Liberia Ebola Sitrep No. 50

Liberia Ebola SitRep no. 91

Ministry of Health and Social Welfare Aug 14, 2014

Cases

National

Lofa County Lofa

Grand Bassa Grand

BongCounty

Bomi County Bomi

Sinoe County Sinoe

Grand Gedeh Grand

Nimba County Nimba

Margibi County Margibi

RiverCess County RiverCess

River GeeCounty River Grand Cape Mount Grand County Montserrado New Cases New Case/s (Suspected) 9 0 0 0 0 0 0 4 4 1 0 0 0 New Case/s (Probable) 20 0 0 0 1 0 14 0 5 0 0 0 0 New case/s (confirmed) 0 0 0 0 0 0 0 0 0 0 0 0 0 Total suspected cases 182 4 44 8 0 0 61 13 44 6 1 0 1 Total probable cases 441 28 25 1 3 0 247 2 130 5 0 0 0 Total confirmed cases 187 9 14 6 4 0 101 2 43 7 0 1 0 Total Number of Confirmed Cases of Sierra Leonean Nationality 12 0 0 0 1 0 11 0 0 0 0 0 0 Total Number of Confirmed Cases of Guinean Nationality 0 0 0 0 0 0 0 0 0 0 0 0 0 Cumulative (confirmed, probable, suspected) cases 810 41 83 15 7 0 409 17 217 18 1 1 1 Outbreak Overview: Case Counts Reported

300 Confirmed 250 Probable Suspect 200

150

100

0 Aug 10-16: Reported Deaths

35 Confirmed 30 Probable Suspect 25

Cases among HCWs

County

Bassa

Gedeh

County

National

Lofa

Grand Grand

BongCounty

Bomi

Sinoe

Grand Grand

Nimba

Margibi

RiverCess

River GeeCounty River

Grand Cape Mount Grand Montserrado

Newly Reported Cases in HCW on 14th Aug 2014 3 0 0 0 2 0 0 0 1 0 0 0 0 Cumulative cases among HCW 90 4 24 3 3 0 16 4 35 1 0 0 0 Newly Reported deaths in HCW on 14th Aug 2014 3 0 0 0 0 0 0 0 3 0 0 0 0 Cumulative deaths among HCW 39 4 4 0 0 0 13 0 18 0 0 0 0

Isolation and Discharges

County

Bassa

Gedeh

County

National

Lofa

Grand Grand

BongCounty

Bomi

Sinoe

Grand Grand

Nimba

Margibi

RiverCess

River GeeCounty River

Grand Cape Mount Grand Montserrado

New Admission on Aug 14 2014 22 0 0 0 0 0 14 0 8 0 0 0 0 Total no. currently in Treatment Units 201 0 0 0 0 0 126 0 75 0 0 0 0 Total discharges on 14th Aug 2014 4 0 0 0 0 0 0 0 4 0 0 0 0 Cumulative admission/isolation 201 0 0 0 0 0 126 0 75 0 0 0 0

Deaths

County

Bassa

Gedeh

County

National

Lofa

Grand Grand

BongCounty

Bomi

Sinoe

Grand Grand

Nimba

Margibi

RiverCess

River GeeCounty River

Grand Cape Mount Grand Montserrado

Newly reported deaths 14th Aug 2014 33 0 0 0 1 0 12 2 18 0 0 0 0 Total death/s in confirmed cases 164 7 7 1 3 0 80 2 60 4 0 0 0 Total death/s in probable cases 192 6 11 1 1 0 82 0 84 6 0 1 0 Total death/s in suspected cases 79 0 5 0 1 0 30 5 37 1 0 0 0 Total death/s in confirmed, probable, suspected cases 435 13 23 2 5 0 192 7 181 11 0 1 0 Case Fatality Rate (CFR) - Confirmed & Probable Cases 56.7 35.1 46.2 28.6 57.1 0.0 46.6 50.0 83.2 83.3 0.0 100.0 0.0 Outbreak Overview: Deaths Reported

140 Confirmed 120 Probable 100 Suspect

0 Aug 10-16: Reported Deaths

35 Confirmed 30 Probable Suspect 25

Contacts

County

Bassa

Gedeh

County

National

Lofa

Grand Grand

BongCounty

Bomi

Sinoe

Grand Grand

Nimba

Margibi

RiverCess

River Gee River County

Grand Cape Grand Mount Montserrado

Newly reported contacts on 14th Aug 2014 61 0 0 0 6 0 0 0 26 29 0 0 0 Total contacts listed 1717 64 216 10 31 0 421 28 838 103 0 6 0 Currently under follow-up 1354 64 198 10 31 0 421 5 577 44 0 4 0 Contacts seen on 14th Aug 2014 1089 58 58 10 31 0 421 0 467 44 0 0 0 Contacts who completed 21 day follow- up 61 5 17 0 0 0 0 0 39 0 0 0 0 Contacts lost to follow-up 9 5 1 0 0 0 0 0 0 3 0 0 0

Laboratory

County

Bassa

Gedeh

County

National

Lofa

Grand Grand

BongCounty

Bomi

Sinoe

Grand Grand

Nimba

Margibi

RiverCess

River GeeCounty River

Grand Cape Mount Grand Montserrado

Specimens collected on 14th Aug 2014 7 0 0 0 0 0 0 3 0 4 0 0 0

Specimens pending for testing 43 0 3 2 1 0 30 3 0 4 0 0 0

Total specimens tested 19 0 0 0 0 0 19 0 0 0 0 0 0

Ebola Disease Outbreak (March 22-Aug 14, 2014)

County

Bassa

Gedeh

County

National

Lofa

Grand Grand

Bong Bong County

Bomi

Grand Grand Sinoe

Nimba

Margibi

RiverCess

River Gee County Gee River

Grand Cape Mount Cape Grand Montserrado

Total Case/s (Suspected) 182 4 44 8 0 0 61 13 44 6 1 0 1 Total Case/s (Probable) 443 28 25 1 3 0 249 2 130 5 0 0 0 Total case/s (confirmed) 193 9 14 6 4 0 105 4 43 7 0 1 0 Cumulative (confirmed, probable, suspected) cases 818 41 83 15 7 0 415 19 217 18 1 1 1

Health Care Workers Cumulative cases among HCW 92 4 24 3 3 0 18 4 35 1 0 0 0 Cumulative deaths among HCW 41 4 4 0 0 0 15 0 18 0 0 0 0

Deaths Total death/s in confirmed cases 170 7 7 1 3 0 84 4 60 4 0 0 0 Total death/s in probable cases 194 6 11 1 1 0 84 0 84 6 0 1 0 Total death/s in suspected cases 82 0 5 0 1 0 31 6 38 1 0 0 0 Total death/s in confirmed, probable, suspected cases 446 13 23 2 5 0 199 10 182 11 0 1 0 #### Cumulative CFR (March 22 - Aug 13, 2014) 57.2 35.1 46.2 28.6 57.1 # 47.5 66.7 83.2 83.3 #DIV/0! 100.0 #DIV/0!

Case Investigation

Daily Case investigation Montserrad Cape Riverces Date: August 14, 2014 o Lofa Bong Margibi Mount Nimba s Bassa Bomi •# of calls received 112 0 1 3 2 1 0 0 1 •# of calls responded to 52 0 0 1 2 0 0 0 0 •# of cases referred to treatment unit 15 0 0 0 2 0 0 0 0 •# of suspected cases 50 0 1 3 1 0 0 0 0 •# of probable cases 2 0 0 0 1 0 0 0 0 •# of suspected or probable cases with specimen taken 0 0 0 0 0 0 0 0 0 •# of bodies 18 0 0 0 0 0 0 0 0 •# of bodies with specimen taken 0 0 0 0 0 0 0 0 0 •# homes sprayed 0 0 0 0 0 0 0 0 0 •# of psychosocial counseling done 0 0 0 0 0 0 0 0 0 # of cases pending transfer 10 0 0 1 0 0 0 0 0 Contacts Tracing Update • Grand Bassa • Two towns (Kleemo & Barkpeh) • Montserrado have 20 dead bodies to be buried. • Burial and spraying teams (20 West Point holding Unit persons) to be trained on Friday. established with 13 patients. • • Two samples were collected from 12 deaths reported in 3 days Jacoblatee Town. One case (Tuesday –Thursday). confirmed • It alleged that about 50 dead bodies have been secretly buried across the river over the past one Month. • About 60 contacts line listed from 2 houses (30 per house) • Nearly 100 contacts across Monrovia have abandoned their homes for different communities. Contacts Tracing Update

Margibi Rivercess • 6 dead bodies in two days •One suspected dead. Case is a • 47 deaths have been resident of Rivercess but travel to documented during the Monrovia and returned with second wave (22-Kakata & 25- illness and refused to seek Dolo’s Town). Needs further medical treatment because of investigation EVD fear • County Inspector now •There is no body bag and OGYN responsible to supervise burial gloves. Dead was buried in • County authority Tarpaulin. (superintendent and CHT) to •Two contacts travel to Nimba meet with Dolo’s Town local and Monrovia authorities and residence.

Update

Grand Gedeh Bomi •Three suspected cases •There are four dead from Bong County found bodies. in Mining Settlements (Putu and CBI).

Lofa Highlights • Total number of patient in Foya Case management center (FCMC) is 126 • Total new cases is 14 (13 from Voinjama District , 1 from Foya) • 12 deaths

Constraints • Limited number of beds and mattresses to transport all the probable and suspected cases at FCMC • The Burial Team in Kolahun has no rainboots • The surveillance office requires a computer for data management

Montserrado Highlights

• Meetings were held with community leaders from West Point to improve contacts tracing, burials and case investigations • Contact tracing meeting planned for tomorrow in West Point • The Monitors report that other contacts in the home are running away once another contact becomes symptomatic. Additionally, many people appear to be smuggling away sick relatives which is posing additional difficulty in contact tracing • The MCHSWT will be training all zonal supervisors and monitors on Saturday • In light of the increasing volume of contacts, a fourth team of contact tracing monitors will be established • Work continues to establish temporary holding centers in Brewerville Nimba Highlights

• The county has resorted to hiring vehicles for burial • 2 new listed contacts from Ganta have escaped unknown destinations • Search continues for 2 probable cases that escaped from Ganta • 90 buckets with faucet were distributed in Sanniquellie, Ganta, Saclepea, Bahn and Karnplay • IEC/BCC materials were distributed in the 6 health districts • Mass community sensitization continues on 4 local radio stations to track 4 contacts who are on the run • UNMIL Head of Field Office donated 3 new phones to the County Task Force to be used as hot lines Nimba Highlights Issues & Constraints • The burial and spraying teams have no vehicle • There are no body bags in County Grand Cape Mount Highlights • The burial team in county is complaining of no Incentive • The burial team has no vehicle • No contact tracing is happening in Tewor and Robertsports Districts • The contact tracing team needs training • There is no funding for gCHVs to follow up on contacts • The staff need training in case management • The county is in dire need of supplies including rain gear, boots, burial materials, survival kits, etc Margibi Highlights • The contacts tracers need to be compensated • C. H. Rennie hospital is awaiting disinfection before reopening • The County is in need of an ambulance and another vehicle for coordination Rivercess Highlights • Case management, burial and IPC committees established but not functional • Epi surveillance sub-committee has been set with a two-day orientation for contact tracers carried out. 10 contact tracers were trained. 30 contacts are being followed with one suspect case being investigated • 60 volunteers were trained for social mobilization with support from Red Cross. 8 District commissioners were orientated on Ebola response to support social and community mobilization in all eight health districts of Rivercess. • Funds have not been released to Rivercess to execute the Ebola response plan • No functional vehicle in the county for Ebola response activities • No training have been conducted for case management and infection control in the county. HCWs are vulnerable Bong Highlights • Community still apprehensive of the contact tracing teams due to denial • Limited manpower to contain the outbreak • Lack of risk allowance for Ebola Emergency teams • Lack of treatment center • Health workers at the two (2) Hospitals have not returned to work • Increase community deaths • Twenty-three contacts were not reached due to resistance from community • Limited logistics (vehicles) • Limited rain gears for teams • Community structures are not active for Ebola response