SUMMARY
Three new confirmed cases of Ebola virus disease (EVD) were reported in the week to 25 October, all of which were reported in Guinea. The country also reported 3 cases the previous week. All 3 new cases are from the same household in the subprefecture of Kaliah, Forecariah, and are registered high-risk contacts linked to a case from the same area last week. There are currently 364 contacts under follow-up in Guinea (an increase from 246 the previous week), 141 of whom are high-risk. An additional 233 contacts identified during the past 42 days remain untraced. Therefore there remains a near-term risk of further cases among both registered and untraced contacts. Sierra Leone reported zero cases for a sixth consecutive week, and will be declared free of EVD transmission on 7 November if no further cases are reported.
Case incidence has remained at 5 confirmed cases or fewer per week for 13 consecutive weeks. Over the same period, transmission of the virus has been geographically confined to several small areas in western Guinea and Sierra Leone, marking a transition to a distinct, third phase of the epidemic. The phase-3 response1 coordinated by the Interagency Collaboration on Ebola2 builds on existing measures to drive case incidence to zero, and ensure a sustained end to EVD transmission. Enhanced capacity to rapidly identify a reintroduction (either from an area of active transmission or from an animal reservoir), or re-emergence of virus from a survivor, and capacity for testing and counselling as part of a comprehensive package to safeguard the welfare of survivors are central to the phase-3 response framework.
The 3 new confirmed cases reported in the week to 25 October are members of the same family and household in the village of Kondeyah, in the subprefecture of Kaliah, Forecariah. The cases are a 25-year-old woman who is 7-months pregnant, and her 10-year-old son and 4-year-old daughter. All are currently receiving treatment. They are the seventh, eighth, and ninth cases in the Forecariah branch of the Ratoma transmission chain. The branch was initiated after a 10-year-old girl who was not a registered contact travelled from Ratoma to Forecariah to seek treatment from several traditional healers who later became ill and were confirmed as EVD-positive. Of 364 contacts under follow-up in Guinea on 25 October, 43 were located in Conakry with 321 located in Forecariah. The 3 new cases have generated 55 high-risk contacts in Kondeyah.
In Sierra Leone, all contacts linked to the country’s 2 most recently active chains of transmission, Bombali and Kambia, have completed 21-day follow-up. The last case to receive treatment was confirmed free of EVD after a second consecutive negative test on 25 September. The country will be declared free of EVD transmission on 7 November if no further cases are reported.
Robust surveillance measures are essential to ensure the rapid detection of any reintroduction or reemergence of EVD in currently unaffected areas. Nine operational laboratories in Guinea tested a total of 644 new and repeat samples in the week to 25 October. In Liberia, 1038 new and repeat samples were tested over the same period in the country’s 4 operational laboratories. 1389 new samples were collected in Sierra Leone (the fourth consecutive weekly decrease) and tested by 9 operational laboratories.