SUMMARY
On 7 November WHO declared that Ebola virus transmission had been stopped in Sierra Leone. The country has now entered a 90-day period of enhanced surveillance, which is scheduled to conclude on 5 February 2016. Both Liberia and Sierra Leone have now achieved objective 1 of the phase 3 response framework: to interrupt all remaining chains of Ebola virus transmission. Guinea reported no confirmed cases in the week to 8 November. A total of 4 cases have been reported from Guinea in the past 21 days, all of whom are members of the same family from the village of Kondeyah, in the subprefecture of Kaliah in Forecariah. All 69 contacts currently being followed in Guinea are located in Kaliah and are scheduled to complete their 21-day follow-up period on 14 November. However, 60 of the contacts are considered to be high risk, and one contact from Forecariah has been lost to follow up with the past 42 days. Therefore there remains a near-term risk of further cases among both registered and untraced contacts.
Robust surveillance measures are essential to ensure the rapid detection of any reintroduction or re-emergence of Ebola virus disease (EVD) in currently unaffected areas, and are central to the attainment of objective 2 of the phase 3 response framework: to manage and respond to the consequences of residual Ebola risks. To that end, Guinea, Liberia, and Sierra Leone have each put systems in place to enable members of the public to report any case of illness or death that they suspect may be related to EVD. In the week to 8 November, 24 634 such alerts were reported in Guinea, with alerts reported from all of the country’s 34 prefectures. Equivalent data are not currently available for Liberia. In Sierra Leone, 1690 alerts were reported from 12 of 14 districts in the week ending 25 October (the most recent week for which data are available).
As part of each country’s EVD surveillance strategy, blood samples or oral swabs should be collected from any individuals with clinical symptoms compatible with EVD, and from any dead person aged 5 years and above who died within 14 days of onset of symptoms and for whom cause of death has not been determined. In the week to 8, November 9 operational laboratories in Guinea tested a total of 633 new and repeat samples from 12 of the country’s 34 prefectures. 89% of all samples tested in Guinea were swabs collected from dead bodies. By contrast, 79% of the 653 new samples tested in Liberia over the same period were blood samples collected from live patients. In addition, all 15 counties in Liberia submitted samples for testing by the country’s 4 operational laboratories. 1294 new samples were collected from all 14 districts in Sierra Leone and tested by 9 operational laboratories. 77% of samples in Sierra Leone were swabs collected from dead bodies.
470 deaths in the community were reported from Guinea in the week to 8 November. This represents approximately 20% of the 2248 deaths expected based on estimates of the population and a crude mortality rate of 11 deaths per 1000 people per year. All but 4 of the 470 reported deaths were buried safely. Equivalent data are not yet available for Liberia. In Sierra Leone, 1452 reports of community deaths were received through the alert system during the week ending 25 October (the most recent week for which data are available), representing approximately 70% of the 2075 deaths expected each week based on estimates of the population and a crude mortality rate of 17 deaths per 1000 people per year.