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Ebola Medicine ApprovedSeptember 27, 2014

The World Health Organization (WHO) has issued a report on “Experimental therapies” for Ebola.

It informs of interests and instances where convalescent blood and plasma and other experimental therapies were applied. However, data is limited and more studies are needed to establish the effectiveness of these therapies. In light of the worsening epidemic, WHO is consulting with experts to identify challenges related to rapid scaling up and implementation of convalescent therapies. “One great appeal of this drive to assess and introduce convalescent therapies is the opportunity to strengthen basic public health infrastructures by helping these countries develop good quality blood services.” 

Also, media sources quoted WHO officials anticipating availability of two experimental Ebola vaccines for small scale use by early 2015. The limited doses are likely to be offered to health care workers and frontline workers. Meanwhile, blood transfusion from Ebola survivors may be treated as an option for treatment.

The European Medicines Agency (EMA) is reviewing data on experimental Ebola treatment to help health authorities take “evidence based decision-making”.

WHO Roadmap: The  update reports a total of 6553 cases and 3083 deaths in the ongoing outbreak. It carries updates on current situation for all Ebola affected countries. Read more on country pages for Democratic Republic of Congo, Guinea, Nigeria, Liberia, Senegal and Sierra Leone

Aid: International Monetary Fund (IMF) plans to support Guinea, Liberia and Sierra Leone with funds over 125 million to deal with the social and economic crises caused by the Ebola outbreak. 

In a separate event, G-7 Foreign Ministers issued a joint statement pledging support to the affected countries. They also made an appeal to other countries to extend assistance for stopping Ebola.

France: A French nurse confirmed with Ebola is being treated with Favipiravir, an anti-viral drug. This medicine is a part of the three experimental drugs that the French government had authorized for import and use.

26 September
Sierra Leone:
Additional quarantine measures have been instigated; Port Loko, Bombali and Moyamba districts and other ‘hot spot’ areas are under isolation. The lastest situation update from the Ministry of Health reports at least 75 new lab-confirmed Ebola cases. Read more…

Spain:
The Spanish missionary who was evactuated from Sierra Leone has passed away on 25 September in Madrid. He contracted Ebola while working as the Medical Director of San Juan de Dios Hospital in Lunsar and was evactuated on 22 September after he became symptomatic. He is the second Spaniard to be infected and pass away during this Ebola outbreak.

United States: Dr Sacra, the third Ebola patient to be evacuated and treated in the US, has made a full recovery and was discharged from Nebraska Medical Centre on 25 September. While Dr Sacra was treated with the experimental drug TKM-Ebola and received plasma transfusions from survivor Dr Brantly, his doctors state there is too little data to know whether the treatments aided his recovery.

Cuba: Media sources have reported that Cuban health officials plan to send over 150 healthcare workers to West Africa to help in the Ebola outbreak. The healthcare workers are currently being trained on Ebola.

Germany: German officials plan to deploy about 2,000 army personnel in West Africa. A 300-bed mobile hospital will also be set up in Liberia.

25 September
Guinea: 
According to news sources, a Red Cross team was attacked in Forecariah, Guinea while handling dead bodies suspected to be infected with Ebola. It is reported that the Red Cross volunteers were injured and the team’s vehicles were vandalised.

DRC: The latest report from the United Nations Office for the Coordination of Humanitarian Affairs has revised the total number of cases downwards following a number of negative laboratory tests. Read more…

Sierra Leone: In a press release, health officials have expressed satisfaction at the end of the three-day stay at home “ose-to-ose ebola tok” campaign. Also, a new Ebola Treatment Unit will be established in Lunsar, Northern Province. Read more…

United States: 
The US Food and Drug Administration (FDA) has announced that “There are currently no FDA-approved vaccines or prescription or over-the-counter drugs to prevent or treat Ebola.” Three companies violating the FDA regulations have been issued warning notices. The firms were associated with promoting products which claim to cure or prevent Ebola infection.

US: The United States (US) Embassy at Ivory Coast conducted a two-day workshop in Abidjan as part of Ebola preparedness and response planning. Officials from ten African countries attended the workshop. In a separate event at the United Nations General Assembly, the US President Barack Obama has urged more countries to join in the fight against the Ebola outbreak.

WHO: In their latest Roadmap Situation Report #5, the World Health Organization includes more than 6,200 cases with 2,700 or more deaths. Guinea is comparably stable with around 3-15 new cases per week, in stark contrast to Liberia and Sierra Leone which have seen staggering numbers of cases in the last three weeks. Liberia’s 1,700 cases recorded in the past 21 days represent more than half of the nation’s total since the beginning of the outbreak. Further investigation into the number of infected healthcare workers (HCWs) in the three most severely affected countries reveals that, of over 370 HCWs, more than 200 have died.

Across Guinea, Liberia and Sierra Leone, around 730 new beds are due to be set up by international partners to add to the existing 820 or so beds in treatment centres. Although commendable, this effort will still leave more than 2,100 additional beds without any formal commitment to build additional capacity. Laboratory capabilities are also being strengthened to meet the diagnostic demand in Sierra Leone and Liberia.

24 September
WHO: The World Health Organization (WHO) has welcomed United Kingdom’s (UK) support towards the Ebola affected countries. Officials from the UK announced a donation of 700 hospital beds to Sierra Leone on 19 September. Two hundred beds are to be delivered very soon. British military engineers will continue to work with the Sierra Leone government to establish the new treatment centres.

Liberia: Clinical trials of Ebola treatments for the first time in West Africa will be commenced soon as per media sources. These will be funded by Wellcome Trust.

Sierra Leone: Media sources have quoted health officials planning an extension of lock-down so that cities such as Freetown and Kenema can be covered.

Spain: A missionary confirmed with Ebola has been taken back to Spain and currently admitted in Carlos III Hospital in Madrid. He is second Spanish patient flown to the country and his condition was described as serious.

A study published in the Lancet estimates the overall case fatality rate of the present Ebola outbreak is around 70%. The experts used 1976 distribution of Ebola outbreak and WHO reports on overall cases and deaths from all affected countries. They state that the current approach “…does not account for the delay between onset of Ebola symptoms and disease outcome (ie, recovery or death). ” The researchers warn that, “If the delay is longer than in 1976, this CFR could be even higher.”

23 September
CDC states “the number of cases in West Africa will rapidly reach extraordinary levels” without increased interventions – possibly over a million:
Using their modelling tool (callled EbolaResponse), the CDC predicts that case numbers could reach between 8,000 to 21,000 by the end of this month in Sierra Leone and Liberia unless effective interventions are scaled up. Right now, case numbers in the two countries combined doubling approximately every 20 days. Without additional interventions and a change in community behavior, CDC says there could be 550,000 – 1.2 million cases by early 2015. To even begin being effective, preventative efforts would need to place at least 70% of all people who have Ebola in a medical facility or other environment where they are unlikely to spread the disease to others. This includes implementing safe burial methods.

Each month that we fail to achieve that goal, daily cases would likely triple. Officials are thus working to increase facilities and other settings in which Ebola patients can minimize their contact with uninfected people, which also requires stocks of supplies and staff to run them. If such facilities can be implemented quickly, and sustained, then the CDC states “the higher projections presented in this report become very unlikely.”

Switzerland:  A nurse working for an international organization in Sierra Leone has been flown to Switzerland and admitted at the University Hospital of Geneva (HUG). He was bitten by a child infected with Ebola. The risk of infection is assumed to be low because the nurse was wearing full personal protective equipment (PPE) at the time of the injury and the bite did not result in a visible wound. Initial tests for Ebola on the healthcare worker were negative, however, he will be observed for three weeks.

Nigeria: According to news sources, some states in Nigeria re-opened schools on 22 September. Authorities have taken steps to train teachers, screen young children and educate parents in an attempt to prevent any further Ebola cases. Lagos and a number of other states have postponed the start of the school year until October.

Sierra Leone: A three-day nationwide lockdown has ended, and media reports say there are more than 200 dead bodies and 150 new cases uncovered. The World Health Organization reports there are 105 new confirmed cases. A recent house-to-house sensitisation campaign is reported to have reached 80% of households nationwide.  Read more…

WHO outbreak summaries: 6 months in: The World Health Organization has released country-specific overviews of the Ebola outbreak, six months after it began in Guinea. The outbreak in Guinea, Liberia, and Sierra Leone began approximately half a year ago and has progressed differently in all three nations. Each country page has more specific details posted.

In Liberia, the country WHO calls “by far the most worrisome”, case counts are climbing “exponentially”. Health services are far beyond overwhelmed; even basic services are largely unavailable and the country’s already-limited medical staff is being infected with Ebola at alarming rates. Large numbers of Ebola patients are turned away from overcrowded treatment facilities, which means not only that they are left ill and suffering but that they can spread the disease further in the community.

In Guinea, WHO highlights terror-induced violence as a major barrier to disease control efforts and states the prospects that the outbreak will come under control are “not good at all”.

In Sierra Leone, as in Guinea, the outbreak spread rapidly once it began and reached major and capital cities. The nation needs more facilities for Ebola patients and staff to care for them. As elsewhere, the outbreak has taken a heavy toll on the nation’s healthcare workers.

Nigeria and Senegal have been called “stable – for the moment.” Both handled their imported cases as quickly as they could and appear to have limited the outbreak within their borders.

Aid and support: Several organisations have extended donations to control Ebola outbreak. These include the African Development Bank (ADB), EuropeAid, Clinton Global Initiative and Irish Aid.

UNMEER: The first UN Mission for the fight against Ebola (UNMEER) teams have reached Accra, Ghana and a location in Liberia to set up operations. The mission was established by the UN Secretary General and will have its headquarters in Accra. It aims to contain the Ebola outbreak by treating people, helping with basic services and preventing spread to unaffected areas.

Outlook: A newly-published article in the New England Journal of Medicine (NEJM) reviews the previous nine months of the West Africa Ebola outbreak and issues stark warnings about the future of the disease. The researchers found that the virus’s current ability to spread is largely similar to that of previous epidemics. However, the scale of the West Africa outbreak is much larger than any other Ebola epidemic in history. The authors say the size of this outbreak is related to the attributes of the populations affected (both urban and highly interconnected) and the inability of the healthcare systems to control the spread in the under-resourced nations. They project that, without a significant change in control efforts, more than 20,000 people will have been infected by 2 November.

The authors conclude: “Notwithstanding the geographic variation in case incidence within and among Guinea, Liberia, and Sierra Leone, the current epidemiologic outlook is bleak. Forward projections suggest that unless control measures — including improvements in contact tracing, adequate case isolation, increased capacity for clinical management, safe burials, greater community engagement, and support from international partners — improve quickly, these three countries will soon be reporting thousands of cases and deaths each week, projections that are similar to those of the Centers for Disease Control and Prevention.”

The WHO follow-up to the NEJM study highlights the need for access to supportive care quickly after developing symptoms. They acknowledge that the current systems are overwhelmed and in dire need of international support.

22 September
Sierra Leone
: The latest WHO report states there are 22 new confirmed cases. There are road closures and houses under quarantine in Moyamba district after an increased risk of Ebola spread following a local burial. Media sources are reporting more than 70 newly-identified dead and over 130 new Ebola cases following the recent shut down. Read more… 

Nigeria: Authorities have confirmed that schools in Lagos state will re-open on 8 October. All schools in the country were closed after a state of emergency to contain Ebola was declared in August. Read more

WHO: The World Health Organization has issued a statement following a second meeting of the International Health Regulations Committee regarding the Ebola outbreak. Flight restrictions has led to economic difficulties and slowed humanitarian response. WHO reiterated that there should be no generalised bans on travel, save for earlier recommendations about restricting the travel of Ebola cases and their contacts.

ECDC: The European Centre for Disease Control and Prevention has issued renewed guidelines (PDF) for the assessment and planning of medical evacuation for Ebola cases.

21 September
UN:
The United Nations has issued a fact sheet (pdf), ‘Global Response to Ebola Crisis’. It states that the Ebola outbreak is “no longer a public health crisis; it is a complex emergency, with significant, social, economic, humanitarian, political and security dimensions”. It outlines a strategy to allow the “UN and the international community . . .to implement a robust and effective response to help the Governments and the people of Guinea, Liberia, Sierra Leone”. The strategy is built on five pillars:

  • Stop the outbreak
  • Treat the infected
  • Ensure essential services 
  • Preserve stability
  • Prevent further outbreaks

Spain: The religious order San Juan de Dios has announced that one their Brothers, the Medical Director of the San Juan de Dios Hospital in Lunsar, Sierra Leone has Ebola. He has been receiving treatment at an Ebola treatment centre in Freetown but asked to be repatriated to Spain.

Sierra Leone: News sources report that a team burying Ebola victims was attacked in Freetown during the 3-day lockdown.

20 September
WHO:
The World Health Organization has welcomed the decision to establish United Nations Mission for Ebola Emergency Response. The mission will bring together the vast resources of the UN agencies, funds and programmes to reinforce WHO’s technical and expertise and experience in disease outbreaks. 

UN: The UN is sending a UN Disaster Assessment and Coordination (UNDAC) team comprised of experts from the UN Office for the Coordination of Humanitarian Affairs (OCHA), European Union (EU) and the Liberian Government to Liberia to assess the response to the Ebola outbreak.

The Security Council yesterday concluded that the outbreak posed a threat to peace and security. The UN Secretary General announced the establishment of the UN Mission for Ebola Emergency Response (UNMEER). The mission is the first in UN history to address a public health threat. The Mission will be coordinated in Accra, Ghana and will bring together the collective assets of the UN and work closely with the Governments in Guinea, Liberia and Sierra Leone. Dr David Nabarro, the UN Secretary General’s Senior Coordinator for the Ebola Response said “The number of cases have doubled in these countries in the last three weeks. To get in front off this, the response must be increased 20-fold from where it is today.”

Sierra Leone: In the latest situation update from the World Health Organization, 33 new cases were confirmed. Read more… 

Nigeria: News sources are reporting that the last suspected patient in Lagos has completed surveillance and tested negative for Ebola.

France: The French MSF staff member who caught Ebola while working in Liberia has arrived in Paris and is receiving treatment in a military hospital. It is not clear what treatment she is receiving. France’s Ministry of Health has authorized the import and use of 3 experimental drugs.

19 September
Guinea:
Media sources are reporting that eight bodies have been found following the attack on a health team near Nzerekore on 16 September.

Sierra Leone: The three-day nationwide stay-at-home campaign has begun, following an address by the President on 18 September. The campaign will finish on Sunday 21 September. Read more…

Nigeria: Media sources report that school teachers are being trained on early detection and management of Ebola cases before school resumes in September.

France: Officials have announced that the country will assist in setting up a military hospital in Guinea to treat Ebola patients.

WHO: Dr Margaret Chan addressed the UN Security Council in New York on 18 September, highlighting that the current Ebola outbreak in West Africa “is a social crisis, a humanitarian crisis, an economic crisis, and a threat to national security” in need of urgent international support.

UN: Following an exceptional meeting of the Security Council, the United Nations has renewed calls to lift regional flight bans and end travel restrictions imposed in the light of the West African Ebola outbreak.

UK: Public Health England has updated its risk assessment (PDF) for the West Africa Ebola outbreak, including current advice for health professionals. The overall risk assessment for England is unchanged and remains “very low”.

18 September
WHO:
 In its Ebola Response Roadmap Situation Report #4, WHO reports the total number of cases (confirmed, probable and suspected) is up to 5335 cases, with 2622 deaths. WHO states: “the upward trend continues in the three countries with widespread and intense transmission (Guinea, Liberia and Sierra Leone). The number of new cases reported from Guinea was stable and Dalaba prefecture is newly affected. Liberia remains the worst affected country, the surge in cases is primarily due to increased cases reported in its capital Monrovia. Maryland county is newly affected. In Sierra Leone the number of new cases is still rising, with high transmission in and around the capital, Freetown, and several districts reporting increased new cases.”

The World Bank Group has approved a grant of US$105 million to Ebola-affected Liberia, Sierra Leone and Guinea. The grant is part of Ebola emergency mobilisation, a joint response led by the United Nations and the World Health Organization.

Guinea: A group of health workers were attacked while they were visiting a remote area in Nzerekore. The group was conducting an information campaign on Ebola. According to media, some of the staff are missing.

Nigeria: Social mobilization efforts, such as education campaigns, are being conducted door-to-door and in public places.

France: Medecins Sans Frontieres (MSF) have announced that a French staff member working in Liberia has tested positive for Ebola. The nurse has been in isolation since she developed a fever on 16 September and she will be evacuated for treatment in France. This is the first time one of MSF’s international staff members have caught the disease. Investigations into how she became infected are underway. Seven national MSF staff members have contracted the virus. Three of them died.

MSF: During the United Nations Member States Briefing on the Ebola outbreak and response, the International President of MSF reiterated that the window of opportunity to contain the Ebola outbreak is closing. She said that MSF was being forced to deny admission to many Ebola-infected people as treatment centres are full. “With every passing week, the epidemic grows exponentially. With every passing week, the response becomes all the more complicated.”

Liberia: The ELWA3 Ebola treatment centre in Monrovia will not be accepting any new patients until investigations are complete into how a French nurse volunteering with Medecins Sans Frontieres became infected.

Sierra Leone: The 59 person Chinese laboratory and medical team have arrived in country. Media sources have also reported that the burial teams are unable to keep up with the number of deaths. 

In the latest update from the Ministry of Health, 29 new confirmed cases were reported. Read more…

 

 

Related:

WHO | Ebola virus disease – World Health Organization

background document potential ebola therapies and vaccines

Anecdotal evidence about experimental Ebola therapies

WHO | Situation reports: Ebola response roadmap

Resources:

Ebola in Africa
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Latest News
–Imported cases
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Outbreak overview
Affected countries
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–Senegal
–Sierra Leone
–Ebola Charts
Ebola Facts
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–Symptoms
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–Treatment
–Case definitions
FAQ
Travel Advice
Travel security advisories – Flight bans and closures
Medical evacuation statement
Education Materials
Webinar recordings
Useful Links
Ebola Risk Management for Organisations
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