Sierra Leone + 2 more

Emergency Appeal Operation Update Ebola Virus Disease Emergency Appeals (Guinea, Liberia, Sierra Leone and Global Coordination & Preparedness) Update No. 29

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Current epidemiological situation + country-specific information

The second week of January 2016 marked the first time since the beginning of the Ebola epidemic in West Africa when all three of the worst-hit countries had gone 42 days without a single new case. Yet the next day, another case was reported in Sierra Leone.

According to the WHO Ebola Situation Report of 20 January 2016, human-tohuman transmission directly linked to the 2014 Ebola Virus Disease (EVD) outbreak in West Africa was declared to have ended in Sierra Leone on 7 November 2015.

The country then entered a 90-day period of enhanced surveillance to ensure the rapid detection of any further cases that might arise as a result of a missed transmission chain, reintroduction from an animal reservoir, importation from an area of active transmission, or reemergence of virus that had persisted in a survivor.

On 14 January 2016, 68 days into the 90-day surveillance period, a new confirmed case of EVD was reported in Sierra Leone after a post-mortem swab collected from a deceased 22-year-old woman tested positive for the EVD. The woman died at her family home in the town of Magburaka, Tonkolili district, and received an unsafe burial. In the preceding 2 weeks the woman travelled from Port Loko, where she was a student, via the districts of Kambia and Bombali before arriving in Magburaka on 7 January.

Reports indicate that her symptoms during travel included vomiting and diarrhoea. The Sierra Leone Ministry of Health and Sanitation (MoHS), with the support of WHO and other partners, responded rapidly to the new case, identifying approximately 150 contacts of whom approximately 50 are deemed to be at high risk. Vaccination of contacts and contacts of contacts is underway under the authority and coordination of the Sierra Leone MoHS. However, the woman’s extensive travel history in the 2 weeks prior to her death, her presentation to and subsequent discharge from a health care facility at which health workers did not use Personal Protective Equipment (PPE), her period of close contact with family whilst ill, and her unsafe burial indicate a significant risk of further transmission. One contact in Tonkolili remains to be traced. The origin of infection is under investigation. A second case of Ebola has since emerged in Sierra Leone with a close relative of the first victim testing positive.

For more than a year, Liberia, Guinea, and Sierra Leone have been experiencing the largest outbreak of Ebola in history. Although Liberia was declared free of Ebola transmission on September 2, 2015, a new cluster of Ebola cases was confirmed in late November 2015 in Paynesville, a suburb of Monrovia. The health system in Liberia continues to monitor for new cases and to take precautions to prevent transmission in the country. IFRC and the RCRC partners are also closely monitoring the situation.

On 29 December, WHO declared that human-to-human transmission of the Ebola virus has ended in Guinea after the completion of 42 days with zero cases since the last person confirmed to have EVD received a second consecutive negative blood test for the Ebola virus RNA. Guinea has now entered a 90-day period of heightened surveillance. The last known positive patient was discharged from the ETC on 16 November 2015. After the last case detected in Sierra Leone, the Government has strengthened surveillance mechanisms in cross-border areas with Sierra Leone.