EBOLA RESPONSE
ROADMAP ROADMAPSITUATION REPORTEBOLARESPONSESITUATION REPORT
31 OCTOBER 2014
HIGHLIGHTSThere have been 13 567 reported Ebola cases in eight affected countries since theoutbreak began, with 4951 reported deaths.
Intense transmission continues in Guinea, Liberia and Sierra Leone.
All 83 contacts of the health-care worker infected in Spain have completed the 21-day
follow-up period.
1667
1018

GuineaLiberia
Sierra Leone

CASES /DEATHSMali
Nigeria
SenegalSpain
United States of AmericaTotal6535

2413112081010411510

5338

4951

13567

SUMMARY
A total of 13 567 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in six
affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain, and the United States of America) and two
previously affected countries (Nigeria, Senegal) up to the end of 29 October. There have been 4951 reporteddeaths. The cases reported are fewer than those reported in the Situation Report of 29 October, due mainly tosuspected cases in Guinea being discarded.
Following the WHO Ebola Response Roadmap structure1, country reports fall into two categories: 1) those withwidespread and intense transmission (Guinea, Liberia, and Sierra Leone); and 2) those with or that have had an
initial case or cases, or with localized transmission (Mali, Nigeria, Senegal, Spain, and the United States ofAmerica). An overview of the situation in the Democratic Republic of the Congo, where a separate, unrelated
outbreak of EVD is occurring, is also provided (see Annex 2).

1. COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
A total of 13 540 confirmed, probable, and suspected cases of EVD and 4941 deaths have been reported up to theend of the 29 October 2014 by the ministries of health of Guinea and Sierra Leone, and 25 October by theMinistry of Health of Liberia (table 1). All districts in Liberia and Sierra Leone have now reported at least one caseof EVD since the start of the outbreak (figure 1). Of the eight Guinean and Liberian districts that share a borderwith C te d voire, only one in Guinea is yet to report a confirmed or probable case of EVD.
A total of 523 health-care workers (HCWs) are known to have been infected with EVD up to the end of 29 October:82 in Guinea; 299 in Liberia; 11 in Nigeria; 127 in Sierra Leone; one in Spain; and three in the United States ofAmerica (two were infected in the USA and one in Guinea). A total of 269 HCWs have died.

1 The Ebola Response Roadmap is available at: http://www.who.int/csr/resources/publications/ebola/response-roadmap/en/.

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EBOLA RESPONSE ROADMAP SITUATION REPORT
WHO is undertaking extensive investigations to determine the cause of infection in each case. Early indications
are that a substantial proportion of infections occurred outside the context of Ebola treatment and care. Infection
prevention and control quality assurance checks are now underway at every Ebola treatment unit in the threeintense-transmission countries. At the same time, exhaustive efforts are ongoing to ensure an ample supply ofoptimal personal protective equipment to all Ebola treatment facilities, along with the provision of training andrelevant guidelines to ensure that all HCWs are exposed to the minimum possible level of risk.
Table 1: Confirmed, probable, and suspected cases in Guinea, Liberia, and Sierra Leone
CountryGuinea

Liberia

Sierra Leone

Total

Case definition

Cumulative Cases

DeathsConfirmed

1409*

Probable

204*

Suspected

54*

All

1667

1018

Confirmed

2515*

Probable

1540*

Suspected

2480*

All6535

2413

Confirmed

3778*

Probable

322*

Suspected

1238*

All53381510

13 5404941*N/A. Data are based on official information reported by Ministries of Health. These numbers are subject to change due to ongoingreclassification, retrospective investigation and availability of laboratory results.

2. COUNTRIES WITH AN INITIAL CASE OR CASES, OR WITH LOCALIZED TRANSMISSION
Five countries (Mali, Nigeria, Senegal, Spain, and the United States of America) have now reported a case or cases
imported from a country with widespread and intense transmission.
n Nigeria, there were 20 cases and eight deaths. n Senegal, there was one case and no deaths. However,following a successful response in both countries, the outbreaks of EVD in Senegal and Nigeria were declared overon 17 October and 19 October 2014, respectively.
On 23 October, Mali reported its first confirmed case of EVD (table 2). The patient was a 2-year old girl whotravelled from Guinea with her grandmother to Mali. The patient was symptomatic for much of the journey. On 22October the patient was admitted to Fousseyni Daou hospital in Kayes. Samples for laboratory confirmation weresent to SERAFO in Bamako and were positive for EVD. The patient died on 24 October. Three suspect cases wereidentified and have been discarded. To date, 85 contacts have been identified and are being followed up. A WHO
preparedness team was already in Mali to assess the country s state of readiness for an initial case. t wasimmediately repurposed to provide expertise and support to Malian health authorities in infection prevention andcontrol, contact tracing and in the training of health-care workers. A WHO team and key partners remain in Maliand continue to provide support.
n Spain, the single patient, who was infected in Madrid, tested negative for EVD on 19 October. A second negative
test was obtained on 21 October. Spain will therefore be declared free of EVD 42 days after the date of the second2EBOLA RESPONSE ROADMAP SITUATION REPORT
negative test if no new cases are reported. All 83 contacts of the HCW infected in Spain have completed the 21day follow-up period.
Figure 1: Geographical distribution of new cases and total cases in Guinea, Liberia, Mali and Sierra Leone

Data are based on official information reported by Ministries of Health. The boundaries and names shown and thedesignations used on this map do not imply the expression of any opinion whatsoever on the part of the World HealthOrganization concerning the legal status of any country, territory, city or area or of its authorities, or concerning thedelimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which
there may not yet be full agreement.

There have been four cases and one death (table 2) in the United States of America. The most recent case is a
medical aid worker who volunteered in Guinea and returned to New York City on 17 October. The patient wasscreened and was asymptomatic on arrival, but reported a fever on 23 October, and tested positive for EVD. The
patient is currently in isolation at Bellevue Hospital in New York City, one of eight New York State hospitals thathave been designated to treat patients with EVD.

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EBOLA RESPONSE ROADMAP SITUATION REPORT
Two HCWs who became infected after treating an EVD-positive patient at the Texas Presbyterian Hospital ofDallas, Texas, have twice tested negative for EVD and have been discharged from hospital. Of 176 possible
contacts, 99 are being monitored and 77 have completed 21-day follow-up.
Table 2: Ebola virus disease cases and deaths in Mali, Spain, and the United States of America
Country

Case definition

Cases

DeathsConfirmed11

Probable00

Suspected00All11Confirmed

10

Probable

00

Suspected

00

All

10

Confirmed

41

Probable

00

Suspected

00All

4*162MaliSpain

United States of America

Total*Includes two HCWs infected in the USA while treating an Ebola patient from Liberia, and a HCW infected in Guinea. Data are based onofficial information reported by Ministries of Health. These numbers are subject to change due to ongoing reclassification, retrospective
investigation and availability of laboratory results.

ANNEX 1: CATEGORIES USED TO CLASSIFY EBOLA CASESEbola cases are classified as suspected, probable, or confirmed depending on whether they meet certain criteria(table 3).
Table 3: Ebola case-classification criteria
Classification

Criteria

Suspected

Any person, alive or dead, who has (or had) sudden onsetof high fever and had contact with a suspected, probableor confirmed Ebola case, or a dead or sick animal OR any
person with sudden onset of high fever and at least threeof the following symptoms: headache, vomiting, anorexia/
loss of appetite, diarrhoea, lethargy, stomach pain, achingmuscles or joints, difficulty swallowing, breathingdifficulties, or hiccup; or any person with unexplained
bleeding OR any sudden, unexplained death.

ProbableAny suspected case evaluated by a clinician OR any person
who died from ‘suspected Ebola and had an
epidemiological link to a confirmed case but was nottested and did not have laboratory confirmation of thedisease.

Confirmed

A probable or suspected case is classified as confirmed
when a sample from that person tests positive for Ebola
virus in the laboratory.

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EBOLA RESPONSE ROADMAP SITUATION REPORTANNEX 2: EBOLA OUTBREAK IN DEMOCRATIC REPUBLIC OF THE CONGO
As of 28 October 2014, there have been 66 cases (38 confirmed, 28 probable) of Ebola virus disease (EVD)
reported in the Democratic Republic of the Congo, including eight among health-care workers (HCWs). In total, 49
deaths have been reported, including eight among HCWs. All suspected cases have now been discarded.
No new reported contacts are being followed. Twenty days have passed since the last reported case tested
negative for the second time and was discharged. The Democratic Republic of the Congo will therefore be
declared free of EVD 42 days after the date of the second negative test if no new cases are reported. Thisoutbreak is unrelated to the outbreak that originated in West Africa.

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