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Reported Ebola cases continue to climb dramatically in Guinea, Liberia, and Sierra Leone, according to an update published online December 16 in the Morbidity and Mortality Weekly Report.
Reported cases totalled 4281 for the 4-week period between November 9 and December 6 compared with 2705 for the 3-week period between October 19 and November 8. The cases occurred in widely distributed geographic districts across all three countries.
Two prefectures in Guinea, six counties in Liberia, and six districts in Sierra Leone reported the highest cumulative incidence rates, with some as high as more than 300 cases per 100,000 population.
Total case counts included suspected, probable, and confirmed cases. However, reporting delays vary by country, so the proportion of reported to actual cases is unknown.
A total of 17,908 Ebola cases had been reported as of December 7 from the three West African countries, according to a December 10 update from the World Health Organization. Peaks in the number of new cases occurred in:
Liberia, with 509 cases during the week of September 5 to 11;
Sierra Leone, with 748 cases during the week of November 9 to 15; and
Guinea, with 292 cases during the week of October 5 to 11.
A total of 6373 Ebola-related deaths had been reported as of December 7, according to the World Health Organization. Investigators are looking into possible transmission in Mali, but transmission was interrupted successfully in Nigeria.
Rural Liberia Facing Continued Problems
Meanwhile, rural health officials in Liberia are reporting that they have some of the same challenges they had early on in the epidemic, according to an accompanying article also published online December 16 in the Morbidity and Mortality Weekly Report.
Aimee Summers, PhD, from the Centers for Disease Control and Prevention's (CDC's) Epidemic Intelligence Service, and colleagues trace the epidemic since the first case was identified on March 22 in Guinea and March 30 in Liberia. By November 2014, Ebola had invaded all 15 counties of Liberia.
Between August 27 and September 10, 2014, the CDC and the Liberian Ministry of Health and Social Welfare assessed Ebola responsiveness in four Liberian counties: Grand Cape Mount, Grand Basa, Rivercess, and Sinoe. County health officials reported at the time that they lacked adequate training related to Ebola and faced serious obstacles in transportation and communication.
Only Grand Bassa reported having staff trained in case investigation and contact tracing. Only two of the counties reported having a functional ambulance, but only Grand Basa reported having an ambulance team capable of transporting an Ebola patient.. Two counties had a laboratory technician trained to handle Ebola specimens, and two did not. All four counties had a limited supply of personal protective equipment.
"Case investigation teams in Grand Bassa and Sinoe reported walking for up to 8 hours from the nearest road and crossing several rivers to reach communities where cases had been reported and where contact tracing and safe burials had not occurred because there were no trained personnel," the authors write.
Also, during the July to December rainy season, all four counties reported impassable roads, or roads accessible to only four-wheel drive vehicles, which were rarely available. A lack of telephone coverage in some areas made communication difficult among health workers.
The health workers received training in case investigation, contact tracing, infection control, safe burials, and health education in all four counties during September through November.
However, as of November, remote officials reported that some of the same challenges still existed.
The CDC authors write that innovative communication and transportation strategies need to be developed, because, "in rural counties, few roads, poor road conditions, and an overall lack of vehicles, vehicle maintenance, Internet connectivity, and limited telephone network coverage impedes epidemic control."
Morb Mortal Wkly Rep. Published online December 16, 2014. Update full text, Summers full text