1. 2014 Ebola outbreak in West Africa 2014 Ebola Virus Disease (EVD) Outbreak in West Africa: Status report Sarah L Barber Representative World Health Organization, South Africa September 19, 2014

2. 2014 Ebola outbreak in West Africa No. EBV cases reported weekly: Jan-Sept 14 Not reported for 11 weeks indicating weak surveillance system 21 March: Laboratory confirmation in Guinea 23 March: WHO deployed experts Mobile laboratory 31March: Liberia declared outbreak of Ebola 26 May: Sierra Leone declared outbreak 23 July Nigeria declared outbreak 23 August Senegal declared Ebola case o Outbreak spread to 5 countries o Liberia: highest number of cumulative cases o Half of infections occurring within the most recent month

3. 2014 Ebola outbreak in West Africa 3 Situation: 14 Sept CountriesCasesDeaths Cumulative Within 21 days%CumulativeCFR Guinea94231233%60164% Liberia 27101429 53%145954% Sierra Leone 1673653 39%56234% Nigeria 216 29%838% Senegal 11 100%00% TOTAL 53472401 45% 2630 49%

4. 2014 Ebola outbreak in West Africa 4 Health workers disproportionately affected Unfamiliar with disease Unfamiliar with disease Lack of gloves, masks, PPEs Lack of gloves, masks, PPEs Weak IC practices: water and soap, sterilization Weak IC practices: water and soap, sterilization Sept 14: 318 (151) Sept 14: 318 (151) Countries CasesDeaths Guinea6130 Liberia 17285 Sierra Leone 7431 Nigeria 115 TOTAL 318151

5. 2014 Ebola outbreak in West Africa Increase in demand outstripped capacity for response- need to scale up 3-5 fold In Liberia, number of Ebola treatment beds (ETU) is 315 (20% of demand). In Sierra Leone, bed capacity is 165 (25% of demand). Health workers have been hardest hit. Although plans are in place to build facilities, there is a critical shortage of clinical teams available to manage them. Laboratory capacity is gradually expanding; however, there are still critical needs in many locations in Sierra Leone and Liberia. Contact tracing complicated by large geographic scope, and efforts accelerated in urban areas. Safe burials continue to be of concern in light of increasing cases and deaths, particularly the safety of community burials and mass cremation. Social mobilization efforts increasing in affected countries. In SL, >28,500 going to 1.5 million homes to provide education about transmision, prevention, and treatment and to encourage families to take sick relatives for observation if symptomatic. Response status: Guinea, Liberia, Sierra Leone

6. 2014 Ebola outbreak in West Africa Response status: Focus on Sierra Leone (14 Sept) 4 Treatment centers (T) 2 partially functional 4 Laboratories (L) 4 partially functional 4 Referral centers (R) 1 partially functional 4 Contact tracing (C) 5 fully functional 4 Safe Burial (B) 3 partially functional 4 Social mobilization (S) 4 partially functional 4 full treatment sites planned: North: South East West Each site Treatment center (T) Laboratory (L) Referral Center (R) Contact tracing (C) Safe Burial (B) Social mobilization (S)

7. 2014 Ebola outbreak in West Africa Agriculture: 40% economic output in SL and Liberia. Quarantine areas: blocked movement of laborers, goods, trade; possibly leading to food shortages and increases in food prices. Mining: slowed or halted production Human capital: In addition to the loss of lives, most health resources dedicated to the Ebola Response. People have no place to obtain health care (malaria, deliveries, immunizations, etc.) S.L.: 3 day lock-down to find cases: all activity stopped. World Bank estimates: Short term reductions in GDP 2014: 2.1 percentage points (Guinea), 3.4 perc pts (Liberia), 3.3 pp (Sierra Leone). Without containment, reductions of 11.7 pp are predicted for in Liberia. African continent suffering from the stigma and fear of Ebola: aversion behaviors: cancellations of conferences, travel, tourism. Economic implications

8. 2014 Ebola outbreak in West Africa 20 August- 16 Sept 2014: 68 cases of EBV reported, with 40 deaths Lab confirmation that “the virus in the Boende district is definitely not derived from the variant currently circulating in west Africa.” Outbreak is occurring in a remote area 1200 km from the provincial capital with no international links/ports. 6th outbreak reported in the country during the past four decades, and the risk of re-emergence of Ebola in the DRC remained present. Low risk of international spread: outbreak is occurring in a remote area, little international traffic, far from international borders or entry points. The government has quickly acted to contain the outbreak. Control measures have been immediately put in place in the outbreak zone by the Ministry of Health. DRC Ebola: separate outbreak

9. 2014 Ebola outbreak in West Africa 2014 Ebola VD Outbreak now affects 5 countries. Nigeria and Senegal, have reported cases imported from countries w/ widespread transmission. The outbreak continues to escalate. In Guinea, Liberia, Sierra Leone, approx 50% of cases and deaths have occurred in the last month. Health and economic implications could be catastrophic over the long term. All countries: strengthen preparedness to rapidly detect and respond to an Ebola exposure. With the anticipation of 6-9 more months of transmission, the probably increases that cases will occur outside the affected countries. Current response effort has been scaled up significantly but there are huge unmet needs (ETCs, medical teams, lab, PPEs, transportation, communication, food supplies, etc) Summary

10. 2014 Ebola outbreak in West Africa Thank you 10