Ebola virus disease 

Disease outbreak news 
30 December 2014

On 29 December 2014, WHO was notified by the National IHR Focal Point for the United Kingdom of a laboratory-confirmed case of Ebola Virus Disease (EVD). This is the first EVD case to be detected on UK soil.

Details of the case are as follows:

The case is a female healthcare worker who has returned from volunteering at an Ebola treatment centre in Sierra Leone. The patient flew from Freetown to London via Casablanca, Morocco before reaching Glasgow on 28 December. The case displayed no symptoms of infectious Ebola throughout the journey, but is believed to have become febrile around the time of arrival to London.

After feeling unwell with fever and myalgia, the case was admitted to the specialist Brownlee Unit for Infectious Diseases on the Gartnavel Hospital campus in Glasgow and placed into strict isolation on the morning of 29 December. The patient was transferred for treatment in isolation at the Royal Free hospital in London on 30 December 2014. Currently, the patient is in stable condition and remains in isolation.

Public health response

A range of public health measures are being implemented by UK authorities with special attention to investigate all possible contacts with the patient during the flight to Scotland via Heathrow.

WHO is in close contact with UK authorities and is facilitating information sharing with involved countries, including Morocco. WHO is ready to further assist as needed.

Future WHO updates on EVD in the UK will not be posted on the Disease Outbreak News. Further information will be available in the WHO’s Ebola Situation Reports, which provide regular updates on the WHO response:






11 December
WHO: The latest World Health Organization situation report as at 10 December reports a total of over 17,000 clinical cases and more than 6,000 deaths in Guinea, Liberia and Sierra Leone. The number of new cases is increasing or stable in Sierra Leone, slightly increasing in Guinea and decreasing in Liberia. About 70% of all people infected in West Africa die, though this number drops to 60% amongst patients who are hospitalised. The United Nations Mission for Ebola Emergency Response (UNMEER) reported that they continue to progress in line on their goal of isolating and treating 100% of cases and safely burying 100% of people who die from Ebola by 1st January 2015.

Senegal: The Senegalese government has geared up preparations for any health eventuality including Ebola ahead of the annual Magal festival in Touba. Read more...

Sierra Leone: The Ministry of Health confirmed 37 new cases in its latest situation update. Read more...

Spain: The Spanish aid worker who had been repatriated from Mali on 21 November has completed the 21 days hospital quarantine. According to a press release, the healthcare professional did not develop symptoms and has been discharged. The patient had been exposed to contaminated material while caring for patients in Mali.

10 December
Sierra Leone: 
Case incidence is still increasing, with almost 400 new confirmed cases in the first week of December. Authorities are concerned that the outbreak in Kono may be far greater than officially reported cases. Unverified information indicates that dozens of people have died at a local hospital, with outbreaks evident in many villages. A team from Kenema will travel to Kono to support the Ebola response there. A "lock-down" restricting movement into and out of the district has been implemented and is expected to be in place until 23 December. Analysis of the Ebola situation in the country published this week indicate significant gaps in infection control by healthcare workers, including during transport of infected patients. In Kenema, cases of Lassa fever have been identified. Read more...

Liberia: Case incidence appears to be declining. Over 1,200 are functioning, in 12 treatment centres across the country. An Ebola Transit Unit consisting of 10 beds has been built by Médecins Sans Frontières (MSF) near Redemption Hospital in New Kru town in Monrovia. Read more...

Guinea: The incidence of new cases continues to trend slightly upwards and expanding geographically, with Telimele recording its first case in more than 12 weeks. The pattern in individual districts ranges from stable but persistent, to intense. In some areas there remains strong community resistance to contact tracing. There is concern that some are travelling into Mali for treatment. Read more...

An editorial published in the International Journal of Epidemiology highlights the importance of Ebola survivors in controlling the epidemic. Thousands of Ebola survivors can contribute in a number of ways. Survivors have immunity to Ebola, opening the possibility for a role as care givers. Survivors may also gain the trust of their local communities more easily than outside agencies because they are familiar with the local language and culture. Finally, the convalescent serum (a blood component) from the survivors has been found useful in the treatment of Ebola patients. Proper training and employment of the survivors as Ebola caregivers may help fight poverty and stigma against Ebola.

United Kingdom: The Department of Health has issued two new information sheets. One targeted for humanitarian aid workers (pdf) and another for their friends and family members (pdf). These help provide some context for the healthcare workers (HCWs) from the UK and the outline expected behaviour, and duty of care, of organisations deploying staff to Ebola-affected nations. The second document provides some practical advice for family and friends supporting HCWs returning to the UK.

Europe: The European Commission held a teleconference on 4 December with Members of the Health Security Committee on Ebola. The UN Special Envoy, Dr Nabarro, commented that although there are some positive results in curbing the spread, there continue to be "hundreds of small outbreaks". Committee members called for more international teams of medical staff and epidemiologists to be mobilised, and trainers to teach the principles of contact tracing, awareness programs and safe burial.

WHO: The Director General of the World Health Organization has again highlighted the need for resilience in healthcare systems in her opening remarks at a WHO convened meeting 10-11 December in Geneva. The spread of Ebola in Guinea between December 2013 and March 2014 happened in the absence of a well-functioning health system and was compounded by the nation only having 1-2 doctors for every 100,000 people. Dr Chan emphasised the need to build primary health care, close to homes, which engage with local communities as a way to promote safe behaviour. Community engagement should also include the traditional healers with a call to include them formally in the healthcare system. Beyond primary care, there is an urgent need for referral systems to hospitals that are appropriately upgraded and able to safely deliver care. Disease detection was also lacking in the Ebola-affected nations of Guinea, Liberia and Sierra Leone and these capabilities should be integrated into the healthcare systems which emerge from this crisis.

9 December
WHO guidance hand hygiene: 
review of available information has confirmed that "Alcohol-based handrubs are the standard of care for hand hygiene of health workers caring for Ebola patients." Bleach solutions "may be used in the interim period in emergency situations until alcohol-based handrubs or soap and water become available" however "WHO recommends implementing a strategy to change to alcohol-based handrub or soap and water". There is "limited evidence" to recommend the use of bleach for hand hygiene however " 0.05% chlorine solution applied for a minimum time of 40 to 60 seconds until hands are dried is appropriate and likely to be efficacious" and "Chlorine solutions are suitable for environmental cleaning, decontamination of personal protective equipment and soiled linen".

USA Vaccine: Development, manufacture, testing, distribution and administration of three experimental Ebola vaccines have been given immunity against legal claims in the United States. The Department of Health and Human Services announced that the declaration should "strengthen the incentive to conduct research and spur development, manufacturing, and the potential use of the vaccines in large scale vaccination campaigns in West Africa". Read more...

Review of airport entry and exit screening: An article published today in US CDC's Morbidity and Mortality Weekly Report, provided an analysis of screening for Ebola. The exit screening data from Guinea, Liberia and Sierra Leone showed that from August to October, none of the travellers denied boarding developed Ebola. However two travellers who passed exit screening subsequently developed Ebola after arrival in the US. Enhanced entry screening for Ebola began in the US in October. Of the almost 2,000 people screened, 86 were referred to public health officers, and seven of them had further medical evaluation. One healthworker flagged on entry screening had no symptoms when entering the US, but developed Ebola six days after arrival. "Together, the combined exit and entry screening processes achieve the following six outcomes; they: 1) prevent travel by ill persons from countries with widespread Ebola transmission until they have had appropriate medical evaluation, 2) reduce the likelihood of a traveler from a country with widespread Ebola transmission becoming ill during travel, 3) allow the quick identification of any illness in persons arriving from countries with widespread Ebola transmission, 4) limit contact of persons being evaluated for Ebola with other persons, 5) facilitate rapid and appropriate clinical care for ill travelers, and 6) provide the arriving traveler with public health education and links with public health authorities." The review concludes these processes are "of critical importance to facilitate rapid detection of illness and implementation of appropriate public health control measures."

Sierra Leone: Media reports say members of the nation's Junior Doctors Association are on "partial strike". They are protesting a perceived lack of care for locally-based medical staff who are infected with Ebola. Most of the local doctors who are working to control the outbreak in the country are from this Association.

Mali: A mobile laboratory capable of diagnosing Ebola has arrived in the country. No new cases have been identified. One person remains in the treatment unit in Bamako while 26 contacts continue to be monitored.Read more...

8 December
Sierra Leone: The Ministry of Health reported 25 newly-confirmed cases for the 7 December and 58 cases for the 8 December. World Health Organization data shows Sierra Leone has now overtaken Liberia as the nation with the most Ebola cases.  Read more...

Liberia: At least 22 members of the UN Mission to Liberia (UNMIL) have been isolated after contacts of the infected peacekeeper were traced. Read more...

7 December
Liberia / Netherlands: Dutch officials announced that an infected UN peacekeeper has been evacuated from Liberia to the Netherlands. The Nigerian patient is now receiving treatment at the University Hospital in Utrecht.

Sierra Leone: Media reports say at least two doctors in Sierra Leone have died of Ebola in the past few days. There are also reports that Red Cross burial teams have been attacked by community members in several areas. Read more . . .

6 December
UN peacekeeping staff quarantined in Bamako have completed their period of observation. None of them developed Ebola symptoms. The staff had been quarantined because they had potentially been in contact with an infected person. They were being treated for injuries at the Pasteur clinic, where a nurse was diagnosed with Ebola.

The nation has not reported any additional cases of Ebola, and said that only one patient remains hospitalsed for treatment. Read more...

5 December
Sierra Leone: 
An additional 25 deaths and 69 confirmed cases have been reported by the Ministry of Health.Read more...

Liberia: The United Nations Mission to Liberia (UNMIL) has a third member infected with Ebola. Read more...

United Kingdom: The Department of Health has issued statistics on the number of notifications and tests carried out by the Imported Fever Service (IFS) in screening suspected Ebola cases (pdf). Other than the infected healthcare worker repatriated from Liberia, no cases of Ebola have been diagnosed in the UK from more than 210 enquiries and 110 tests. More than 1,300 people have been screened by the port authorities, with around 40 low-risk individuals directed to self monitor and only two people referred to healthcare facilities for further tests.

United States: Like the UK, the US CDC reported how many people it has investigated for possible Ebola infections. From July through mid-November, 650 patients were brought to their attention. Most had not travelled to an Ebola-affected country and did not have contact with an Ebola patient. (Thus they did not meet criteria for further investigation.) Ultimately, 61 of the people were tested. Four had the virus. The CDC said that, in some of the 650 incidents, the patients did not receive timely examinations and treatment as medical staff consulted about whether they had Ebola. That’s an issue when most of these people had no actual risk factors. CDC stated the importance of identifying who is not a possible Ebola case and treating them promptly. Of the 33 who were tested for Ebola, the most common diagnoses were malaria and other viral illnesses such as influenza.

4 December
Sierra Leone:
 The Ministry of Health reports 26 deaths and 93 newly-confirmed cases. Read more...

According to the latest World Health Organization Situation Report, there have been more than 17,000 cases and 6,000 deaths worldwide from Ebola. The number of new cases is increasing in Sierra Leone, slightly increasing in Guinea and stable in Liberia. About 70% of all people infected in West Africa die, though this number drops to 60% amongst patients who are hospitalised. The United Nations Mission for Ebola Emergency Response (UNMEER) reported that they have "likely" met their goal of isolating and treating 70% of cases and safely burying 70% of people who die from Ebola by 1st December. However, there continue to be hard-to-reach hot spot areas in remote locations which fall below these targets. Activities will need to be intensified in order to reach the target of 100% isolation and 100% safe burial by 1 January. See the individual country pages for further details.

Europe: Following the experience of health authorities in Spain, the European Centre for Disease Prevention and Control (ECDC) and the European Food Safety Authority (EFSA) issued a joint statement on the risk of Ebola virus linked to household pets (pdf). Although much remains unknown, there is no current evidence that dogs or cats can develop the disease and transmit the virus. Risk assessments on pets that have been in contact with human Ebola cases should be done jointly by veterinary and public health authorities on case-by-case basis. In animals, much of the natural history of the Ebola virus remains unknown. Therefore, "the probability of a human becoming infected [after contact with an infected pet] could range from very low to high." Periods of isolation or home restriction may be considered for pets in contact with human cases.

United States: A US healthcare worker was medically evacuated to Atlanta, Georgia on 4 December following possible exposure to Ebola in West Africa. Details are limited.

3 December
The latest World Health Organization situation summary reports a total of over 17,000 clinical cases and over 6,000 deaths in Guinea, Liberia and Sierra Leone as at 30 November. The total number of deaths has been revised down after more than 1,000 deaths in Liberia were removed from the count on 1 December, due to "ongoing reclassification, retrospective investigation and availability of laboratory results."

Sierra Leone: An additional 61 confirmed cases and 26 confirmed deaths were announced by the Ministry of Health. Read more...

2 December
Sierra Leone: 
The Ministry of Health announced 27 confirmed deaths and 72 confirmed cases. The government also began preventing people from entering or leaving Tonkolili district (Northern province) in an effort to control the spread of Ebola. This measure will remain in place until 15 December. During this period, the borders of the district will be sealed and authorities will conduct a door-to-door awareness-raising campaign in the area. Visitors will not be allowed into the district, though vehicles passing through it will be allowed to enter, provided they do not stop.Read more...

Mali: One confirmed case remains hospitalised and no new cases have been identified as of 30 November. Read more...

Spain: The World Health Organization officially declared the Ebola outbreak in Spain over today. It has been 42 days (two Ebola incubation periods) since the country's single case recovered from infection.

1 December
Sierra Leone:
 The Ministry of Health reports 75 newly-confirmed cases. Of the 138 health care workers who have been infected, 106 have died. Read more...

Italy: The doctor undergoing treatment in Rome is reported to be in a critical condition. He is receiving another dose of convalescent serum from a patient who recovered in Germany.






The Ebola outbreak in West Africa was first reported in March 2014, and has rapidly become the deadliest occurrence of the disease since its discovery in 1976.

In fact, the current epidemic sweeping across the region has now killed more than all other known Ebola outbreaks combined.

Up to 4 November, 4,960 people had been reported as having died from the disease in five countries; Liberia, Guinea, Sierra Leone, Nigeria and the United States. A further death has been reported in Mali.

The total number of reported cases is in excess of 13,000.

The World Health Organization (WHO) admits the figures are underestimates given the difficulty collecting the data and warns there could be as many as 20,000 cases by the end of November if efforts to tackle the outbreak are not stepped up.

Ebola deaths in West Africa

Up to 4 November


Deaths - probable, confirmed and suspected

(Includes one death in US and one in Mali)

  • 2,766 Liberia

  • 1,130 Sierra Leone

  • 1,054 Guinea

  • 8 Nigeria


Liberia children orphaned, ostracized by Ebola

In this photo taken Sunday, Sept. 28, 2014, Promise Cooper, 16, Emmanuel Junior Cooper, 11, and Benson Cooper, 15, sit at their St. Paul Bridge home in Monrovia, Liberia. The Cooper children are now orphans, having lost their mother Princess in July, and their father Emmanuel in August. Their 5-month-old baby brother Success also succumbed to the virus in August. Ruth, their 13-year-old sister is being hospitalized with Ebola. The three never fell sick to the deadly disease. (AP Photo/Jerome Delay)

MONROVIA, Liberia (AP) — First 16-year-old Promise Cooper's mother complained of a hurting head and raging fever, and she died days later on the way to the hospital.

The following month, her father developed the same headache and fever. Her baby brother grew listless and sick too, and refused to take a bottle.

That's when Promise knew this was not malaria.

She had heard about Ebola on the radio. When she tended to her father, she washed her hands immediately afterward. Desperate to keep her three younger siblings safe, she urged them to play outside their one-room home. Yet she was powerless before an invisible enemy, as her family of seven disintegrated around her.

In the meantime, neighbors and relatives were starting to become suspicious. No one came by to check on the kids, not even their grandparents.

Word, like the virus, was spreading through Liberia's capital: The Coopers had Ebola.


In Liberia's large, deeply religious families, there is usually an aunty somewhere willing to take in a child who has lost a parent. But Ebola, and the fear of contagion and death, is now unraveling bonds that have lasted for generations.

At least 3,700 children across Liberia, Guinea and Sierra Leone have lost one or more parents to Ebola, according to the U.N. children's agency, and that figure is expected to double by mid-October. Many of these children are left to fend for themselves, and continue to live inside infected houses.

Promise was used to looking after her younger siblings, and often carried a baby cousin on her hip around the neighborhood. When her mother was alive, they would alternate weeks of cooking. She knew how to make porridge for breakfast, rice with potato greens for dinner.

When her father fell sick, she took over all the things her mother used to do. There was no school because of the Ebola epidemic, so she had time to wash her brothers' soccer jerseys and jeans.

But nothing she did could help 5-month-old Success, whose name reflected his parents' dreams. Just like their mother, the little boy died. There was nobody to help them and no ambulance to spare, so his body stayed in the house for several days.

By the time the ambulance finally came to take away her father and the tiny corpse bundled in blankets, 11-year-old Emmanuel Jr. was stricken too.

Promise watched as medics packed half her family into the back of the ambulance. She was now alone with 15-year-old Benson and 13-year-old Ruth.

She could not afford a phone call to see how their father and brother were doing, even if she could get through on the hotline for relatives that was almost always busy. A taxi to the Ebola clinic across town cost even more. An uncle stopped by to drop off some money, but left without touching the children for fear of infection.

Promise resolved to keep the family together until her father came back.

She decided to use what little cash she had to buy plastic bags of drinking water. The family had a cooler, and she planned to sell the bags she bought at $1 a piece for $2.

Day after day, though, no customers came. Nobody wanted to buy water from the girl whose mother died of Ebola, and whose father and brother were at the clinic. Promise looked healthy, but fear was overcoming compassion in the St. Paul Bridge neighborhood where they lived.

If the children sat down somewhere, people would spray bleach after they got up. When they tried to buy something with what little money they had, vendors refused to serve them.

Neighbors didn't want the Cooper boys playing with their children. And even though health workers had disinfected the path from the well that went right past their house, women took their brightly colored plastic buckets the long way around instead.

Promise, overcome with grief and beaten down by stigma, became depressed.

"Why don't you want to talk to me? Why God does nobody want to come around?" she sobbed. "We are human beings."


Finally she scraped together enough change from a cousin to take a taxi to the gates of the Ebola clinic. A security guard said he would check whether Emmanuel Cooper Sr. was on the list of the living.

Promise and Ruth paced outside the barbed-wire topped walls of the clinic for what felt like hours, waiting for an answer on when he would be coming home.

The guard came back. He said he was sorry, but their father was dead.

The girls broke down sobbing.

No one could tell them if 11-year-old Emmanuel was still alive.


Even as Promise lost both her parents, another man in the community was trying to document just how many children were orphaned in the St. Paul Bridge community. Kanyean Molton Farley, a human rights researcher by day, devoted all his spare time to making a list of the now 28 parentless children living alone. In most cases, teenagers like Promise are now raising their siblings amid an overwhelmed social welfare system.

"The story of the Cooper children touched my gut, and I never stopped coming back," he said one morning, as he dropped off soap for the children.

The family's rent was already paid through the end of the year, but they soon ran out of money to pay the electricity. Farley worried most of all that Promise could fall prey to an older man. At 16 and hungry, she was vulnerable to abuse.

Then the Cooper children caught a lucky break: Promise saw her brother's face on television, among government photos of children who had survived Ebola at the city's clinics but were still separated from their families.

"It's him, it's him!" she told Farley. Off they went to get Emmanuel — the first in the family to survive the plague sweeping their neighborhood.

Not long after Emmanuel came home, Ruth became feverish and unwell one night. How could this be happening again? A terrified Promise called their friend Farley late at night. He couldn't come until morning because of the curfew.

So he told her to use the family's mattresses as room dividers in the single bedroom where they all slept. Ruth would stay on one side; the healthy children would sleep on the other.

At first light, an ambulance called by Farley took Ruth to the hospital.


Now it is just Promise and the boys.

She insists they will never go live with strangers. Yet they no longer want to stay in the house where their parents lay dying and their brother's body sat for days.

On a Sunday afternoon after church, there is no television to watch without electricity. The TV set sits gathering dust with a soiled stuffed unicorn on top of it.

The children sleep together in their parents' bed at night, instead of crowding on the floor below as they did in their previous life. Some nights her brothers weep for their mother, and Promise tries to be firm but caring.

"I tell them Ma and Pa are no more, and that they shouldn't worry about that," she says. "We must concentrate on living our lives because they are gone."

Just a few weeks ago, their aunt Helen came around to the house — the first family member to do so in months. She had been upcountry when the children's parents died and wanted to see how they were doing.

It pains her to think of her brother, and what he would say about the children out of school, cooking and cleaning for themselves.

"I have to come back because everyone has abandoned them," says Helen Kangbo, breast-feeding her 1-year-old daughter Faith after joining her nieces and nephews for a paltry dinner of rice. "I must have the courage to come."

Of course, now that Helen is in contact with the children, she is shunned by the same extended family that fears Promise and her siblings.

Each day Promise mixes up bleach and water in bottles to keep the house and her brothers clean. "Don't go around people. Don't touch your friends. Anything you touch, you wash your hands," she scolds them.

Days later, she says her prayers have been answered: After three weeks at an Ebola treatment center, 13-year-old Ruth is cured. She is still weak, so she is staying with Farley's family. When Ruth is well enough she will return home.

Here in their house, there is little trace left of dead loved ones, because authorities have burned their parents' clothing in a bid to stop the spread of the disease. The only photos of their parents are on their voter ID cards. And the only reminder of Success is the two bottles of baby powder, still sitting on a table in the room.




WHO declares end of Ebola outbreak in Nigeria

20 October 2014

The Ebola virus was introduced into Nigeria on 20 July when an infected Liberian man arrived by aeroplane into Lagos, Africa's most populous city. The man, who died in hospital 5 days later, set off a chain of transmission that infected a total of 19 people, of whom 7 died.

According to WHO recommendations, the end of an Ebola virus disease outbreak in a country can be declared once 42 days have passed and no new cases have been detected. The 42 days represents twice the maximum incubation period for Ebola (21 days). This 42-day period starts from the last day that any person in the country had contact with a confirmed or probable Ebola case.

Today, 20 October, Nigeria reached that 42-day mark and is now considered free of Ebola transmission.

WHO commends the Nigerian Government's strong leadership and effective coordination of the response that included the rapid establishment of an Emergency Operations Centre.

When the first Ebola case was confirmed in July, health officials immediately repurposed technologies and infrastructures from WHO and other partners to help find cases and track potential chains of transmission of Ebola virus disease.

WHO, United States Centers for Disease Control and Prevention (CDC), Médecins Sans Frontières (MSF), UNICEF and other partners supported the Nigerian Government with expertise for outbreak investigation, risk assessment, contact tracing and clinical care.

Strong public awareness campaigns, teamed with early engagement of traditional, religious and community leaders, also played a key role in successful containment of this outbreak.

The Nigerian government and staff in the WHO country office are well aware that the country remains vulnerable to another imported case. The surveillance system remains at a level of high alert.

Nigeria has revised its national preparedness and response plan to ensure that the country is well prepared for other imported cases of the disease.



Imported cases
Many locations are testing people who have travelled to Ebola-affected countries and returned with a fever and other symptoms. Nigeria, Senegal and the United States have confirmed imported cases of Ebola. HANDSA is monitoring these closely.

14 October
Germany: The United Nations Mission in Liberia (UNMIL) doctor who was evacuated to Germany has died. The Sudanese medic was being treated at St Georg Hospital in Leipzig.

Liberia: The Government of Liberia has announced plans to build 16 further ETUs to raise the nation's bed capacity to more than 2000. Other units are due to open in the near future, including one in Old Congo Town, Monrovia. 

UNMEER: The latest reports from the UN Mission for Ebola Emergency Response for 13 & 14 October highlights nearly 8,700 cases and more than 4,150 deaths with no slowing in the "upward trajectory" of Ebola disease activity. Infections amoung healthcare workers are also increasing with 416 infected as at 8 October, of which 233 people have died. There is an urgent need for personal protective equipment (PPE), particularly in Liberia in centres which are not presently treating Ebola cases. General medical service provision is suffering as a result of the lack of PPE. More than 21,000 household hygiene kits have been dispatched to Liberia to support the management of cases in households until sufficient ETU beds are made available.

Nigeria, Senegal: The WHO has issued a new situation assesment which explains that although the outbreak in these nations has not yet been declared over, the announcement will be made within 7 days if there continue to be no new cases. 

CDC: Three articles have been published in this week's Morbidity and Mortality Report (MMWR) relating to Ebola preparedness in New York City, a cluster of Ebola cases in Monrovia affecting healthcare workers and the response of the Liberian Ministry of Health and Social Welfare in implementing an Incident Management System. 

Treatment/Vaccines: The Director of the National Institute of Allergy and Infectious Disease (NIAID) has published a blog post, expanding on some of the NIAID-led developments in research towards new treatments and vaccines for Ebola. It covers the use of ZMapp, brincidofovir and lamivudine in combating Ebola, explaining that these are in the early stages of evaluation with further study planned. Two Ebola vaccine candidates are also entering trial stages with one underway in Maryland with more study sites planned.

13 October
WHO: In the Director-General's key note address to the Regional Committee for the Western Pacific, the Ebola outbreak was described as an unprecedented "health event threaten[ing] the very survival of societies and governments in already very poor countries." The number of new cases is rising exponentially in Guinea, Sierra Leone and Liberia. The statement emphasised the impact of widening social and economic inequalities on the severity of the outbreak, the economic losses which often arise from "uncoordinated and irrational efforts to avoid infection", and although this disease mostly affects the poor, left unchecked there is a risk of global impact. The lack of proper health infrastructure in the West African nations has added to the damage wrought by Ebola. The Director-General also questioned the paucity of medicines and vaccines against Ebola, despite it being identified nearly forty years ago and concludes with the assertion that this outbreak highlights the fact that "...the world is ill-prepared to respond to any severe, sustained, and threatening public health emergency." 

In another event, the World Health Organization has annouced plans to develop a common set of tools to strengthen preparedness efforts against Ebola in currently unaffected countries in Africa. The toolkit will include a comprehensive checklist to help assess the level of preparedness and to prompt nations to request assistance. The countries have been categorised on the basis of risk to exposure, trade patterns and health infrastructure. The highest priority countries - Cote d’Ivoire, Guinea Bissau, Mali and Senegal will be targeted initially.

Sierra Leone: In the latest WHO situation reports, 137 newly confirmed cases have been identified up to 11 October.

Liberia: Media sources report that healthcare workers have planned an indefinite strike starting midnight 12 October.

Canada, US: In a press release the Government of Canada has confirmed the launch of the first human trials of its Ebola vaccine at the the Walter Reed Army Institute of Research in Silver Spring, Maryland, United States.

ECDC: The European Centre for Disease Control has published initial guidelines on "Entry and exit screening measures" (PDF) for European Union (EU) member states. The guidelines acknowledge the importance of exit screening in affected countries, although early study into these measures suggests that no confirmed Ebola (EVD) cases have yet been detected attempting to depart. The value of entry screening is questioned, except:

  • where there are doubts about the efficiency of exit screening 
  • to detect the few who may develop fever between the time of departure and the time of arrival. This could be considered in particular for long haul flights with multiple connections, extending beyond 12 hours.  

The use of both non-contact infrared thermometers (NCIT) and thermal scanner cameras (TSC) are explored, together with the history of these technologies in previous epidemics. The ECDC concludes that "Overall, screening for EVD among travellers may detect a few contagious EVD cases over time. Given that exit screening is in place in the affected countries and the poor intrinsic performance of the methods available, entry screening for EVD is likely to have an exceedingly low yield and represents a high investment, which may only contribute to a limited extent, to the prevention of importation of the disease."

12 October
United States:
A healthcare worker at the Texas Health Presbyterian Hospital who cared for the nation's first Ebola developed a fever on 10 October and was confirmed to have Ebola today. The woman is hospitalized in isolation, and reportedly only had contact with one other person while showing signs of Ebola. That person is under "active monitoring" and has no symptoms. This is the first time Ebola has moved person-to-person in the United States, and only the second time it has ever spread between people outside Africa. (The first was a healthcare worker in Spain, announced last week.) The general public in Texas is not at risk.

11 October
The nurse's condition is said to be improving, following treatment with ZMapp.

United States: Journalists from US NBC News who worked with an infected photojournalist (see story below, 6 October) have been ordered into quarantine in New Jersey. The order came after the crew did not comply with voluntary isolation. None of them have any symptoms of illness.  They are required to stay in home isolation until 22 October. The infected photojournalist is said to be improving.

10 October
Sierra Leone:
Koinadugu remains the only district without confirmed cases of Ebola. On October 8, new cases were laboratory confirmed in Kono, Western Area, Moyamba and Bo. Travel restrictions are in place for seven of the country's 12 districts - medical clearance and special permits are required. 

Liberia: Unverified reports indicate that over 1300 peace-keepers of the Nigerian Army are under monitoring after unspecified contact with a Sudanese man who came to their camp, and died of Ebola.

Guinea: Media sources have reported a spike in Ebola cases at the Donka Ebola Treatment Centre.

WHO: In an update to the Ebola Response Roadmap, around 350 new cases and 160 deaths bring the totals to 8,376 and 4,024 respectively. This increase takes into account data up to 8 October, 3 days since the last full report. Although speculation about Gbarpolu county in Liberia has been circulating for some time, two cases have been confirmed there for the first time. Activity in two other counties appears to have stopped: River Cess and Maryland. It remains to be seen if this is a true reflection given the difficulty in aggregating accurate reports cited in the 8 October publication.

9 October
WHO Europe
: The risk that Ebola will spread in Europe is low, though it is practically inevitable that a few cases will occur there due to international travel. This is the message from a  issued by the Regional Director of Europe's WHO Regional Office, who also stressed that "European countries are among the best prepared in the world to respond to viral haemorrhagic fever, including Ebola."

The 8 October situation report by the UN Mission for Ebola Emergency Response (UNMEER) highlights some of the constraints to health service delivery, the end of a health worker boycott in Bong County and an additional burial team for Liberia. In Guinea, a new Ebola Treatment Centre will be set up and staffed by the French Red Cross, and education campaigns have reached over 125,000 people in the last week.

United Kingdom: Media reports state that UK authorities may add "enhanced screening" for travellers arriving from Ebola-affected areas at Heathrow and Gatwick airports and at Eurostar train terminals. These measures could include taking a person's travel history, discussing their contacts and travel plans as well as a medical screening. The United States just announced that they will enact measures at five international airports (see below). The British government statement on the enhanced screening measures, which includes advice from the Chief Medical Officer, reiterates that the overall risk to the UK public "continues to be very low".

In other news, the Ministry of Defence have announced they will provide a ship and 3 helicopters, as well as 750 personnel to help set up Ebola treatment centres and an Ebola training academy. 

United States: The possible contact of the confirmed case who was under investigation in Dallas has tested negative for Ebola.

Authorities will enact extra health screening measures in five airports in the country: John F. Kennedy International Airport (in New York),Newark, Washington-Dulles, Chicago O'Hare and Atlanta. These five facilities receive around 94 percent of all travellers who enter the United States from the Ebola-affected nations of Guinea, Liberia and Sierra Leone. The CDC says measures will start next week in most places, with early initiation in New York on 11 October. Travellers arriving from Ebola areas will be observed for signs of illness, asked questions about their health and exposure to Ebola, and reminded to monitor their health for symptoms. Their temperature will also be measured.

Liberia, Germany: A second member of the United Nations Mission in Liberia (UNMIL) team has been infected with Ebola. He has since been evacuated from Liberia to Leipzig, Germany for treatment in the St. Georg Hospital. He is the third Ebola case to be treated in the country. Two previous cases were treated in Hamburg and Frankfurt.

Spain: Additional people have been placed under monitoring, and media reports say the infected nursing assistant is in declining health. There are also reports that the woman stated she may not have followed infection control protocols closely enough, particularly when removing protective equipment.

8 October
By the week ending 5 October, 8,033 people have been infected and 3,865 have died according to this week's Ebola Roadmap SitRep. The situation in all three West African nations continues to deteriorate with widespread and sustained transmission of the disease. Liberian workers are struggling to collect and process data on the severity of disease activity in the country and lab reports are not being included in national reporting. This significantly underestimates the genuine picture. More detail is included on the individual country pages but in summary: Guinea has recorded around 100 new confirmed cases in the past week; Liberia struggles to collect data but estimates of more than 200 clinical cases in the past week likely underplays the true situation; Sierra Leone also has seen a rise in cases week on week with more than 350 in the past week alone.

Sierra Leone: The Health Ministry has reported new cases and deaths in their latest update. 

United States: The man hospitalised with Ebola in Dallas died. One of his possible contacts started showing signs of illness and is being tested for Ebola at the Texas Health Presbyterian Hospital. The photojournalist evacuated from Liberia who is being treated at the Nebraska Medical Center has begun treatment with the experimental antiviral medication Brincidofovir.

Liberia: An interim care centre to look after children orphaned by Ebola has been opened by Child Fund International in Monrovia.

There are several reports that the government will restrict media coverage at health facilities. They state that this is to protect the privacy of patients and healthcare workers and to ensure the safety of staff and journalists. Healthcare workers will not be allowed to give any information, and all interviews require advance approval from the Ministry of Health.

Samaritan's Purse launched a new home-based education programme. This training will help community members support Ebola patients in remote areas more safely. Ebola patient care will be addressed, and participants will receive a kit that includes protective clothing, medicines, disinfectants and rehydration supplies. The first round will be implemented in River Gee County. The organisation also plans to build the first Community Care Centre in that county. 

Sierra Leone, Norway: A Norwegian aid worker has been infected with Ebola in Sierra Leone while volunteering with MSF in Bo district. She was isolated and has been repatriated to Norway to receive treatment in Oslo.

Outlook: The World Bank has cautioned that the economic impact of the Ebola outbreak, which already is projected at US$2.2-7.4 billion loss by the end of 2014, could be as high as US$32 billion if neighbouring countries are also significantly infected. These figures are considered a "High Ebola" scenario, presuming slow containment of the current outbreak and spread of the virus to additional areas in the region. The report (PDF) suggests that these projected losses could be mitigated if other countries mount a robust response similar tot he one seen in Nigeria and Senegal.

The Food and Agriculture Organization (FAO) published their year-long response plan (PDF) to the Ebola outbreak. The four pillars of the response aim to: stop the spread of disease; boost incomes and agricultural production; build resilience in the communities, and; strengthen response coordination. They predict that harvests will be severely affected by the lack of available labour in Guinea, Sierra Leone and Liberia. This threatens food security in those countries. Tens of thousands will be impacted.

7 October
The US CDC downgraded its travel advisory for Nigeria to its lowest level (Level 1 - watch). Risk of infection there has decreased as the nation's limited outbreak was brought under control. No new cases have been reported since early September.

Liberia: The World Health Organization (WHO) and Ministry of Health have launched a new training program for healthcare workers in Monrovia. At least six people who survived Ebola infections will participate and share their experiences. A mock Ebola treatment unit has been constructed for the two-week long course. Over 400 health workers will attend sessions. Once they successfully complete the program, trainees will be eligible to work in Ebola treatment centres across the country.

In their latest situation report, the Ministry of Health confirmed additional cases and deaths.

The US CDC released an assessment of the Ebola case burden, health care infrastructure, and emergency preparedness in four counties in southeastern Liberia (Grand Gedeh, Grand Kru, River Gee, and Maryland) in August. This was before any of these areas had Ebola cases, but while the outbreak was affecting other parts of the country. These areas previously had six physicians, but half of them had already left the country due to the epidemic. Nursing staff had abandoned their posts in half the hospitals reviewed, and students and volunteers were often found providing medical care and responding to emergencies in their absence. Gloves were in low supply or completely absent. There was not enough personal protective equipment to care for Ebola patients and healthcare providers were not trained in its use. Handwashing stations were found only in operating rooms, if anywhere, and supplies of soap, bleach, and alcohol-based hand gel had run out. Only two of the four counties had isolation facilities and these lacked water, electricity, and waste disposal facilities. No Ebola surveillance systems were in place. Some of these issues have been remedied since August, but this report paints a clear and unfortunate picture of the limited resources available in some affected areas to fight this Ebola outbreak.

Spain: Media sources reported that a second healthcare worker has been isolated at a hospital in Madrid with diarrhoea, a possible symptom of Ebola, though initial tests for Ebola were negative.

WHO: The World Health Organization released a situation assessment regarding the mode of transmission of the Ebola virus. They refute claims that Ebola can spread through the air and state that speculations that the virus may mutate into an airborne disease are unfounded. The Ebola virus spreads thought direct physical contact with infected bodily fluids or contaminated surfaces and objects. This echoes the statement issued by the UN Mission for Ebola Emergency Response on 3 October [PDF].

Also making headlines from WHO is a statement from the European Director that additional cases of Ebola in Europe are "unavoidable" due to international travel between Europe and Africa. In actuality, imported cases of Ebola are a threat in countries worldwide until the epidemic in West Africa is controlled - a point highlighted by the recent case in the United States and discussed on our Outbreak Outlook page.

The WHO will be convening an informal consultation on to discuss how science can assist in the response to the Ebola epidemic. The teleconference is scheduled for 7 October.

Uganda: A 30-year-old man died from Marburg haemorrhagic fever in Kampala on 28 September. Dozens of people are being monitored after having had contact with the man with several developing symptoms. It is unknown how the first case contracted the disease, investigations into this outbreak continue. Marburg virus belongs to the same family of viruses as Ebola virus and is also transmitted through contact with bodily fluids. Marburg disease has no vaccine or cure, and can cause similar symptoms to Ebola such as fever, headache, vomiting, diarrhoea and bleeding. Public health measures will be needed to prevent this outbreak spreading. This outbreak is independent to the Ebola epidemic ongoing in West Africa.

Aid: Norway is extending support to control the Ebola outbreak in the affected countries in the form of funds, personnel and equipment.

US: The patient in Dallas remains in critical but stable condition, and the treating hospital revealed that he has been receiving an experimental antiviral medication called brincidofovir since 4 October. The drug is manufactured by a North Carolina-based company, Chimerix, who stated that their drug had been given Emergency Investigational New Drug Applications (EIND) by the U.S. Food and Drug Administration (FDA).

6 October
Spain: A nurse who cared for two Ebola patients evacuated from Liberia and Sierra Leone in August and September has been confirmed infected with the virus. This is the first know instance of a person being infected with Ebola outside Africa.

MSF: Another Medecins Sans Frontieres health worker has been infected with Ebola. The Norwegian doctor has been working in Bo, Sierra Leone, and developed a fever on 5 October. She will be evacuated to Oslo for treatment. Norway has designated the Oslo University Hospital as the country's Ebola treatement centre. An investigation into how she was infected is underway.

United States: Media sources have reported that the American patient, a photojournalist infected with Ebola in Liberia, will be arriving in the country today and admitted to Nebraska Medical Centre.

In other news, media sources report that there are seven healthcare workers among the 10 close contacts of the Dallas case.

Sierra Leone: The Ministry of Health has reported new confirmed cases.

Liberia: US Navy mobile Ebola laboratories are operating at the Island clinic, Monrovia and in Bong County.

In other news, the Ministry of Information Culture Affairs and Tourism has introduced a new media access policy. Journalists must secure written permission if they want to take photographs or conduct interviews at Ebola healthcare facilities. According to the Minister, this policy protects the privacy of patients and healthcare workers and is being implemented to protects the health and safety of both Liberians and international journalists.

Ethiopia: New sources are reporting that a 24-hour Ebola testing service has been launched at Bole International Airport, Addis Ababa, specifically to monitor and test passengers from 21 West African destinations.

5 October
Sierra Leone:
The Public Health Agency of Canada has deployed a second field laboratory and staff to join an existing PHAC team working in Kailahun, eastern Sierra Leone. The laboratories will contribute to efforts to rapidly diagnose Ebola. The team will monitor the effectiveness of measures designed to prevent infection in the local communities.

Treatment: The World Health Organization has issued a position paper on the use of convalescent blood or plasma in treating Ebola outbreaks. This interim guidance for national health authorities and blood transfusion services covers guidelines on selecting donors; screening and handling blood; transfusion processes and other topics.

4 October
The Public Health Agency of Canada has clarified their position on donated vaccines. The Agency has confirmed that the 800-1000 vaccine doses are ready to be transported once "WHO requests that they be transferred or deployed." This shipment is dependent on safety and ethical considerations which are yet to be resolved by WHO and the global community.

Aid: The German government has delivered medical supplies to Liberia in the first mission involving the German Air Force. The NGO-led German Liberia clinic (GERLIB) has established a 48-bed isolation centre for Ebola cases in Paynesville, Monrovia.

US: The number of contacts under close monitoring in Dallas has been reduced from 100 to around 50, with 10 labelled as "high risk" contacts. CDC officials met a flight landing in Newark, New Jersey from Brussels, Belgium on 4 October following reports that a passenger from Liberia was ill on board. 

France: The French nurse who was medically evacuated to France for treatment on 19 September has recovered and been discharged from hospital. The nurse was infected while working as a volunteer with MSF in Liberia. A health ministry statement confirmed the nurse received a number of new antiviral medications, including Avigan (favipiravir).

Germany: The doctor from Senegal who was evacuated to Hamburg has recovered and been discharged from hospital. The doctor had contracted Ebola whilst working for the World Health Organization in Sierra Leone.

Nigeria: The Federal Ministry of Health has finalised plans to carry out "Train the Trainer" sessions across all states as part of enhanced preparedness for Ebola. These sessions will be directed at both health WO.