SUMMARY
Human-to-human transmission directly linked to the 2014 Ebola virus disease (EVD) outbreak in West Africa was declared to have ended in Sierra Leone on 7 November 2015. The country then entered a 90-day period of enhanced surveillance to ensure the rapid detection of any further cases that might arise as a result a missed transmission chain, reintroduction from an animal reservoir, importation from an area of active transmission, or re-emergence of virus that had persisted in a survivor. On 14 January, 68 days into the 90-day surveillance period, a new confirmed cases of EVD was reported in Sierra Leone after a post-mortem swab collected from a deceased 22-year-old woman tested positive for Ebola virus. The woman died on 12 January at her family home in the town of Magburaka, Tonkolili district, and received an unsafe burial. In the preceding 2 weeks the woman travelled from Port Loko, where she was a student, via the districts of Kambia and Bombali before arriving in Magburaka on 7 January. Reports indicate that her symptoms during travel included vomiting and diarrhoea. The Sierra Leone Ministry of Health and Sanitation (MoHS), with the support of WHO and other partners, responded rapidly to the new case, identifying approximately 150 contacts of whom approximately 50 are deemed to be at high risk. Vaccination of contacts and contacts of contacts is underway under the authority and coordination of the Sierra Leone MoHS. However, the woman’s extensive travel history in the 2 weeks prior to her death, her presentation to and subsequent discharge from a health care facility at which health workers did not use personal protective equipment (PPE), her period of close contact with family whilst ill, and her unsafe burial indicate a significant risk of further transmission. One contact in Tonkolili remains to be traced. The origin of infection is under investigation.
Human-to-human transmission linked to the most recent cluster of cases in Liberia was declared to have ended on 14 January 2016. Guinea was declared free of Ebola transmission on 29 December 2015, and has now entered a 90-day period of enhanced surveillance that is due to end on 27 March 2016.
With guidance from WHO and other partners, ministries of health in Guinea, Liberia and Sierra Leone have plans to deliver a package of essential services to safeguard the health of the estimated more than 10 000 survivors of EVD, and enable those individuals to take any necessary precautions to prevent infection of their close contacts. Over 300 male survivors in Liberia had accessed semen screening and counselling services by 17 January 2016.
To achieve the second phase 3 response framework’s key objective of managing residual Ebola risks, WHO has supported the implementation of enhanced surveillance systems Guinea, Liberia and Sierra Leone to enable health workers and members of the public to report any case of febrile illness or death that they suspect may be related to EVD. In the week to 17 January, 876 alerts were reported in Guinea from all of the country’s 34 prefectures, with the most alerts (869) reports of community deaths. Over the same period 9 operational laboratories in Guinea tested a total of 316 new and repeat samples (16 samples from live patients and 300 from community deaths) from only 17 of the country’s 34 prefectures. In Liberia, 826 alerts were reported from all of the country’s 15 counties, most of which (725) were for live patients. The country’s 5 operational laboratories tested 861 new and repeat samples (718 from live patients and 143 from community deaths) for Ebola virus over the same period. In Sierra Leone 1271 alerts were reported from the country’s 14 districts. The vast majority of alerts (1106) were for community deaths. 1044 new and repeat samples (26 from live patients and 1018 from community deaths) were tested for Ebola virus by the country’s 7 operational laboratories over the same period.