The decline in confirmed cases of Ebola virus disease (EVD) has halted over the last three weeks. To accelerate the decline towards zero cases will require stronger community engagement, improved contact tracing and earlier case identification. In the week to 19 April, a total of 33 confirmed cases was reported, compared with 37 and 30 in the preceding weeks.
In the week to 19 April, Guinea reported 21 confirmed cases, compared with 28 cases the previous week. Sierra Leone reported 12 confirmed cases, compared with 9 cases reported the previous week. Liberia reported no confirmed cases.
A total of 4 Guinean prefectures reported at least one confirmed case in the week to 19 April, compared with 5 the previous week. Transmission remains confined to the west of the country and is primarily focused on the prefecture of Forecariah, bordering Sierra Leone, which reported 86% of national confirmed cases.
In Sierra Leone, Western Area Urban, which includes the capital Freetown, reported 6 confirmed cases, which represent half of the cases reported nationally, a slight increase from 4 cases the previous week. Koinadugu, which borders Guinea to the north, reported 1 new confirmed case of unknown origin. Other districts reporting new confirmed cases were Kambia (4 cases) and Port Loko (1 case) in the west of the country. In the week to 19 April, 4 districts reported at least one confirmed case compared to 3 districts the previous week.
Response indicators from Sierra Leone present a mixed picture. The number of EVD-positive deaths that were identified in the community after post-mortem testing was 3 (1 in Kambia, 1 in Western Area Urban, 1 in Koinadugu) in the week to 19 April and the percentage of new cases arising from known contacts was below 50% in the week to 12 April (44%). Laboratory indicators reflect heightened vigilance: large numbers of samples were collected (1467) and less than 1% these tested EVD-positive (12 of 1467 samples).
Response indicators for Guinea also present a mixed picture. A total of 6 deaths from EVD in the week to 19 April were identified post-mortem in the community compared with 8 deaths the previous week. The percentage of confirmed cases that arose among registered contacts remained below 50% for the third consecutive week, at 46% in week to 12 April (the most recent week for which data are available), but an increase on 29% reported in the previous week. Laboratory indicators improved with the number of laboratory samples tested increasing for a fifth consecutive week to 565 samples tested in the week to 19 April and the number of positive samples dropping to 6% compared to 10% the previous week.
Community engagement appears to be steadily improving in Guinea and Sierra Leone, but more needs to be done to identify all chains of transmission. A case-finding and community awareness-raising campaign took place in the Guinean prefecture of Forecariah from 12 to 15 April, identifying 12 new confirmed cases, 7 of these from post-mortem testing, representing 52% of confirmed cases reported in Forecariah during that period. A similar campaign is planned for the prefecture of Coyah (launch date 24 April) and later in Dubreka, Conakry, Kindia and Boffa.
The last confirmed case in Liberia died on 27 March and was buried on 28 March. Heightened vigilance is being maintained throughout the country. In the 5 days to 19 April, 212 new laboratory samples were tested for EVD, with no confirmed cases. Forty-two days will have elapsed since burial of the last confirmed case on 9 May.
There were no new health worker infections were reported in the week to 19 April.