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 of 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 case 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. Approximately 150 contacts associated with the case were listed in 4 districts; the total number of contacts currently under follow-up (as at 2 February) is 112. A number of contacts deemed to be at highest risk of developing EVD, including members of the close family of the index case, were transferred to voluntary quarantine facilities (VQFs) for the duration of their 21-day follow-up period. On 20 January, one of the contacts residing in a VQF in the district of Tonkolili developed symptoms and tested positive for Ebola virus. This second case in the cluster is the aunt of the index case, and cared for her during her illness. She was transferred to an Ebola treatment centre in Freetown, where she continues to receive treatment.
The 4 contacts who were residing in the same VQF as the most recent case at the time she became ill will remain under observation until 11 February, 21 days after their last possible exposure. All 108 other contacts associated with the index case will complete their 21-day follow-up period on 3 February. However, 48 of the 108 are yet to be traced, and efforts to locate them will continue for at least a further 21 days from 3 February. All 48 missing contacts, 18 of whom are high risk, were originally listed in Kambia.
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 have accessed semen screening and counselling services.
To achieve the second key objective of the phase 3 response framework of managing residual Ebola risks, WHO has supported the implementation of enhanced surveillance systems in 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 31 January, 1063 alerts were reported in Guinea from all of the country’s 34 prefectures, with the vast majority of alerts (1060) reports of community deaths. Over the same period 9 operational laboratories in Guinea tested a total of 346 new and repeat samples (14 samples from live patients and 332 from community deaths) from 17 of the country’s 34 prefectures. In Liberia, 1062 alerts were reported from all of the country’s 15 counties, most of which (925) were for live patients. The country’s 5 operational laboratories tested 1003 new and repeat samples (807 from live patients and 196 from community deaths) for Ebola virus over the same period. In Sierra Leone 1287 alerts were reported from the country’s 14 districts. The vast majority of alerts (1071) were for community deaths. 1059 new and repeat samples (76 from live patients and 983 from community deaths) were tested for Ebola virus by the country’s 7 operational laboratories over the same period.