The Ministry of Health (MoH) reported in the December 18th SITRep that the number of Ebola cases are still at a dangerous level. The epidemic started when only one new case was confirmed every ten days. When the epidemic gained momentum in July, there were three new confirmed cases per day. Since July, the rate of new cases per day peaked near 80 and has since declined to its current average of 6 new cases per day. Although recent months have seen a huge decline in confirmed cases Ebola is still at an extremely dangerous level. The below map illustrates the locations of confirmed cases over the past 21 days. The absence of cases in certain areas, like Lofa, illustrates the success of some Ebola training programs and community education campaigns, and the need to replicate these successes particularly in cluster areas.
In our previous article on Ebola Hotspots, we discussed the need for focusing on reaching rural communities and identifying outbreak clusters. From the MoH SITRep reports, we gathered information about some of these cluster areas. In a community in Grand Bassa, near the border of Margibi county, there have been 22 confirmed Ebola cases in the past 21 days.[i] Another hot spot was identified in the southern part of Sinoe county and five cases have been confirmed. In addition, a hot spot team was dispatched to Nimba county in mid-December, but their findings have not yet been reported.[ii]
The confirmed cases in these hotspots are outside the ETU treatment areas and so far there is no information on where these individuals are being treated. However, based on the confirmed case numbers from the nearest ETUs it does not appear they were admitted to one of these facilities. On December 22nd, there were 76 total patients in Ebola Treatment Units across the country and of these, 33 were confirmed cases.
Based on the Rapid Isolation and Treatment of Ebola (RITE) strategy, hot spot teams are deployed when counties notify the Ministry of Health (MoH) of cases in an area. The hot spot teams’ priorities are to:
- Promote rapid isolation of:
- Probable/suspect ed cases
- Asymptomatic contacts
- Confirm the presence of Ebola in community
- Provide community education and psychosocial support
- Support safe transport and safe burial
- Conduct situational assessment (e.g., population size and mobility, accessibility to current ETUs, security concerns, communication needs)
The goals of the hot spot teams are very [Description: The figure above is a photograph showing a nearly impassable bridge on the road connecting Sinoe County, Liberia with Monrovia, the closest location with Ebola treatment units during September 2014.] [i] similar to the teams in urban areas; except they face more logistical challenges. According to a December 19th CDC report, confirming Ebola cases is challenging because of a lack of trained personnel, poor transportation and communication networks. For example, Sinoe county reported 5 confirmed cases but they do not have a laboratory technician that is trained in handling Ebola samples. In addition, case investigation teams operating in Grand Bassa county have walked as many as eight hours to reach communities where there were reported cases, in part because of inaccessible roads caused by inclement weather. According to these reports a lack of telephone coverage has also hindered the investigation and reporting of Ebola cases. According to internal sources, the case reporting procedures that were established in urban areas require data to be transferred to five separate individuals for approval in order for case information to be entered into reports. The reporting of this data is almost exclusively dependent on telephone networks.
These challenges are part of the reason why the confirmation of just three cases per day is still considered a dangerous level. The time it takes from being notified about a potential hot spot, down to the confirmation of a case varies across the region and is affected by a large number of factors. As a result contact tracers and medical personnel have to play catch up when hot spots are found and the danger of transmission during this period is high.
 Dec 18th SITRep
 Dec 18th SITRep
 Dec 22nd Action Item Log
 Road picture from CDC Report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6350a5.htm?s_cid=mm6350a5_w