3 April 2016

Liberia: Guinea Source of Latest Liberia Outbreak As Second Case Confirmed

Photo: UNICEF / Tanya Bindra
Volunteer in Freetown go door-to-door to educate residents about the modes of transmission of Ebola (file photo).

Monrovia — Liberia has confirmed a second case of Ebola making, bringing to two the number of infections in the latest resurgence of the deadly virus.

Tolbert Nyensuah, Deputy Minister of Health and Social Welfare told FrontPageAfrica Sunday that the son of the index case in the latest resurgence, a deceased 30-year-old woman, has now been confirmed with Ebola and is being treated at a unit in Monrovia. "Both are from the same cluster and family", the Minister said.

Minister Nyensuah said 99.9 percent contact tracing additional contacts will be added or drop after re-clarification.

"Ten health care workers where the index case died under voluntary precautionary observations. Liberia triggers its huge response capacity to properly handle the latest flare up of EVD. Calling on citizens and residents to be calmed but take prevent measures, report sick people, wash hands, report dead body for swabbing that's how the index case was discovered."

Guinea Likely Source, Again

The Minister also revealed that there is strong indication that the index case came from Guinea on 21 March 2016 when the border was closed with Guinea. "She travelled to Monrovia with her 3 children the 5 years old is sick and confirmed of EVD. We are investigating in both Guinea and Liberia how she entered but knowing the porous borders we are not suppressed. She entered Liberia before getting sick or manifesting signs and symptoms of Ebola."

March 21st was the same day Liberia announced that it was shutting down its borders to curb the spread of the virus out of Guinea. Liberia was declared free of new transmissions of the virus in January. "We have ordered the border with Guinea closed with immediate effect," Mr. Nagbe said. "The border will remain closed until the situation in Guinea improves. We are not taking any chance at all."

In March 2014, a rapidly evolving outbreak of Ebola haemorrhagic fever started in Guinea. The outbreak subsequently spread to Liberia, Sierra Leone, Nigeria, Senegal, and Mali. 1 Aug 2014: WHO and the government of Sierra Leone, Guinea and Liberia launched a joint US$ 100 million response plan. On March 29, 2016, WHO terminated the Public Health Emergency of Concern for the Ebola outbreak in West Africa.

According to WHO's March 30, Situation Report, a cluster of 2 confirmed and 3 probable cases of Ebola was reported on March 17 in Guinea. Three more confirmed cases were reported on March 21, 26, and 28, respectively. Viral sequencing data indicate that virus present in one of the confirmed cases is closely related to virus that circulated in south-eastern Guinea in November 2014.

WHO first declared Liberia free of Ebola virus transmission on May 9, 2015. The country subsequently experienced a cluster of six Ebola cases in June 2015 and was declared free of transmission again on September 3, 2015.

A second cluster of three cases was reported in November 2015, and WHO declared the country free of transmission for the third time on January 14, 2016. In these countries, which previously had locally acquired or imported Ebola cases, at least 42 days (two incubation periods) have elapsed since the last day that any person in the country had contact with a person with confirmed Ebola.

The Ebola virus has killed about 11,300 people in the two countries plus Sierra Leone since late 2013. New cases have dwindled virtually to zero, but the World Health Organization has warned of flare-ups, or emerging clusters, of new cases.

Survivors' After Effect

Last Friday, Liberia announced a new case of the virus which was later confirmed by the World Health Organization(WHO) that a 30-year-old woman had died last Thursday at the Redemption Hospital and immediately began to identify people who may have come into contact with her.

Liberia's neighbour Guinea, which had been declared free of Ebola in December, also has been confronting a new cluster of cases that first emerged in February. Guinean health authorities had been using an experimental vaccine in an effort to contain that flare-up, injecting nearly 800 people who have come into contact with the eight known patients, all in two southern prefectures.

At the same time, the organization warned that small flare-ups of Ebola were likely in the coming months because of its persistence in some survivors, and said that the three countries "must maintain strong capacity to prevent, detect and respond to further outbreaks." The organization has maintained a staff of nearly 1,000 in the region to help if needed.

The 30-year, according to an update from the National Emergency Operation Center Incident Management System, arrived in Monrovia on March 21, 2016 with her three children, ages 7, 3, and 3(twins) during the period when the border between Liberia and Guinea was closed.

"She temporarily resided for a day in a rooming house at the Soul Clinic area in Paynesville. Recognizing that there is an EVD outbreak in Guinea, the landlord asked her to leave the following day, March 22nd).

'Pretense': Family Concealed Ebola Death

According to the report, the woman then moved to the Somalia Drive, SKD Boulevard in the Swankmore Community in Paynesville, Central Monrovia District, Montserrado County.

The woman, according to the Incidence Management Team report, resided there for a week before manifesting symptoms of weakness and bloody Diarrhea on March 28. "On March 30, 2016, she was taken by taxi to public hospital in Paynesville and refused admission because it was maternal ward hospital only.

She went in the same taxi, to a private facility called the Ma Watta Clinic in Jacob's Town, Paynesville where she was admitted overnight and received IV fields. On March 31st, she died at the facility and was transferred by the same taxi with her sister to Redemption Government Hospital in New Kru Town under the pretense that she was still alive."

At Redemption, the report notes, she was pronounced dead on arrival. "On the same day, lab tests in the corpse confirmed EVD. Further investigation on possible source of infection is ongoing. Before the PCR result was confirmed less than 24 hours, the response was triggered."

The National Incidence team immediately convened a meeting at the Emergency Operations Center(EOC) on April 1, 2016 to address all issues pertinent to a rapid response toward containment and the ministry of health immediately issued an official press release confirming a positive case on April 1, 2016.

The Montserrado County 9 Coordination has since been reactivated and mechanisms put in place for a rapid and effective response. The County EOC at Duport Clinic held its first meeting on Friday, April 1, 2016.

48 Contacts Identified

Authorities say a total of 48 contacts have been identified and lined listed including nine members of the community, 17 from the household and 11 healthcare workers. Among these, 28(including 11 healthcare workers and 17 family members are considered as high risk. All Contacts have been seen (99 percent contact tracing) and additional contact tracing is underway.

At least four family members of the index case are currently in the Ebola Treatment Unit at ELWA - 3 and the Incidence Manager is urging all partner organizations to coordinate through the County Health Officer as the only conduit.

"There will be one comprehensive listing of all personnel activated for response activities by all government and partner agencies, so as to avoid duplication and harmonize payment measures.

Eleven response pillars have been reactivated and the pillar leads tasked with coordination of respective thematic areas. Key interventions including contact tracing and active case finding; WASH infection prevention and control (IPC), dead body management, psychosocial."

Authorities say support and social mobilization have been reactivated and intensified voluntary precautionary observation of high risk contacts have been initiated but are cautioning and encouraging the public not to panic.

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