• November 21, 2014

Disease outbreak news 19.11. 2014

The total number of 15,145 cases and 5,420 deaths (35.8% mortality) in the six currently affected countries (Guinea, Liberia, Sierra Leone, Spain, the United States and Mali) and in countries where the epidemic is finished (Senegal and Nigeria) . There is still a problem with the total number of malaria cases and deaths in this epidemic since not all cases are reported.

WHO officially declared completed outbreaks of Ebola in Senegal (on 17/10/2014) and Nigeria (10/19/2014).

According to the activity of the virus and the prevalence of the disease, currently occupied countries are divided into three categories: countries with wide-spread and intense transmission (Guinea, Liberia and Sierra Leone); countries to a few cases or localized transmission (Spain, USA and Mali); and countries that are neighbors and have strong trade ties with countries with active transmission.

Countries with wide-spread and intense transmission

Since the beginning of the epidemic so far, reported a total of 15 113 (probable, confirmed and suspected) cases and 5406 deaths from the Ministry of Health of Guinea, Sierra Leone and Liberia (Table 1).

Table 1. Confirmed, probable, and suspicious deaths of Ebola virus in Guinea, Liberia, Nigeria and Sierra Leone, to November 19, 2014

Country Case Definition  diseased  Cases in the last 21 days  deaths
Guinea  confirmed 1.698 308 982
Probable 210 7 210
Suspicious 63 * 0
Вкупно 1.971 315 1.192
Liberia confirmed 2.643 340 *
Probable 1.762 192 *
Suspicious 2.664 * *
Total  7.069 532 2.964
Sierra Leone confirmed 5.056 1.389 1.041
Probable 79 5 174
Suspicious 938 * 35
Total  6.073 1.349 1.250
Total 15.113 2.241 5.406

* Not available.

  • Transmission of EVB Guinea persisted, although the incidence has stabilized or decreased in some areas. Registered 74 new confirmed cases reported in Guinea, in the last week (Figure 1).
  • The number of cases in Liberia after weeks, decreased from mid-September to late October. Liberia reported 80 confirmed and probable cases in the last week. Nationally, on average, between 10 and 20 laboratory-confirmed cases are reported every day. In terms of the trend, there has been a decline followed by stabilization and reaching a plateau in the last 4 weeks (Figure 1).
  • Transmission of EVB remains high in Sierra Leone, with 533 new confirmed cases reported during the last week. Many of these cases were reported in the western and northern part of the country (Figure 1).
  • In Guinea and Liberia to the national level, the incidence does not increase more, but still increasing in Sierra Leone. Epidemics in Guinea and Liberia exist due to intense transmission in several key areas, while the transmission is intense in the northern and western parts of Sierra Leone.
  • The response to the epidemic of EVB continues in the three most affected countries. Over 1,000 beds now operational in 18 Ebola-treatment centers. As this number increases, so does the capacity for isolation of patients, thus preventing further transmission of the disease. The capacity to implement the funerals of people who died from EVB safe and dignified manner, is a key part of the process of stopping the transmission. More than 4,800 safe and dignified funerals are organized from the beginning of the epidemic. Accurate and timely laboratory diagnosis of EVB cases is also an integral part of the response to this epidemic. Samples from all 53 EVB-affected areas of the three most affected countries, can be transported to a laboratory for testing within 24 hours of taking the sample.

Countries with a few cases or localized transmission

Five countries – Nigeria, Senegal, Spain and the US Small previously reported one or more cases imported from a country with widespread and intense transmission.

In Nigeria, were registered 20 cases and 8 deaths. In Senegal, was registered only one case. However, after the successful response to the epidemic in both countries, the WHO officially declared completed outbreaks of Ebola in Senegal (10/17/2014) and Nigeria (19/10/2014).

In Mali, were  reported total of 6 cases (5 confirmed and one probable), and 5 deaths (4 confirmed, one probable). Recent cases have been reported in the capital Bamako and were not associated with EVB first case in the country. All identified contacts associated with the primary event completed the 21-day follow-up. By November 16, 2014, were identified and monitored a total of 384 contacts; 96 of 384 contacts are health workers.

In Spain passed 28 days from the day to the affected nurse caring for the patient with Ebola in Madrid, obtained two negative results and is discharged from hospital. Spain will be declared free from EVB 42 days after the second negative test if no new reported cases. All 83 contacts nurse completed the 21-day follow-up.

In the United States, are registered four cases and one death. A health worker in New York and two in Texas are negative for Ebola, after double testing,are released from the hospital home care. All contacts in the country completed the 21-day follow-up.

Table 2. Cases of Ebola virus disease in Nigeria, Senegal, Spain, USA and Mali

Country  Case Definition Diseased  deaths
Nigeria confirmed 19 7
Probable 1 1
Suspicious 0 0
Вкупно 20 8
Senegal confirmed 1 0
Probable 0 0
Suspicious 0 0
Total 1 0
Mali confirmed 5 4
Probable 4 1
Suspicious 0 0
Total 6 5
USA confirmed 4 1
Probable 0 0
Suspicious 0 0
Total 4 1
Spain confirmed 1 0
Probable 0 0
Suspicious 0 0
Total 1 0
Total   32 14

  Annex 1. Status of EVB in DR Congo

 By November 19, 2014, are registered 66 cases (38 confirmed, 28 probable) of Ebola virus disease (EVB) in the Democratic Republic of Congo, including eight of healthcare workers. Total reported 49 deaths, including eight of healthcare workers. The results of the latest suspected case is not known.

This epidemic is not related to the epidemic in Western Africa (Guinea, Liberia, Nigeria, Senegal, Sierra Leone and Mali) and Spain and the United States.

  Annex 2. EVB for health workers

The exposure of healthcare workers EVB during this epidemic continues to be alarming. So far, 584 health workers developed EVB, and of them, 329 health workers have died as a result of EVB (56.3%). This number included two health workers from Mali (of which one died), 11 in Nigeria, one in Spain and three in the United States. Over the last week, eight health workers have been reported in Liberia and Sierra Leone in 3. Continue research on exposure of healthcare workers.

 Annex 3. Criteria used to classify cases of Ebola

 Ebola cases are classified as: confirmed (any suspicious or probable case of positive laboratory result); probable (every suspected case evaluated by a doctor or any deceased suspected case that has an epidemiological link with the confirmed case, when it is not possible to take samples for laboratory confirmation); or suspicious (any person, alive or dead, who had a sudden onset of high fever and had contact with the suspect, probable or confirmed case of Ebola or dead or sick animals, or any person with sudden onset of high fever and at least three of the following symptoms: headache, vomiting, anorexia / loss of appetite, diarrhea, lethargy, abdominal pain, sore muscles or joints, difficulty swallowing, difficulty breathing, or any person with unexplained bleeding or sudden, unexplained death) .

The total number of cases is subject to change due to reclassification, retrospective investigation, consolidation of cases and laboratory data and improved surveillance. The data published in the report are based on available information reported by Ministries of Health.

Figure 1. Distribution of EVB cases in West Africa after weeks

mapa ebola

(Source: ECDC – Epidemiological update: outbreak of Ebola virus disease in West Africa, 14.11.2014)