EBOLA SITUATION REPORT

 No confirmed cases of Ebola virus disease (EVD) were reported in the week to 6 December. Investigations are continuing into the origin of infection of the cluster of 3 confirmed cases of EVD reported from Liberia in the week to 22 November, with a working assumption that the cluster arose as a result of a rare re-emergence of persistent virus from a survivor. The first-reported case in that cluster was a 15-year-old boy who tested positive for EVD after admission to a health facility in the Greater Monrovia area on 19 November. He was then transferred to an Ebola treatment centre along with the 5 other members of his family. Two other members of the family – the boy’s 8-year old brother and his 40-year-old father – subsequently tested positive for EVD whilst in isolation. Both tested negative twice for Ebola virus on 3 December. The 15-year-old boy died on 23 November. In addition to the family of the first-reported case, 165 contacts have been identified, including 15 high-risk contacts. Contacts are now in the third week of their 21-day follow-up period.  On 7 November WHO declared that Sierra Leone had achieved objective 1 of the phase 3 framework, and the country has now entered a 90-day period of enhanced surveillance scheduled to conclude on 5 February 2016. As of 6 December it had been 20 days since the last EVD patient in Guinea received a second consecutive EVDnegative blood test. The last case in Guinea was reported on 29 October 2015.  The recent cases in Liberia underscore the importance of robust surveillance measures to ensure the rapid detection of any reintroduction or re-emergence of EVD in currently unaffected areas. In order to achieve objective 2 of the phase 3 response framework – to manage and respond to the consequences of residual Ebola risks – Guinea, Liberia, and Sierra Leone have each put surveillance systems in place to enable health workers and members of the public to report any case of illness or death that they suspect may be related to EVD to the relevant authorities. In the week to 6 December, 19 864 such alerts were reported in Guinea, with alerts reported from all of the country’s 34 prefectures. Equivalent data are not currently available for Liberia. In Sierra Leone, 1420 alerts were reported from all 14 districts in the week ending 15 November (the most recent week for which data are available).  As part of each country’s EVD surveillance strategy, blood samples or oral swabs should be collected from any live or deceased individuals who have or had clinical symptoms compatible with EVD. In the week to 6 December 8 operational laboratories in Guinea tested a total of 582 new and repeat samples from 12 of the country’s 34 prefectures. 84% of all samples tested in Guinea were swabs collected from dead bodies. By contrast, 82% of the 1020 new and repeat samples tested in Liberia over the same period were blood samples collected from live patients. In addition, all 15 counties in Liberia submitted samples for testing by the country’s 5 operational laboratories. 1363 new samples were collected from all 14 districts in Sierra Leone and tested by 8 operational laboratories. 95% of samples in Sierra Leone were swabs collected from dead bodies.  964 deaths in the community were reported from Guinea in the week to 6 December through the country’s alert system. This represents approximately 43% of the 2248 community deaths expected based on estimates of the population and a crude mortality rate of 11 deaths per 1000 people per year. Equivalent data are not yet available for Liberia. In Sierra Leone, 1282 reports of community deaths were received through the alert system during the week ending 15 November (the most recent week for which data are available), representing approximately 62% of the 2075 deaths expected each week based on estimates of the population and a crude mortality rate of 17 deaths per 1000 people per year. EBOLA SITUATION REPOR