UPDATE ON EBOLA OUTBREAK According to the Ministry of Health and Sanitation (MOHS), a total of 36 suspected cases have been reported with 14 confirmed cases. All confirmed cases are from Kailahun District and 5 deaths. All suspected cases from Bo, Koindu and Western Area urban are negative. Medical tents pre-positioned at Kenema Government Hospital and training of staff on case management completed. Outreach medical team now at Koindu in Kailahun District searching for the missing confirmed cases in the community and conducting contact tracing. Ministry of Health officials and MSF are also in Koindu setting up the Isolation unit. Training of medical staff for the Isolation unit in Koindu and Kailahun commenced today. MSF to provide tents and other equipment to set up Isolation units in three hospitals in Western Area and one hospital in Makeni. UNICEF donates 15 drums of chlorine to the Ministry of Health to help boost the fight against Ebola. Ministry of Education to send letters and Ebola sensitization packages to all schools and learning institutions to increase education and sensitization on Ebola. MSF is to fly in 5 experts that will include a doctor, nurse, logistician Water and Sanitation expert and a team leader and one metric ton of medical supplies and Isolation units to boost the fight against Ebola. Biweekly Report, Metabiota Inc. Kenema/Freetown - 1 - Update on Ebola fever # 31 May 27 to 29 Per request of Ministry of Health and Sanitation Sierra Leone “EMERGENCY PREPAREDNESS AND RESPONSE TO EBOLA FEVER” On May 24th the first in country Ebola confirmed case from Koindu health post (Kailahun District) occurred and tested positive for Ebola Zaire at the Kenema Government Hospital Laboratory (see ANNEX 1 “Ebola Investigation »). POST-TRAINING & SURVEILLANCE ME April 2-18: 375 MOHS Health Workers trained (Previous reports). April 7, to date: TRAINING ASSESSMENT & ACTIVE FIELD SURVEILLANCE (ANNEX 2) : follow up of training implementation, community counseling, case tracing, etc.) – Annex 1: May 7th: Kailahun district (report # 26); May 8th to 10th: Kono district (r# 27); May 11th: Koinadugu district # 28); May 14th: Bombali district (#(29); May 17th: Kambia district (# 29) o May 21th: Pujehun district: Post training active survey. § Visited localities, communities: Fairo, Jendema Port Health and Immigration Post, Zimmi § Meeting with: the Jendema port health and immigration post team; the Health staff in these communities and alerted to be looking for Ebola cases. No suspected cases were reported among all the sites visited and listed above at that time. § Lungi Airport, Port Health facilities and Suzan Bay Harbor, Port Health facilities were visited by the team. ANEEX 3 : Summary of the MOHS Ebola fever emergency Preparedness and response Promed Post LABORATORY SUPPORT (MOHS/Metabiota VHF laboratory, & Lassa fever Laboratory, at MOHS Kenema Government Hospital) Reporting on Ebola response: laboratory molecular diagnostic o Real Time RT-PCR using CRP reagents o Antigen capture as a confirmatory test, using USAMRIID reagents. (Annex 4) As for May 28 Date District Real Time RT-‐PCR Ag capture Ebola molecular diagnostic Patient status 21-‐mai-‐14 Bo Negative Negative Negative -‐ 21-‐mai-‐14 Bo Negative Negative Negative -‐ 23-‐mai-‐14 Kailahun Positive Positive Ebola Alive 23-‐mai-‐14 Bo Negative Negative Negative -‐ 25-‐mai-‐14 W. Urban Area Negative Negative Negative -‐ 25-‐mai-‐14 Kailahun Positive Positive Ebola Alive 25-‐mai-‐14 Kailahun Positive Positive Ebola Alive 26-‐mai-‐14 Kenema Negative Negative Negative -‐ 26-‐mai-‐14 Bo Negative Negative Negative -‐ 26-‐mai-‐14 Koinadugu Negative Negative Negative -‐ 26-‐mai-‐14 Kailahun Positive Positive Ebola Alive 26-‐mai-‐14 Kailahun Positive Positive Ebola Alive 26-‐mai-‐14 Kailahun Positive Positive Ebola Alive 26-‐mai-‐14 Kailahun Positive Positive Ebola Deceased 26-‐mai-‐14 Kenema Negative Negative Negative -‐ 27-‐mai-‐14 Kailahun Negative Negative Negative -‐ 27-‐mai-‐14 Kailahun Positive Positive Ebola Alive 27-‐mai-‐14 Kailahun Positive Positive Ebola Alive 27-‐mai-‐14 Kailahun Positive Positive Ebola Deceased 27-‐mai-‐14 Kailahun Positive Positive Ebola Alive 27-‐mai-‐14 Kailahun Positive Positive Ebola Alive 27-‐mai-‐14 Kailahun Positive Positive Ebola Alive 27-‐mai-‐14 Kailahun Positive Positive Ebola Alive 27-‐mai-‐14 Kailahun Negative Negative Negative -‐ 28-‐mai-‐14 Bo Negative Negative Negative -‐ Biweekly Report, Metabiota Inc. Kenema/Freetown - 3 - ANNEX 1 Ebola Investigation Preliminary Field Report (James Bangura reporting; MOHS/Metabiota) Date: 28th May 2014 Locations: Daru Town, Koindu Town, Buedu Town, and Kolorsu village, Kailahun district, Eastern Sierra Leone Name of Investigators: The investigation was a joint venture comprising Ministry of Health and Sanitation Kailahun District, Metabiota Inc. Sierra Leone and Personnel of the Lassa Fever Project in Kenema as follows: § Dr. James Squire – District Medical Officer Kailahun, MOHS § Mohamed Lamin - District Surveillance Officer Kailahun, MOHS § James Bangura – Metabiota Inc. Lassa fever Project § Michael Gbakie, Lassa fever Project-MoHS § Lansana Kanneh, Lassa fever Project-MoHS § Eric Moosa – Health superintendent Kailahun – MOHS Duration of filed trip: 26th – 27th May 2014 Nature Of Problem: The first case of Ebola in Sierra Leone was confirmed in Koindu Kailahun District. No epidemiological details about the case including travel were available. Thorough epidemiological investigation was needed for the case and the communities. The team was task with this responsibility. Preliminary Findings: After meetings and interviews with both health facility staff and community stakeholders. The investigation team documented exposure and other details of the index case (Mammie Lebbie) as follows: § She was reported to have attended a funeral service of traditional healer who suddenly died of unknown cause (probable Ebola case) in Gbondu village about three miles from Koindu town late April § The traditional healer was reported to have been treating cases from Guinea during the current Ebola outbreak § Two other similar deaths in the same household of the traditional healer were reported in early May § All individuals that attended the funeral ceremony of the traditional healer became sick presenting with fever, diarrhea and vomiting including the index case under investigation § No known travel history outside Sierra Leone for both the index case and Probable case was reported to the investigation team § Ebola compatible cases by case definition were reported to the investigation in the surrounding communities in Koindu § There is great denial on the presence and confirmation of Ebola by the community members in their communities due to the absence of visible hemorrhagic symptoms among confirmed cases Biweekly Report, Metabiota Inc. Kenema/Freetown - 4 - § Active transmission of Ebola virus in ongoing in the various communities in both Buedu and Koindu and surrounding villages in the Kissi Teng and Kissi Tongi chiefdoms Actions Taken: § Investigated one probable case that died in Daru, contacts listed for monitoring § Nine more samples were collected from suspected cases all reported to have attended the funeral of the same probable case that died as in index case and sent to Kenema for lab confirmation (May 26th) § Participated in the district taskforce meeting on Ebola to discuss the situation and next steps (May 27th) § Held stakeholders and community meetings in both Buedu and Koindu communities in an attempt to seek permission and support from members in the investigation details needed (May 26th & 27th) § Supervised burial ceremony in Kolorsu village of a confirmed case that was evacuated by community members from the health facility in refusal to transfer case to Kenema isolation center (May 27th) § Contacts of one confirmed case were listed for follow up Challenges: § Relatives and community members in Koindu town refused transfer of index case and other Confirmed cases to Kenema isolation center Biweekly Report, Metabiota Inc. Kenema/Freetown - 5 - ANNEX 2 As for May 28, major sites of active Surveillance & Investigation for Ebola fever preparedness & response in Sierra Leone Ebola Epidemic area Biweekly Report, Metabiota Inc. Kenema/Freetown - 6 - Annex 3 Promed Post ProMED-mail | 27/05/2014 14:32 promedmail.org/direct.php?id=2501116 Page 1 of 5 Published Date: 2014-05-27 13:55:28 Subject: PRO/AH/EDR> Ebola virus disease - West Africa (48): Sierra Leone, more cases, preparedness Archive Number: 20140527.2501116 EBOLA VIRUS DISEASE - WEST AFRICA (48): SIERRA LEONE, MORE CASES, PREPAREDNESS ****************************************************************************** A ProMED-mail post promedmail.org ProMED-mail is a program of the International Society for Infectious Diseases isid.org Date: Mon 26 May 2014 Source: Sierra Leone Ministry of Health and Sanitation [edited] Ebola fever disease [EVD] emergency preparedness and response ------------------------------------------------------------- A few days ago health officials in Guinea reported an increase of ebolavirus activity in particular in the Kissidougou aera (centered by the Gueckedou or Gueckedougou prefecture) close to the borders of Sierra Leone and Liberia: 11 suspected cases (2 were then confirmed), and 41 contacts were reported last week. Since 18 May 2014, the MOHS [Ministry of Health and Sanitation] surveillance team in Kailahun, Sierra Leone, observed an increase in the number of patients presenting with diarrhea and vomiting symptoms in the communities around Koindu town; 3 patients died including a nurse, a student and a housewife on 23 May 2014. These cases are under investigation. On 24 May 2014 one sample was collected from a patient, suspected EVD case, at Koindu health post, Kailahun District (bordering Guinea) and sent 25 May 2014 to the Lassa Fever Laboratory LFL (supported by Metabiota Inc. and Tulane/Harvard Universities). The sample was immediately tested by MOHS and showed positive for ebolavirus Zaire by conventional RT-PCR (MOHS -- Harvard University reagents) and by real time RT-PCR (Metabiota Inc., USAMRIID and Critical Reagents Program reagents). Further tests including antigen detection and IgM ELISA are currently being run (Metabiota Inc. -- USAMRIID reagents). The Lassa Fever Laboratory is receiving more samples from suspected cases and potential contacts of this confirmed case; 8 more samples from viral hemorrhagic fever (VHF) suspected cases were received on 26 May 2014. The same tests were run (conventional RT-PCR and real time RT-PCR) and the LFL confirms 6 more cases originating from Kailahun District. The Lassa fever outreach team is currently on site in Kailahun investigating, searching for suspected cases and contacts; 300 kits of personnel protective equipment have been distributed to health officials in Kailahun, the Lassa Ward and the Lassa Fever Laboratory in Kenema (USAMRIID, Metabiota) and more are to be delivered shortly (Tulane, USAMRIID, Metabiota Inc.). The World Health Organization was notified on 25 May 2014 of an Ebola virus disease [EVD] outbreak in Sierra Leone including one laboratory confirmed case and 5 community deaths reported from Koindu area bordering the current Ebola fever epidemic epicenter of Gueckedou, Guinea. ProMED-mail | 27/05/2014 14:32 promedmail.org/direct.php?id=2501116 Page 2 of 5 Global results -------------- From the Ebola Surveillance & VHF Preparedness - Metabiota Inc. Laboratory team at KGH in partnership with the MOHS Lassa fever Laboratory of Kenema Government Hospital (supported by Tulane University): from 19 Mar to 20 May 2014 a total of 140 EVD suspected cases sampled in Sierra Leone tested negative for ebolavirus. Suspected cases of Lassa fever and other potential VHF were also tested for ebolavirus when required, 14 samples tested positive for Lassa virus and one for West Nile virus. Training -------- 385 health workers at the national level have been trained in 3 weeks for emergency preparedness and response to EVD(MOHS/Metabiota Inc.). Intensified health communications and a weekly task force chaired by the Minister were implemented. Since then, upon request of the MOHS, a Metabiota Daily report has been produced since the beginning of the Ebola alert in Sierra Leone reporting on laboratory diagnostics, training progress and other issues related to EVD preparedness and response. 30 reports have been produced for the MOHS and WHO to monitor the EVD outbreak response. Background ---------- - 23 Mar 2014: samples from 2 patients from Guinea, collected by the Guinean authorities were handed to the MOHS (Sierra Leone) investigation field team and subsequently referred to the Lassa laboratory and the Metabiota Viral Hemorrhagic Fever (VHF) team at the Kenema Government Hospital. All were found to be negative for Ebola, Lassa fever, Marburg and Yellow fever by real time RT-PCR on the following day. - 24 Mar 2014: Sierra Leone outbreak response is decided, after MOHS (Ministry of Health and Sanitation) official request. Partners (Metabiota Inc. USAMRIID, NIH) are contacted to support the response - 25 Mar 2014: an MOHS multidisciplinary field team carried out epidemiological investigations to examine reports on the death of a suspected case; 15 probable contacts were identified, sampled and tested negative by RT-PCR for all existing 5 known ebolavirus species. - 28 Mar 2014: 2 Metabiota Inc. experts leave Washington for Freetown with approx. 800 pounds (363 kg) of equipment, reagents and other supplies (such as, personal protective equipment (PPE) from USAID). The aim was to develop an efficient health survey of the border adjacent to the Guinean epidemic region, where confirmed and suspected EVD cases have been reported. The immediate objectives included: all necessary means for an early and specific diagnosis of EVD and providing a reporting system (forms) for a precise follow up and early response on suspected EVD cases: intensive and emergency training for all Health Officers of the most threatened districts bordering Guinea and Liberia and the Western district sheltering air and sea transportation facilities for commercial exchanges with Guinea and Liberia; assess risk, identify means (reporting forms, practical material for case management, disinfection, safe environment) and develop strategy for prevention of viral hemorrhagic fever emergence and/or spread in country. Partners -------- National including the Ministry of Health and Sanitation: HE the Minister of Health, Chief Medical Officer (CMO), Director of Infectious Disease Control; MOHS Kenema Government Hospital (KGH), KGH including the Lassa Fever Laboratory, and the Metabiota VHF team: Biological diagnostic of VHF; WHO office in Freetown: Regional reporting on Ebola outbreak and training; MSF: awareness and reporting on Ebola suspected cases; US Embassy: in country facilitator (airport, MOHS). International: WHO Geneva: Communicable Disease Programs; USAMRIID: expertise (RS), equipment and reagents; NIH: providing expertise (LH), equipment and reagents; Tulane University (laboratory support from Harvard University); USAID: providing supplies (PPE, protective masks, etc.) ProMED-mail | 27/05/2014 14:32 promedmail.org/direct.php?id=2501116 Page 3 of 5 Training -------- After the 1st Task Force meeting on EVD emergency preparedness and response, chaired by the Minister, attended by the 2 Metabiota experts as requested by the MOHS, it was decided to train in less than 10 days all key health officers involved in the response of medical support/clinics (case management), survey (case definition) and field investigation (contacts) on EVD. A total of 75 Hospital Medical Officers, 35 Surveillance Medical Officers and, 25 Port Health Officers have been trained in 8 days. Also 50 Primary Heath care workers from 5 districts (250 trainees) were trained by the previous trainees (Health Officers): total of 385 health workers from Sierra Leone have been trained and supported by complementary equipment (PPE, rubber boots, concentrated bleach, WHO VHF manual, thermometers, etc.), and other reporting forms. Ultimately post training and active surveillance (by the former trainees) has been conducted in the 5 districts bordering the Guinea EVD epidemic area. Laboratory diagnostics ---------------------- Metabiota Inc., working with the MOHS, had previously installed Zaire Ebola-specific real time RT-PCR (2012), which was used to screen the 1st cases reported to ProMED-mail. Since that time and under MOHS and WHO guidance, Metabiota Inc., with support from international partners from the US (USAMRIID, DTRA, NIH, and others), the Democratic Republic of Congo (INRB) and Gabon (CIRMF), have installed and are currently running a full suite of Ebola specific and differential diagnostics, including: Zaire Ebola-specific antigen and IgM capture ELISAs, Zaire Ebola-specific and pan-filovirus RT-PCR, as well as published PCR assays for the detection of Lassa fever, yellow fever and other confounding, locally endemic pathogens, as well as laboratory reagents and equipment, and personal protective equipment (PPE) for health workers exposed to suspected cases. Also the Lassa fever laboratory, supported by Tulane University has developed an ebolavirus test (conventional RT-PCR) provided by Harvard University. All Ebola suspected cases are tested by both collaborating teams as a permanent and efficient control. Providing supplies ------------------ PPE: masks, gloves, lab coats and full suits, shoe covers, respirators -- as well as general laboratory supplies (from international partners at USAMRIID, NIH, and Metabiota Inc. Cameroon) Material & methods ------------------ Reagents and supplies given by USAMRIID and NIH, including 2 thermal cyclers (USAMRIID/Metabiota), one MagPix(R) (multiplex platform for qualitative and quantitative analysis of proteins and nucleic acids); real time RT-PCR for Ebola, Marburg, Lassa viruses, yellow fever, West Nile and chikungunya viruses; IgM and IgG ELISA assays for Ebola serology; Ebola antigen capture ELISA. Capacity building ----------------- A MOHS-KGH laboratory technician has been trained to perform real time RT-PCR against all pathogens presently tested. Training continues on other assays. Providing expertise ------------------- The head of the laboratory, present full time on site, joined by 2 scientists from the Applied Diagnostics Branch, Diagnostic Systems Division, USAMRIID. Senior scientist coordinated and supervised Metabiota support (scientific & academic) to MOHS and under the guidelines of WHO Metabiota Inc. Provided Public Health comprehensive forms (public health sectors recording data from clinic, laboratory, epidemiology and surveillance). Upgraded the security level & data management system (recording, analysis, transfer) of the sample collection for EVD/VHF in partnership with KGH Lassa Ward (HK); security level of the Lassa laboratory was upgraded by all partners; protocols reviewed for safe handling and disposal of Ebola samples and waste; laboratory workers and visiting scientists protection enhanced. ProMED-mail | 27/05/2014 14:32 promedmail.org/direct.php?id=2501116 Page 4 of 5 Safety ------ A specialized infectious disease ambulance provided by Metabiota Inc. is being used to transport all suspected cases and every precaution is made to protect both health care workers and local populations from the risk of spread of the diseases. The MOHS National Task Force, working with Metabiota Inc. and other partners, is continuing to actively conduct surveillance for EVD, as well as for Lassa fever; the Kenema Government Hospital has been designated as the central treatment facility for anyone suspected of contracting either Ebola or Lassa fever in the country. -- Communicated by Ministry of Health & Sanitation Freetown Sierra Leone [ProMED-mail thanks the Sierra Leone Ministry of Health and Sanitation for this update. The collaboration with external partners is exemplary. We would be interested to know why so many different types of tests are necessary to confirm an EVD case, but suppose these are experimental reagents being field tested for research as well as public health purposes. There is an excellent map by CDC of the affected areas at cdc.gov/vhf/ebola/images/outbreaks/GuineaSLeone-map-041414.jpg Kailahun should now be coloured red. - Mod.JW] See Also Ebola virus disease - West Africa (47): Sierra Leone, more cases 20140526.2500090 Ebola virus disease - West Africa (46): Guinea WHO update 20140526.2498287 Ebola virus disease - West Africa (45): Sierra Leone, new case Ebola virus disease - West Africa (44): Guinea, new cases 20140525.2497408 Ebola virus disease - West Africa (43): Guinea, new cases 20140524.2495778 Ebola virus disease - West Africa (42): WHO update 20140522.2491069 Ebola virus disease - West Africa (41): fatal 20140521.2489228 Ebola virus disease - West Africa (37): Sierra Leone preparedness 20140512.2467545 Ebola virus disease - West Africa (35): WHO, MSF, Senegal preparedness 20140509.2462239 Ebola virus disease - West Africa (33): WHO, global threat 20140503.2447967 Ebola virus disease - West Africa (31): Guinea, region 20140430.2441776 Ebola virus disease - West Africa (29): corrs. Guinea 20140428.2435643 Ebola virus disease - West Africa (26): WHO, MSF 20140424.2427963 Ebola virus disease - West Africa (24): Liberia, Zambia airport screening 20140422.2421188 Ebola virus disease - West Africa (23): Cote dIvoire, bushmeat ban 20140421.2419488 Ebola virus disease - West Africa (22): WHO, control 20140419.2416170 Ebola virus disease - West Africa (21): ECDC travel advice 20140419.2414770 Ebola virus disease - West Africa (20): WHO update, UNICEF 20140417.2412005 Ebola virus disease - West Africa (19): new strain, Guinea new cases, Mali NOT 20140417.2409996 Ebola virus disease - West Africa (18): survivors, more cases 20140416.2407657 Ebola virus disease - West Africa (17): Liberia, Sierra Leone, WHO, MSF, EU 20140414.2404280 Ebola virus disease - West Africa (16): Sierra Leone & Mali NOT, economy 20140413.2400734 Ebola virus disease - West Africa (15): Morocco, Ghana, Portugal all NOT 20140412.2399043 Ebola virus disease - West Africa (14): Morocco susp, virus stability 20140411.2396631 Ebola virus disease - West Africa (13): WHO, Mali susp, UNICEF 20140411.2395327 Ebola virus disease - West Africa (12): WHO, mapping 20140410.2393603 ProMED-mail | 27/05/2014 14:32 promedmail.org/direct.php?id=2501116 Page 5 of 5 Ebola virus disease - West Africa (11): Guinea 20140409.2391500 Ebola virus disease - West Africa (08): WHO, miscellaneous reports 20140403.2379386 Ebola virus disease - West Africa (05): Guinea, Liberia, Sierra Leone WHO update 20140401.2373662 Ebola virus disease - West Africa (03): Liberia, timeline 20140331.2369368 Ebola virus disease - Guinea (04): WHO update, Conakry conf., alerts 20140328.2364547 Ebola virus disease - Liberia ex Guinea: susp. alert, RFI 20140326.2360265 Ebola virus disease - Guinea (03): WHO update, travel health advisories 20140326.2359361 Ebola virus disease - Guinea (02): bat eating banned 20140326.2359281 Ebola virus disease - West Africa: Guinea, Zaire ebolavirus suspected 20140322.2349865 Ebola - Sierra Leone: susp. alert, RFI 20140322.2349697 Undiagnosed viral hemorrhagic fever - Guinea (02): Ebola conf. 20140322.234969 .................................................jw/mj/jw ©2001,2008 International Society for Infectious Diseases All Rights Reserved. Read our privacy guidelines. Use of this web site and related services is governed by the Terms of Service. Biweekly Report, Metabiota Inc. Kenema/Freetown - 7 - Annex 4 Laboratory Diagnostic Antigen test EBOLA ANTIGEN CAPTURE All tests are duplicated (ie. two wells). Dark and light blue = Negative controls / Red = Positive controls Green sample tests : Dark blue well = positive sample (viral antigen captured) Clear green = negative sample
Posted on: Sat, 31 May 2014 06:47:08 +0000
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