Thursday, August 7, 2014

Wikipedia:2014 West Africa Ebola outbreak

2014 West Africa Ebola outbreak
This page has a quote of this from August 7th 2014. However, if this is a week or more later when you are reading this you might want to click the above word button for the latest news as well as the history of all this. 

2014 West Africa Ebola outbreak

From Wikipedia, the free encyclopedia
2014 West Africa Ebola outbreak
Guinea Liberia Sierra Leone Ebola Map August 4 2014.jpg
Situation map of the outbreak as of 4 August 2014
Date February 2014–present
Location Guinea, Liberia, Sierra Leone, Nigeria
Casualties
932 deaths / 1711 cases (as of 4 August 2014)[1]
An epidemic of the Ebola virus disease is ongoing in some West African countries. The outbreak first began in Guinea in March 2014.[2] Since its initial outbreak, the virus has spread to Liberia, Sierra Leone, and Nigeria. The outbreak is the most severe of its kind in recorded history in regard to both the number of human cases and fatalities.[3] A total of 1711 suspected cases with 932 deaths have been reported by the World Health Organization (WHO) as of 4 August 2014, of which 1070 cases and 603 deaths have been laboratory confirmed to be Ebola.[4] Various organizations, including the Economic Community of West African States (ECOWAS), U.S. Centers for Disease Control, and the European Commission have donated funds and mobilized personnel to help counter the outbreak; charities including Médecins Sans Frontières, the Red Cross,[5] and Samaritan's Purse are also working in the area.

Development of the outbreak

Initial outbreak in Guinea

On 25 March, 2014, the World Health Organization (WHO) reported that the Ministry of Health of Guinea had reported an outbreak of Ebola virus disease in four southeastern districts: Guekedou, Macenta, Nzerekore and Kissidougou with suspected cases in the neighboring countries of Liberia and Sierra Leone being investigated. In Guinea, a total of 86 suspected cases, including 59 deaths (case fatality ratio: 68.5%), had been reported as of 24 March.[6] An initial report suggested that it was a new strain of ebolavirus,[7] but this was refuted by later studies which placed it within the lineage of the Zaire strain.[8][9] On 31 March, the U.S. Centers for Disease Control sent a five-person team "to assist Guinea Ministry of Health and World Health Organization lead an international response to the Ebola outbreak".[6] By 23 April, the total number of suspected and confirmed cases was 242, including 142 deaths at a fatality rate of 59%.[10] Around 23 May, the outbreak spread to Guinea's capital Conakry,[6] a city of about two million inhabitants. According to Ibrahima Touré, Country Director of Plan Guinea, an NGO: "The poor living conditions and lack of water and sanitation in most districts of Conakry pose a serious risk that the epidemic escalates into a crisis. People do not think to wash their hands when they do not have enough water to drink."[11]

Subsequent spread

In Liberia, the disease was reported in Lofa and Nimba counties in late March,[12] and by mid-April, the Ministry of Health and Social Welfare had recorded possible cases in Margibi and Montserrado counties.[13]
Sierra Leone, Mali and Ghana identified suspected cases of the pestilence by mid-April, but all clinical samples of suspected cases tested negative for Ebola virus.[14] The overall situation with the Ebola virus infection in Guinea improved in May. For several days no new alerts or cases of nosocomial transmission (hospital-acquired infections) were reported from Liberia and from five out of the six affected prefectures in Guinea. Gueckedou was the only hotspot where community transmission and deaths were still being reported.
From 23 to 27 May 2014, three previously affected districts (Guéckédou, Macenta and Conakry), four new districts (Boffa, Télimélé, Boke and Dubréka) and one new country (Sierra Leone) reported several new EVD clinical cases.[15] In mid-June the first cases in Liberia's capital Monrovia were reported.[16]
Médecins Sans Frontières described the situation as being "totally out of control" in late June.[17] By early July, Liberia had reported 107 infections (52 laboratory-confirmed) and at least 65 deaths from Ebola,[18] and while only four deaths had been reported outside Lofa County by mid-April,[13] in mid-June, the MOHSW announced seven additional deaths in Montserrado County alone.[19]
The outbreak has progressed rapidly in Sierra Leone. The first cases were reported on 25 May in the Kailahun District, near the border with Guéckédou in Guinea.[20] By 20 June, there were 158 suspected cases, mainly in Kailahun and the adjacent district of Kenema, but also in the Kambia, Port Loko and Western districts in the north west of the country.[21] By 17 July, the total number of suspected cases in the country stood at 442, and had overtaken those in Guinea and Liberia.[22] By 20 July, cases had additionally been reported in the Bo District;[23] the first case in Freetown, Sierra Leone's capital, was reported in late July.[24][25]
The first case in Nigeria was reported by WHO on 25 July: Liberian government official and naturalized American Patrick Sawyer traveling from Liberia, where he was exposed to Ebola, to Nigeria and arriving at the city of Lagos by air on 20 July was hospitalised and later died of the disease on 25 July.[24][26][27][28][29] In response the hospital where he was being treated was shut down and quarantined and the health officials who were treating him were isolated in an attempt to stop the spread of the virus. [30][31][32]

Response by country

Current epidemic

The national authorities of Guinea, Sierra Leone, and Liberia have activated their national emergency committees, prepared Ebola virus disease response plans and carried out needs assessments.[9]
WHO's Regional Director for Africa, Luis Sambo, visited the affected countries from 21 to 25 July, meeting with political leaders, ministers of health, NGOs and other agencies. He stressed the need to "promote behavioural change while respecting cultural practices."[28]

Guinea

The border between Guinea and Liberia remained open in April; Guinea's ambassador in Monrovia noted his government's belief that efforts to fight the disease directly would be more effective than closing the border.[33]

Liberia

On or before 23 July, the Liberian health ministry began to implement a strategic plan in line with the Accra meeting's conclusions to improve the country's response to the outbreak.[34]
On 27 July, Ellen Johnson Sirleaf, the Liberian president, announced that Liberia would close its borders, with the exception of a few crossing points such as the country's principal airport, at which screening centres are being established; the worst-affected areas in the country are to be placed under quarantine.[35] Football events were banned, because large gatherings and the nature of the sport increase transmission risks.[36] Three days after the borders were closed, Sirleaf announced the closure of all schools nationwide, including the University of Liberia,[37] and a few communities were to be quarantined.[38]

Nigeria

There have been two confirmed and six other suspect cases in Nigeria as of 5 August 2014.[39] First was an imported case of a Liberian-American Patrick Sawyer, who traveled by air from Liberia, became violently ill on arriving in the city of Lagos. On 20 July, Sawyer flew into Nigeria via Lomé and Accra from Liberia, and he died five days later in Lagos. In response, the Nigerian government increased surveillance at all entry points to the country; health officials were placed at entry points to conduct tests on people arriving in the country. Initial reports noted that sixty-nine individuals previously in contact with Sawyer (including airport staff, fellow flight passengers and health workers at the hospital where Sawyer was hospitalized) were placed under close surveillance without symptoms.[40] Subsequently Arik Air, Nigeria's main airline, stopped flying to Liberia and Sierra Leone.[35] On 4 August, it was confirmed that the doctor who treated the patient tested positive for the virus strain and is being treated.[41] The suspect cases include a Nigerian man who traveled to Guinea.[4]

Saudi Arabia

On 1 April, Saudi Arabia stopped issuing visas for the Muslim pilgrimage to Mecca to those from Guinea, Liberia, and Sierra Leone.[42] Despite this, however, it was reported that on 3 August a man suspected of being infected with Ebola returned home to Saudi Arabia from Sierra Leone and died within three days of arrival while being tested for the disease in the port city of Jeddah. Tissue samples were sent to an international reference lab on the advice of the World Health Organization to determine the cause of death.[43]

Sierra Leone

Sierra Leone has instituted a temporary measure which includes reactivation of its "Active Surveillance Protocol" that will see all travelers into the country from either Guinea or Liberia subjected to strict screening to ascertain their state of health.[44] The government of Sierra Leone declared a state of emergency on 30 July and deployed troops to quarantine the hot spots of the epidemic.[45]

Spain

On 5 August 2014, the Brothers Hospitallers of St. John of God confirmed that the Spanish Brother Miguel Pajares was infected with the Ebola virus while volunteering in Liberia. The religious organization also confirmed that it informed the Spanish Ministry of Foreign Affairs and Cooperation and the Ministry of Health, Social Services and Equality and requested his repatriation.[46]

United States

On 31 July 2014, U.S. health officials from the Centers for Disease Control issued a travel advisory for Guinea, Liberia and Sierra Leone, warning against non-essential travel.[47]
American aid worker Kent Brantly, infected with the Ebola virus, was flown to the United States at the beginning of August and treated in Atlanta at Emory University Hospital, near the headquarters of the Centers for Disease Control.[48] Brantly had become infected while working in a Monrovia treatment center as medical director for the aid group Samaritan’s Purse; Nancy Writebol, one of Brantly's missionary coworkers, became infected at the same time and was flown to the same hospital.[49][50][51]
On 6 August 2014, the CDC moved its Ebola response to Level 1 (the highest on a scale from 1 to 6) to increase the agency's ability to respond to the outbreak.[52]

Other countries and international organizations

Senegal's Ministry of Interior has ordered all movements of people through the southern border with Guinea to be suspended indefinitely to prevent the spread of the disease, according to a statement published on 29 March by state agency APS.[53] Since 26 March, Mauritania closed all crossings along the Senegal River, the natural border between Mauritania and Senegal, except for the Rosso and Diama points of entry.
The humanitarian aid organisation Médecins Sans Frontières (Doctors Without Borders) has a team of 300 staff working in Guinea, Sierra Leone and Liberia, has set up specialist centers to give medical care to affected people, and has sent over 40 tonnes of equipment and supplies.[54] Samaritan's Purse is also providing direct patient care in multiple locations in Liberia.[55]
On 24 July, WHO's Director General met with agencies and donors in Geneva to facilitate an increase in funding and manpower to respond to the outbreak.[28]
On 30 July, Hong Kong's health authorities stepped up surveillance against the Ebola virus as a Hong Kong woman who fell ill after visiting Kenya tested negative for the disease. She was in stable condition in isolation.[56]
As of 1 August 2014, the Centers for Disease Control (CDC) has staff in Guinea, Sierra Leone, Liberia, and Nigeria to assist the local Ministries of Health and WHO-led response to the outbreak.[57]
As of 5 August 2014, British Airways has suspended all flights to and from Liberia and Sierra Leone until the end of August, due to fears surrounding the Ebola outbreak.[58]

Economic Community of West African States

On 30 March 2014, during the 44th Summit of the heads of state and government of West Africa, Economic Community of West African States (ECOWAS) disbursed US$250,000 to deal with the outbreak.[59] At the event in July of that year, the Nigerian government donated US$500,000 to the Liberian government to aid the fight against the virus.[60]
In July, the WHO convened an emergency sub-regional meeting with health ministers from eleven countries in Accra, Ghana.[61] On 3 July 2014, the West African states announced collaboration on a new strategy, and the creation of a World Health Organization sub-regional centre in Guinea "to co-ordinate technical support";[62] the centre was inaugurated in Conakry on 24 July.[63]
On 31 July, the WHO and West Africa nations announced $100 million in aid to help contain the disease.[64]

European Union

In March, the European Commission (EC) gave €500,000 to help contain the spread of the virus in Guinea and its neighbouring countries. The EC has also sent a health expert to Guinea to help assess the situation and liaise with the local authorities. EU Commissioner for International Cooperation, Humanitarian Aid and Crisis Response Kristalina Georgieva said: "We are deeply concerned about the spread of this virulent disease and our support will help ensure immediate health assistance to those affected by it. It's vital that we act swiftly to prevent the outbreak from spreading, particularly to neighbouring countries."[65]
In April, a mobile laboratory, capable of performing the molecular diagnosis of viral pathogens of risk groups 3 and 4, was deployed in Guinea by the European Mobile Laboratory project (EMLab) as part of the WHO/GOARN outbreak response. Prior samples were analyzed at the Jean Mérieux BSL-4 Laboratory in Lyon.[66]
Germany's Foreign Office issued travel warnings for all affected countries at the end of July.[67] Spain did so on August 2.[68]

Morocco

Beginning in April, Morocco reinforced medical surveillance at the Casablanca airport, a regional hub for flights from and to West Africa.[69][70] In early August, Liberian interior minister Morris Dukuly announced the Ebola death of a Liberian man in the country.[71] However, the Moroccan Ministry of Health announced that the person died of a heart attack, rather than Ebola.[72][73]

Philippines

The Philippine Department of Foreign Affairs has raised Alert Level 2 in Guinea, Liberia and Sierra Leone and has temporarily halted the sending of Filipino workers to the affected countries since June 30. Filipino seafarers are also cautioned about potentially contracting Ebola when their ship docks in affected countries.[74]
7 Filipino workers from Sierra Leone were monitored for Ebola symptoms; all were found to be clear of the disease.[75]
The Department of Health expressed its willingness to send medical workers to Ebola-affected countries to help contain the outbreak.[76]

In culture

"Ebola in Town", a dance tune by a group of West African rappers warning people of the dangers of the Ebola virus and explaining how to react, became popular in Guinea and Liberia in the first quarter of 2014.[77][78]

Containment

Efforts

Awareness campaigns in Freetown, Sierra Leone's capital, were delivered in August 2014 on the radio or through car loudspeakers.[79]

Complications

Difficulties faced in attempting to contain the outbreak include the outbreak's multiple locations across country borders,[17] inadequate equipment given to medical personnel,[80] funeral practices such as washing a body,[81] and reluctance among country people to follow preventive practices,[82] including "freeing" suspected Ebola patients from isolation,[24][83] and suspicion that the disease is caused by sorcery, or that doctors are killing patients.[84] In late July, the former Liberian health minister Peter Coleman stated that "people don't seem to believe anything the government now says."[35]
There was also an attack on aid workers who were hurrying to retrieve "freed" patients and did not explain to villagers who they were,[85] and the Red Cross were forced to suspend operations in Guinea after staff were threatened by a group of men armed with knives.[86] Demonstrations outside the main hospital treating Ebola patients in Kenema, Sierra Leone, on 25 July were broken up by police.[87]
Several healthcare workers have been infected. Among the fatalities is Samuel Brisbane, a former advisor to the Liberian Ministry of Health and Social Welfare whom British newspaper The Guardian described as "one of Liberia's most high-profile doctors".[88] Two American aid workers at a treatment center in Monrovia run by Serving In Mission /Samaritan's Purse have also been infected.[88][89] On 2 August, Kent Brantly, one of the two workers, was flown into Atlanta's Emory University Hospital for treatment, making him the first patient infected with EVD in the United States.[90] On 29 July, leading Ebola doctor Sheik Umar Khan from Sierra Leone died in the outbreak.[91][92]

Fatality rate

The infection and mortality data from Guinea, where new infections almost came to a standstill by 18 June, indicate a fatality rate of about 64%, which includes also cases of probable and suspected Ebola infections, as reported by the World Health Organization.[1] Guinea and WHO disagree on patient data, including mortality data.[93]

Virology


A researcher working with the Ebola virus while wearing a BSL-4 positive pressure suit to avoid infection
Main article: Ebola virus
The strain of virus affecting people in the current outbreak is a member of the Zaire lineage.[94]
Initial test results had suggested that the Zaire ebolavirus (EBOV) in Guinea was a different clade than the strains from outbreaks in the Democratic Republic of Congo and Gabon.[95] This result, however was contradicted by two subsequent reports.
The first of these reports reached the conclusion that the outbreak "is likely caused by a Zaire ebolavirus lineage that has spread from Central Africa into Guinea and West Africa in recent decades, and does not represent the emergence of a divergent and endemic virus".[96]
A second report published in June 2014 also supports the latter view, determining that it was "extremely unlikely that this virus falls outside the genetic diversity of the Zaïre lineage" and that their analysis "unambiguously supports Guinea 2014 EBOV as a member of the Zaïre lineage".[94]

Treatment


Researchers looking at slides of cultures of cells that make monoclonal antibodies. These are grown in a lab and the researchers are analyzing the products to select the most promising of them.
No ebola virus-specific treatment exists. Treatment is primarily supportive in nature and includes providing fluids, administration of anticoagulants and procoagulants, maintaining oxygen levels, pain management, and the use of medications to treat bacterial or fungal secondary infections.[97][98][99] Early treatment may increase the chance of survival.[100]
In August 2014 an experimental treatment was used for the first time in two humans. The treatment drug was referred to as ZMapp, an antibody response related therapy. The initial response appears positive. ZMapp was produced by MAPP Biopharmaceutical Inc. using a three-mouse monoclonal antibody, and transferred into tobacco plants (of the genus Nicotiana) for mass production.[101][102][103]

Economic effects

In addition to the loss of life, the outbreak is having an economic effect. In early April, Conakry's Palm Camayenne Hotel, which is popular among businessmen and politicians, reported that it had less than a third of occupancy rate. At the same time, Brussels Airlines flights from Brussels to Conakry experienced reduced passenger traffic, while flights in the reverse direction experienced heavier traffic, and regional airline Gambia Bird delayed the start of a route to Conakry after Senegal closed its border with Guinea because of the outbreak.[104]
Non-essential employees of British firm London Mining in Sierra Leone were transported out of the country in June following an outbreak of the virus. At the time, at least 50 suspected cases of Ebola with five deaths had been reported.[105]
The ongoing outbreak in Sierra Leone caused the closure of schools, markets, Kailahun's lone bank and stores.[106]

Timeline of the outbreak

A timeline of the outbreak follows, using data reported by the Centers for Disease Control and Prevention[6] and the World Health Organisation.[1] The table also includes suspected cases that are yet to be confirmed for the virus.
In addition to the cases and deaths listed in the table below, there has been one related death of a Liberian man in Morocco reported 1 August,[71] and a case of a Spanish missionary reported 5 August.[107]

Evolution of total cases and deaths.
Date of report Total Guinea Liberia Sierra Leone Nigeria
cases deaths cases deaths cases deaths cases deaths cases deaths
4 Aug 2014 1711 932 495 363 516 282 691 286 9 1
1 Aug 2014 1603 887 485 358 468 255 646 273 4 1
30 Jul 2014 1440 826 472 346 391 227 574 252 3 1
27 Jul 2014 1323 729 460 339 329 156 533 233 1 1
23 Jul 2014 1201 672 427 319 249 129 525 224

20 Jul 2014 1093 660 415 314 224 127 454 219

18 Jul 2014 1048 632 410 310 196 116 442 206

15 Jul 2014 964 603 406 304 172 105 386 194

10 Jul 2014 888 539 409 309 142 88 337 142

8 Jul 2014 844 518 408 307 131 84 305 127

2 Jul 2014 759 467 413 303 107 65 239 99

24 Jun 2014 599 338 390 270 51 34 158 34

18 Jun 2014 528 337 398 264 33 24 97 49

10 Jun 2014 474 252 372 236 13 9 89 7

5 Jun 2014 438 231 344 215 13 9 81 7

2 Jun 2014 354 208 291 193 13 9 50 6

27 May 2014 309 200 281 186 12 9 16 5

23 May 2014 270 181 258 174 12 9



14 May 2014 245 164 233 157 12 9



5 May 2014 243 162 231 155 12 9



30 Apr 2014 233 153 221 146 12 9



23 Apr 2014 220 143 208 136 12 9



21 Apr 2014 215 136 203 129 12 9



17 Apr 2014 209 129 197 122 12 9



10 Apr 2014 169 108 157 101 12 9



7 Apr 2014 163 102 151 95 12 7



2 Apr 2014 135 88 127 83 8 5



1 Apr 2014 130 82 122 80 8 2



31 Mar 2014 114 70 112 70 2 0



27 Mar 2014 103 66 103 66





26 Mar 2014 86 60 86 60





25 Mar 2014 86 59 86 59





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