Location/Time: Monrovia, Liberia: 2015-11-20
Disease: Ebola Virus Disease (EVD)
Recap/Description of Hazard: Liberia, which has claimed Ebola-free status twice in the year 2015 – on May 9th and September 3rd – has confirmed 3 new cases of E.V.D. in the capital Monrovia. The novel infections are thought to be the result of Ebola persisting in persons after infection, though the index case of the new outbreak, a 10-year-old boy, has had no known contact with infected persons or travel to infected areas. The boy has spread the disease to two family members, and was cared for by up to 7 healthcare workers not wearing Personal Protective Equipment (PPE).
Ebola’s reappearance is potentially due to:
IDIS Level: This is a Category 3 IDIS level associated with a non-routine response, and the potential for social disruption.
Relevance: E.V.D. has persisted in West Africa since the outbreak first began in March 2014. Although transmission has decreased greatly in the region due to intense surveillance, contact tracing, community buy-in, and international support, only one country, Sierra Leone, remains Ebola-free. Countries are far better poised to respond to novel infections, but there is still much unknown about the virus, including how the virus persists asymptomatically post-infection, and how it is originally transmitted.
Current vs. Forecast: No available forecast for EVD. Sierra Leone has been declared Ebola-free since November 7th, and Guinea reported no new cases of EVD in the past week, though they have not reached the 42-day period without infection. These are the first infections in Liberia in over 3 months.
Guidance: Situational awareness is advised when traveling to or within affected countries.
Indicators: Ascel Bio is closely tracking the rate of spread of the new infections, the novelty of the transmission chain, and the transparency of the response.
Final Observation: The resurgence of cases in Liberia is a sign that the Ebola-free status in one country is not enough to be truly free from threat. As noted above, potential scenarios leading to reintroduction in Monrovia include: the transmission of live virus from a survivor, previously unrecognized community transmission, disease translocation from Guinea or Sierra Leone, or reintroduction from the ecosystem. There are positive signs, however: Liberia is poised to respond quickly and effectively to this outbreak; an experimental vaccine exists that may be used to prevent further transmission; and, the reintroduction of cases from Ebola survivors (7 suspected incidences) have yet to lead to large outbreaks.