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[stem-ebola] PRO/AH/EDR> Ebola virus disease - West Africa (197): Mali, Ethiopia, Guinea

A ProMED-mail post
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International Society for Infectious Diseases

In this update:
[1] WHO: Ebola response roadmap situation report 25 Oct 2014
[2] Mali: index case dies, many exposed
[3] Ethiopia sending 200 volunteers
[4] Guinea: AmeriCares donation

[1] WHO: Ebola Response Roadmap Situation Report 25 Oct 2014
Date: Sat 25 Oct 2014
Source: WHO Global Alert and Response (GAR), Pandemic and Epidemic
Diseases, Situation reports: Ebola response roadmap [summ. edited]

Situation report update -- 25 Oct 2014
A total of 10 141 confirmed, probable, and suspected cases of Ebola
virus disease (EVD) have been reported in 6 affected countries
(Guinea, Liberia, Mali, Sierra Leone, Spain, and the United States of
America) and 2 previously affected countries (Nigeria, Senegal) up to
the end of [23 Oct 2014]. There have been 4922 reported deaths.

Following the WHO Ebola Response Roadmap structure, country reports
fall into 2 categories: 1) those with widespread and intense
transmission (Guinea, Liberia, and Sierra Leone); and 2) those with or
that have had an initial case or cases, or with localized transmission
(Mali, Nigeria, Senegal, Spain, and the USA).

Countries with widespread and intense transmission
A total of 10 114 confirmed, probable, and suspected cases of EVD and
4912 deaths have been reported up to the end of [18 Oct 2014] by the
Ministry of Health of Liberia, [21 Oct 2014] by the Ministry of Health
of Guinea, and [22 Oct 2014] by the Ministry of Health of Sierra
Leone. All but one district in Liberia and all districts in Sierra
Leone have now reported at least one case of EVD since the start of
the outbreak. Of the 8 Guinean and Liberian districts that share a
border with Cote d'Ivoire, only 2 are yet to report a confirmed or
probable case of EVD.

A total of 450 health care workers (HCWs) are known to have been
infected with EVD up to the end of [23 Oct 2014]: 80 in Guinea; 228 in
Liberia; 11 in Nigeria; 127 in Sierra Leone; one in Spain; and 3 in
the USA. A total of 244 HCWs have died.

WHO is undertaking extensive investigations to determine the cause of
infection in each case. Early indications are that a substantial
proportion of infections occurred outside the context of Ebola
treatment and care. Infection prevention and control quality assurance
checks are now under way at every Ebola treatment unit in the 3
intense-transmission countries. At the same time, exhaustive efforts
are ongoing to ensure an ample supply of optimal personal protective
equipment to all Ebola treatment facilities, along with the provision
of training and relevant guidelines to ensure that all HCWs are
exposed to the minimum possible level of risk.

Country: cases (all) / deaths
Guinea: 1553 / 926
Liberia*: 4665 / 2705
Sierra Leone**: 3896 / 1281
Total: 10 114 / 4912

*For Liberia, 276 more confirmed deaths have been reported than have
confirmed cases.
**For Sierra Leone, 127 more probable deaths have been reported than
have probable cases. 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.

Countries with an initial case or cases, or with localized
Five countries (Mali, Nigeria, Senegal, Spain, and the USA) have now
reported a case or cases imported from a country with widespread and
intense transmission.

In Nigeria, there were 20 cases and 8 deaths. In Senegal, there was
one case and no deaths. However, following a successful response in
both countries, the outbreaks of EVD in Senegal and Nigeria were
declared over on [17 Oct and 19 Oct 2014], respectively.

On [23 Oct 2014], Mali reported its 1st confirmed case of EVD. The
patient was a 2 year old girl who travelled from the Guinean district
of Kissidougou with her grandmother to the city of Kayes in western
Mali, which is about 600 km [373 mile] from the Malian capital Bamako
and lies close to the border with Senegal. The patient was symptomatic
for much of the journey. On [22 Oct 2014], the patient was taken to
Fousseyni Daou hospital in Kayes, where she died on [24 Oct 2014]. At
present, 43 contacts, of whom 10 are HCWs, are being monitored;
efforts to trace further contacts are ongoing. A WHO team was already
in Mali to assess the country's state of readiness for an initial
case. A rapid response team will also arrive in the coming days.

In Spain, the single case tested negative for EVD on [19 Oct 2014]. A
2nd negative test was obtained on [21 Oct 2014]. Spain will,
therefore, be declared free of EVD 42 days after the date of the 2nd
negative test if no new cases are reported. A total of 83 contacts are
being monitored.

There have now been 4 cases and one death in the USA. The most recent
case is a medical aid worker who volunteered in Guinea and returned to
New York City on [17 Oct 2014]. The patient was screened and was
asymptomatic on arrival but reported a fever on [23 Oct 2014] and
tested positive for EVD. The patient is currently in isolation at
Bellevue Hospital in New York City, one of 8 hospitals in New York
State that have been designated to treat patients with EVD. Possible
contacts are being identified and followed up. Two HCWs who became
infected after treating an EVD-positive patient at the Texas
Presbyterian Hospital of Dallas, Texas, have now tested negative for
EVD. Of a total of 176 possible contacts linked with these cases, 109
are currently being monitored; 67 have completed 21-day follow-up. In
Ohio, 153 crew and passengers who shared a flight with one of the
infected HCWs (prior to the patient developing symptoms) are being
followed up, though they are considered low-risk and are not
considered to be contacts.

Country: cases (all) / deaths
Mali: 1 / 1
Spain: 1 / 0
USA: 4 / 1
Total: 6 / 2

communicated by:

[The full update is available at the source URL above. It includes:
- tables of confirmed, probable, and suspected cases in the 6
currently affected countries (Guinea, Liberia, Mali, Sierra Leone,
Spain, and the United States of America).
- map of the geographical distribution of new cases and total cases in
Guinea, Liberia, and Sierra Leone.
- Annex 1: Categories used to classify Ebola cases (suspected,
probable, confirmed).
- Annex 2: overview of the situation in the Democratic Republic of the
Congo, where a separate, unrelated outbreak of EVD is occurring. -

[2] Mali: index case dies, many exposed
Date: 25 Oct 2014
Source: BBC [edited]

The authorities in Mali have confirmed the death of the country's 1st
Ebola patient, a 2 year old girl. The World Health Organization said
the toddler had travelled hundreds of km by bus from Guinea through
Mali showing symptoms of the disease. More than 40 people known to
have come into contact with her have been quarantined. The girl was
being treated in the western town of Kayes, after arriving at a
hospital on Wed [22 Oct 2014].

The child had travelled more than 1000 km (600 miles) from Guinea
through the capital, Bamako, to Kayes. "The child's symptomatic state
during the bus journey is especially concerning, as it presented
multiple opportunities for exposures, including high-risk exposures,
involving many people," WHO said. The girl's mother died in Guinea a
few weeks ago, and the child was then brought by relatives to Mali...

communicated by:

[An earlier report said 6 nurses who attended the little girl in Kayes
Hospital had been quarantined. This is a disaster for the country and
the world. It is not a single, non-fatal case as in Senegal, nor an
imported case with few contacts quickly contained, as in Nigeria and
the USA, but something very much worse.

For a map of Kayes in Mali, see
- Mod.JW]


Mauritania: closes border with Mali over Ebola fears
25 Oct 2014: Reuters [link]

communicated by:

[Sad to say, but is there any reason to think that this border closure
will be any more effective than others in West Africa? In exculpation,
governments have to be seen to be taking firm steps. - Mod.JW]

[3] Ethiopia sending 200 volunteers
Date: 24 Oct 2014
Source: ReliefWeb [edited]

The Ethiopian government has pledged to deploy 200 volunteer health
professionals to West Africa and also donated USD 500 000 to Liberia,
Guinea and Sierra Leone. The health professionals comprise medical
doctors, nurses, field epidemiologists, environmental health personnel
and public health specialists. These will engage in Ebola case
management/treatment, surveillance, contact tracing, social
mobilization, and community engagement, and will also assist national
health systems in the affected countries to continue their essential
and basic health, food, water and sanitation services.

Making the announcement, the Ethiopia minister of health, Dr
Kesetebirhan Admasu, said: "This new commitment of deploying medical
staff can be considered as a continuation and commitment of Ethiopia's
firm stand for African solidarity. Ethiopia shall and will continue to
support all efforts until this dreadful crisis is over."

Welcoming the Ethiopia offer, the commissioner for social affairs, Dr
Mustapha Sidiki Kaloko, expressed appreciation to the government and
people of Ethiopia for the exemplary contribution and hopes that the
positive decision of Ethiopia will encourage other member states to
favourably respond to the AU [African Union] chairperson's call for
contributions from member states in the fight against Ebola. In
response to the Ebola epidemic, the AU has deployed medical volunteers
to Liberia and Sierra Leone under its African Union Support to Ebola
Outbreak (Operation ASEOWA). The commission is deploying another batch
of health experts to Guinea next week...

[byline: Wynne Musabayana <MusabayanaW@xxxxxxxxxxxxxxxx>]

communicated by:

[4] Guinea: AmeriCares donation
Date: Source: Relief Web [edited]

Nearly 30 000 lbs [13 600 kg] of safety equipment and medical supplies
from AmeriCares is headed to Guinea for health workers fighting the
Ebola epidemic. The shipment -- AmeriCares 1st aid delivery to Guinea
for the crisis -- includes more than 350 000 masks, 35 000 gowns and
other protective equipment to support the Ebola response in Guinea.
This personal protective equipment will be distributed to Ebola
treatment units and health clinics and will be used to train health
workers in infection control procedures.

"There are new cases of the virus reported every week in Guinea," said
AmeriCares vice president of emergency response Garrett Ingoglia.
"With the proper protective gear, we know we can stop the virus from
spreading to health workers, who offer the best hope for containing
the epidemic."

The shipment will be delivered on a humanitarian flight organized by
Airlink, a Washington DC-based nonprofit that connects aid
organizations with free passenger and cargo transportation. Airlink
has established an air bridge to streamline transportation of
critically needed supplies to combat the Ebola outbreak in West

communicated by:

[AmeriCares sent 60 000 lbs of similar Ebola aid to Liberia in
September 2014; see ProMED post Ebola virus disease - West Africa
(182): vaccine, orphans, S.Leone, prevention 20140930.2817719. Not to
denigrate such charity to Guinea, but judging by the latest case
figures one might have thought that Sierra Leone, with 2.5 times the
number of reported cases, is in greater need, and also, as long as
Sierra Leone has cases, Ebola will return to Guinea in cross-border

Readers, please note: there are items of interest about the US
quarantine controversy, insurance rate increases for businesses
regarding Ebola, and questions about infection of dogs in other
threads: see Hot topics tab on the ProMED home page at
<>. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at

[See Also:
Ebola virus disease - West Africa (196): WHO, Mali conf. case ex
Guinea, Liberia 20141024.2894887]
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