National Ebola Response Centre (NERC) National Weekly Ebola Newsletter: July 2015

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1 Key Points: There were three new cases were confirmed EVD+ during the reporting week. Two from the Western Area Urban and from Port Loko district. All 3 confirmed cases were from live blood The NERC is monitoring 10 EVD events across the country. Three in the Western Area Urban (WAU), 1 in Western Area Rural (WAR), 2 in Port Loko and 4 in Kambia district NERC Principals and key partners visited the DERC in Port Loko district. The purpose of the visit was to discuss the extension of the Operation Northern Push plan with DERC officials and the partners in the response Thirty three babies and their mothers are being closely monitored by the WA ERC following the EVD+ confirmation of the 23 day old baby at PCMH The practice of illegal burial is still continuing in villages in some EVD infected chiefdoms. A Quarantine Home Health Care SOP has been developed and approved. This SOP provides guidelines on health care service delivery in quarantined homes. A number of households were released from quarantine in Targrin, Kaffu Bullom and Mabranka in Masimera Chiefdom. This has led to the closure of 2 EVD events. NATIONAL OVERVIEW EVD Updates: During the reporting week, 3 cases were confirmed EVD+ from live blood. Two cases from the Western Area Urban and 1 Port Loko district. The case recorded in Port Loko is from a quarantined home in Mamusa village, Marampa chiefdom. One of the cases recorded in the Western Area Urban is from a known source, whilst the other case is from an unknown source. EVD Events: The NERC is currently monitoring 10 EVD events in 8 chiefdoms 1 across four districts. Three in the WAU, 1 in the WAR, 2 in Port Loko and 4 in Kambia district. During the reporting week 2 EVD events closed. The last quarantined home in Targrin/Tardi which had 6 contacts were released on 16 July. This event commenced when the famous traditional healer was confirmed EVD+ on 1 June. Additionally, the event in Mabranka village, Masimera chiefdom which commenced on 25 June following confirmation of a 24 year old man who was EVD+ ended this week. Summary of EVD Events: Western Area Urban and Rural are monitoring 4 events: Patton Street event: This event commenced, following the EVD+ case of a street scavengeron 18 Jul. 1 Including WAR and WAU.

2 Hagan Street Event, WAU: Commenced when a 23 day old baby was confirmed EVD+ from a swab on 10 July. No case has been linked to this event since it commenced. Peninsula Road Goderich Event, WAR: Commenced when a 3 day old baby was also confirmed EVD+ from a swab on 10 July. No case has been linked to this event since it started. Magazine Wharf event, WAU: Since the start of this event on 15 June following the EVD + confirmation of a fisherman there have been 19 EVD+ cases linked to the event. Port Loko DERC is monitoring 2 EVD events: Mathianal Banah Village event, Masimera Chiefdom: Commenced on 1 July following the EVD confirmation of a 50 year old EVD+ woman. There has been no further EVD infection linked to this event since it commenced. Mamusa event, Marampa Chiefdom: Commenced on 16 June, following the escape of a heavily pregnant woman from quarantine in Kaffu Bullom to Marampa chiefdom. EVD+ confirmed cases continue to be linked to this event. Kambia district is monitoring 4 events: Laya Village event, Samu Chiefdom: This event commenced when a 22 year old commercial bike rider died in the community and was swabbed EVD+ on 29 June. There has been no new positive EVD confirmation linked to the index case. Kambia 1 event, Magbema Chiefdom: Started when a 33 year old health worker was confirmed EVD+. There have been no new cases recorded with this event. Kamango village event, Bramaia Chiefdom: Commenced when a 60 year old woman was confirmed EVD+ on 30 May. The last recorded case was on 1 July. Kadalo event, Tonko Limba Chiefdom: Commenced when a practicing herbalist was confirmed EVD+. No new case has been epi linked to this event. Other News: During the reporting week, NERC principles and partners visited the DERC in Port Loko district. The purpose of the visit was to discuss the extension of the Operation Northern Push (ONP). During the visit, the DERC presented their new plan titled Operation Enduring Zero. The DERC informed that in the district s drive to reach enduring zero Ebola, a more data-driven approach aimed at informing all partners on the status of implemented activities will be instituted. Presentations on RSLAF s surveillance initiative and quarantine light were also made by a representative of RSLAF. Additionally, two hospitals in Kaffu Bullom Chiefdom were visited to assess the status of Infection Prevention and Control (IPC) measures. The visit was concluded with a courtesy call at the home of the Paramount Chief where transitional challenges faced by the DERC and its partners in the response were discussed. During the reporting week, the Quarantine Home Health Care SOP was presented on 16 July and endorsed by ipact. The purpose for the development of the SOP is to provide guidance for delivery of healthcare services to people held up in quarantined homes). The SOP provides the opportunity for health care facilities to be provided to quarantined people by the Quarantine Health Team (QHT). The services will include but not limited to; antenatal care, talks on health education, chronic disease management, and the

3 treatment of other acute conditions that might occur but do not satisfy the EVD+ case definition. The QHT will work closely with the PHUs in administering these services. PRIORITY DISTRICTS Western Area 2.1 Western Region New cases this week District w/c 13 July w/c 6 July Hotspots 2 New cases last week 10 Western Urban 2 9 Magazine Wharf, Goderich, Hagan Street Western Rural 0 1 Peninsula Road, Goderich EVD Epi Update: During the reporting week, only 2 EVD+ cases were recorded from live blood. This saw a remarkable decrease in the number of confirmed cases this week, compared to last week when 9 EVD+

4 cases were recorded. One of the cases recorded was from a known source whilst the other was from an unknown source. EVD Event: The Western Area is currently monitoring 4 EVD events. Three in the WAU at Hagan Street, Patton Street and Magazine Wharf, and 1 in the WAR in Goderich. Following the case of the 23 day old baby EVD that was confirmed EVD swab positive 10 July, an additional 9 health care workers from PCMH have also been transferred to the VQF in Hastings on 17 July. Currently 63 health care workers remain under surveillance in relation to this case. Thirteen other low risk health care workers are also being monitored in their local communities. Additionally, 9 family members have been quarantined at the home in Peninsula Road Goderich, where the baby became symptomatic before being transferred to PCMH. Furthermore, a total of 33 babies and their mothers who were in the same ward as the 23 day old baby are also being closely monitored in their various communities. Magazine Wharf event, WAU: A 30 year old male nurse, who was a high risk contact, became symptomatic on 12 July and was confirmed EVD+ from live blood on 14 July. He was recently released from the VQF in Hastings on 12 July and has shown no signs of being EVD+. He became symptomatic on 13 July and was confirmed EVD+ after his release. The source of infection is epi linked to a lady who he had cared for while she was admitted at the Princess Christian Maternity Hospital (PCMH) and was later confirmed EVD+ on 16 June. He has been transferred to the PTS 1 in Hastings and is said to be responding to treatment. Additionally, a 23 year old man described as a street scavenger and from no fixed address was confirmed EVD+ on 17 July. The WA ERC reported that the man showed wet EVD symptoms along the Magazine and Patton Street vicinity and was eventually arrested by two RSLAF personnel. He was taken to the PCMH for an EVD test which proved positive. The man reportedly gave 34 Patton Street as his home address, however it was later revealed that he had left the location three years previously. It was further reported that he moves around with friends at Magazine Wharf, a location he visits frequently. He is currently undergoing treatment at the 34 Military Hospital and is said to be responding positively. District Response Activities: Following the case of the health worker at PCMH, a number of other health workers from the hospital have been moved to the VQF for effective monitoring. No home has been put under quarantine following the EVD+ confirmation of the male nurse. Similarly, the WA ERC is still in the process of establishing the epi link for the case of the 23 year old man as he has no fixed address. Five of his friends with whom he had had close contacts with before his EVD+ confirmation were identified and have been line listed for possible transfer to the VQF. The WA ERC continued with investigations during the reporting week to identify more possible contacts he might have come in contact with. Following the cases recorded from Magazine Wharf, the Social Mobilization Pillar has increased its engagements with communities through dialogue sessions at the Wharf. The WA ERC reported that, community people had not been previously cooperative in reporting the sick in the community. An outcome of these engagements as reported has led to the effective participation of community people

5 informing the WA ERC about sick people in the community. Monitoring movement of strangers in and around the wharf and reporting has also been increased. A basic communication and inter personal skills training workshop was held for social mobilizers across Magazine Wharf. The purpose of the training was to improve the delivery of the response in targeting communities. Currently, social mobilization activities at Magazine Wharf have been community led and participatory. The Western Area Coordinating team in partnership with an NGO, distributed food and non-food items to 41 children in quarantined communities at Magazine Wharf on 15 July. The team has plans to extend the donations to 72 additional children at the Wharf. The WA ERC continues to search for the 2 missing contacts who escaped from the VQF 2 weeks ago. Kambia 2.2 Northern Region New cases this week 0 New cases last week 3 District w/c 13 July w/c 6 July Hot spots Kambia 0 3 Kadalo, Kagboto, Rosinor, Laya Gboroh, Lay Lump, Kamango, Kambia 1 Epi Update: The EVD chain of transmission seems to remain under control within the last 7 days in the district. No case was confirmed EVD+. Since the commencement of Operation Northern Push on 16 June, the district has recorded EVD+ cases for 4 consecutive weeks, however this is the first week that the district has not recorded a confirmed case. EVD Events: The DERC is currently monitoring 4 EVD events in 4 chiefdoms across the district. One each in Laya- Samu Chiefdom, Kambia 1-Magbema Chiefdom, Kamango-Braiama and Kadalo in Tonko Limba Chiefdom. It is anticipated that a number of households in Kadalo village will be released from quarantine in the next coming week if no quarantined contact becomes symptomatic. Following the EVD confirmation of the 33 year old Community Health Worker on 5 July in Kambia 1, other households in Sanda Morie village-kambia 1, Katimpi Road, Kalikia- Kambia 2, in Magbema and Samu Chiefdoms have also been put under quarantine during the reporting week. This proactive action was taken by the DERC due to the recent interactions the newly quarantined contacts had with the health worker close to his death. These contacts are currently under strict monitoring and surveillance by response staff to ensure that they are immediately identified and isolated if they become symptomatic. Operation Northern Push (ONP) Monitoring of Peripheral Health Units (PHU) in the district was conducted during the reporting week. The purpose was to assess the IPC status in these PHUs and also, to further identify possible contacts that the health care worker who became infected on 5 July might have come in contact with before his death. The DERC held a meeting with all pillar leads during the reporting week. The purpose was to plan and strategize further ways that community people could be best engaged to effectively participate in the

6 response. The engagements were held in Bramaia, Samu, Mambolo and Tonko Limba chiefdoms with the exception of Mambolo, the 3 highlighted chiefdoms remains active in transmission of EVD. A training on health screening was conducted for RSLAF and the SLP by the Centre for Disease Control (CDC) during the reporting week. The purpose was to better equip the targeted participants on identifying symptomatic cases at road check points. Port Loko New cases this week 1 New cases last week District w/c 13 July w/c 6 July Hot spots 1 Port Loko 1 1 Kombrabai, Mamusa Epi Update: One case was confirmed EVD+ from live blood. This case was recorded in Mamusa village and from a quarantined home. EVD Events: The DERC is currently monitoring 2 events. One each in Mamusa, Marampa Chiefdom and the other in Mathianal Banah Village in Masimera Chiefdom. During the reporting week, 2 EVD events were closed. The last quarantined home in Targrin/Tardi with 6 contacts was released on 16 July. Since this event commenced on 1 June, 4 other contacts have become infected with the EVD virus from the index case. The closure of this event breaks the EVD chain of transmission from the index case in the chiefdom. Currently, Kaffu Bullom chiefdom has no more households under quarantine. This event resulted in 68 contacts being quarantined in 8 HHDs. Additionally, the event in Mabranka village, Masimera chiefdom which commenced on 25 June following the EVD confirmation of a 24 year old man was also concluded during the week. A household with 15 contacts was also released from quarantine during the reporting week. Since this event commenced, none of the 15 contacts fell ill or became symptomatic. Mamusa Village event: A 40 year old woman became symptomatic on 10 July and was confirmed EVD+ on 14 July from a quarantined home. The woman is said to be responding to treatment at the ETC. Following this case, 48 contacts (15 high risk) have been identified and are closely being monitored. Other News: Community denial in accepting the role of the burial team still poses a major challenge in the district. During the reporting week, the DERC received reports of illegal burials of a 21 year old female and a 2 year old baby in Mabure Kasseh village, BKM chiefdom. WHO had initial investigations with 15 people who participated in the burial process. The outcome of the initial investigation will be communicated in subsequent report. During the reporting week, 5 quarantined households of 40 contacts were released from quarantine on 15 July following the illegal burial of a travelling herbalist who passed away on route to Mayan while seeking traditional treatment. In mid June 2015, the travelling herbalist fell ill in Mondo village and was secretly removed from the village assisted by two of his family members. They headed towards the village of

7 Mayan in search of another herbalist to assist in treating him. On arrival in Mayan, he was rejected by community people and forced to return to his village. The traditional healer died on route to Mondo and was given an illegal burial in the bush. Requests to later exhume his corpse by community people was honoured but he was not swabbed. However, in order to ensure the public health safety of other household members and community people, 5 households were put under quarantine. During the quarantine period no contact showed any signs of being symptomatic and have all been released. Additionally 24 contacts from 2 households were put under quarantine on 19 July following the illegal burial of 2 of their relatives in Mabure village in Bureh Kasseh Maconteh Chiefdom. The bodies were not swabbed and causes of their deaths remains unknown. The contacts were put under quarantine for monitoring and surveillance and for public health safety. Operation Northern Push (ONP) The leadership of the DERC presented a brief on Operation Enduring Zero, which is the new name given as a phase two intervention to the original Operation Northern Push. During the implementation of the proposed plan, a more data-driven approach to inform partners and all in the response on the implementation of activities will be instituted. The Social Mobilization Pillar is in the process of putting up structures aimed at controlling the activities of NGOs in the district. The overarching goal of this approach is to avoid duplication of activities and further ensure that all activities are implemented as planned and in a coordinated manner. Two people who look sick and trying to balance the check points were arrested at Gbereh Junction. One of them died when they were intercepted; the other was admitted at the GOAL ETU. A test was conducted the result proved negative; but the patient is still under observation. The driver who was transporting them was arrested and the vehicle decontaminated. There has been some sensitization messaging to clear the accusation by community people that swabbers are removing body parts when conducting swab tests. In order to alleviate the fears of community people and further build their confidence, the DERC has introduced a new system which will allow community people to participate in an open swabbing process but within certain distances in order to ensure their safety. A team from DERC conducted an assessment visit. The purpose was to assess how social mobilization activities are being carried out in Sanda Mabolongton (being one of the silent areas), Dibia and Bureh Kasseh Maconteh chiefdoms. The assessment visit was followed by community engagements, where community people were encouraged to be eye openers and be vigilant in reporting sick cases and especially strangers that visit the chiefdom. Social Mobilisation teams were further urged to work closely with contact tracers and other partners in the response. Radio discussions and jingles on EVD related matters continued to raise the awareness of community people on EVD issues. Most impressive is that religious leaders still continue to incorporate and disseminated EVD messages during public prayers.

8 A five man roving team has been setup and trained by Red Cross, Oxfam and Restless development. These teams will be involved in monitoring response related activities. This includes monitoring activities of social mobilisation officers, contact tracers etc Concern: The DERC continues to raise concerns over the treatment of sick people by traditional healers in the community. Flouting of the EVD rules and regulations with contempt also poses a major challenge in containing the spread of the EVD in the district.

9 08/06/ /06/ /06/ /06/ /07/ /07/2015 National Ebola Response Centre (NERC) Daily average new confirmed cases, by week (Source: Surveillance Pillar/ MoHS Labs Data) *Confirmed case for the 17 th July is under investigation with surveillance District Treatment and holding bed capacity (Source: DERC Daily R2) 08 Jun 15 Jun 22 Jun 29 Jun 06 Jul 13 Jul Bo Bombali Bonthe Kailahun Kambia Kenema Koinadugu Kono Moyamba Port Loko Pujehun Tonkolili Western Area Combined Percentage of weekly confirmed cases by district, by week (Source: MoHS) District 08 Jun 15 Jun 22 Jun 29 Jun 6 Jul 13 Jul Kailahun 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Kenema 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Kono 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Kambia 42.86% 25.00% 25.00% 44.44% 21.43% 0.00% Koinadugu 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Bombali 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Tonkolili 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Port Loko 57.14% 50.00% 25.00% 22.22% 7.14% 50.00% Pujehun 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Bo 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Moyamba 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Bonthe 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Western Combined 0.00% 25.00% 50.00% 33.33% 71.43% 50.00% Total EVD alerts vs visits & dead body alert vs safe burials, by week(source: DERC Daily R2) EVD Alerts Alert Response % response 100% 99% 100% 98% 100% 100% Dead Body Alerts Safe Burials % response 97% 101% 100% 98% 97% 98% Indicators of control, by week (source: Surveillance Pillar/MoHS Labs Data) Average households in quarantine, by week (Source: DERC Daily R2)