola virus disease - West Africa (163): volunteers, Sierra Leone,
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Ebola virus disease - West Africa (161): hospital ships, military
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Ebola virus disease - West Africa (160): Senegal, Liberia, tests,
media 20140911.2766294
Undiagnosed viral hemorrhagic fever - Guinea: (NZ) RFI
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