A total of 30 confirmed cases of Ebola virus disease (EVD) were reported in the week to 5 April. This is the lowest weekly total since the third week of May 2014. Case incidence in Guinea decreased to 21, compared with 57 confirmed cases the previous week. Liberia reported no confirmed cases. Sierra Leone reported a fifth consecutive weekly decrease from 25 confirmed cases in the week to 29 March to 9 in the week to 5 April.
A total of 6 Guinean prefectures reported at least one confirmed case in the week to 5 April, compared with 7 the previous week. Affected prefectures were in the western area, around and including the capital, Conakry. In total, 10 prefectures/districts in Guinea and Sierra Leone reported a confirmed case in the week to 5 April, compared with 12 the previous week. Of 55 districts in Guinea, Liberia, and Sierra Leone that have reported at least one confirmed case of EVD since the start of the outbreak, 35 have not reported a case for over 6 weeks.
In the context of falling case incidence and a receding zone of transmission, treatment capacity exceeds demand in Liberia and Sierra Leone. Accordingly, and with technical guidance from WHO, national authorities in both countries have begun to implement plans for the phased safe decommissioning of surplus facilities. Each country will retain a core capacity of high-quality Ebola treatment centres, strategically located to ensure complete geographic coverage, with additional rapid-response capacity held in reserve.
Response indicators for Guinea continue to present a mixed picture. Of 19 confirmed deaths from EVD in the week to 5 April, 7 (37%) were identified post-mortem in the community, compared with 15 of 35 (43%) the previous week. However, 21 unsafe burials were reported over the same period, compared with 20 the previous week. The proportion of confirmed cases that arose among registered contacts decreased slightly, from 53% in the week to 22 March to 48% in week to 29 March. Taken together these data indicate that though surveillance is improving, unknown chains of transmission could be a source of new infections in the coming weeks.
In Sierra Leone, cases were reported from 4 western districts: Kambia (2 cases), Port Loko (1 case), Western Area Rural (1 case), and Western Area Urban (5 cases), which includes the capital, Freetown.
Sierra Leone reported zero cases on 3 days during the week to 5 April. The absence of any reported unsafe burials over the same period, the low proportion of all EVD-positive deaths (3 of 32: 9%) that were identified in the community after post-mortem testing, and the low proportion of laboratory samples that tested EVD-positive (10 of 1524: 1%) over the same period strengthen confidence that the downward trend in case incidence will be continued. However, the proportion of cases that arose among registered contacts fell for the second consecutive week to 56% in the week to 29 March (the most recent week for which data are available), suggesting that challenges remain.
The last confirmed case in Liberia died on 27 March. Investigations are ongoing to establish the origin of infection. A total of 332 contacts associated with the case are being monitored. Heightened vigilance is being maintained throughout the country. In the week to 29 March, 310 laboratory samples were tested for EVD, with no confirmed cases.
There were no new health worker infections in the week to 5 April, with the cumulative total remaining at 861 since the start of the outbreak. In accordance with the 45-day reinforcement of emergency measures declared in western Guinea, several private clinics have been closed after EVD cases were treated on the premises.