1. YALE- TULANE ESF-8 SPECIAL REPORT
WEST AFRICA – EBOLA 2014
CURRENT SITUATION
GUINEA
LIBERIA
SIERRA LEONE
EUROPEAN UNION
NGOs
3 OCTOBER 2014
LIBERIA
• MINISTRY OF HEALTH AND SOCIAL
WELFARE
NIGERIA
• NIGERIA MINISTRY OF HEALTH
• NIGERIA EMERGENCY
MANAGEMENT AGENCY
• EBOLA ALERT
SIERRA LEONE
• MOHS
• MINISTRY OF HEALTH AND
SANITATION
INTERNATIONAL ORGANIZATIONS
• RELIEF WEB
• HUMANITARIAN RESPONSE
• GLOBBAL EBOLA RESPOINSE
• UNICEF
• UN NEWS CENTER
• LOGISTICS CLUSTER
WHO
• WORLD HEALTH ORGANIZATION –
AFRICA
• GLOABAL EBOLA RESPONSE
COALITION
• WHO EBOLA PORTAL
• WHO AFRP EPR OUTBREAK NEWS
• DISEASE OUTBREAK NEWS
• GLOBAL ALERT RESPONSE - EBOLA
• WHO – EBOLA
• IFRC
NGO
• MSF
• ACT ALLIANCE
• CATHOLIC RELIEF
• SAMARITAN'S PURSE
US GOVERNMENT
• US EMBASSY MONROVIA –
LIBERIA
• US EMBASSY – CONAKRY,
GUINEA.
• US EMBASSY – SIERRA LEONE
• US EMBASSY – NIGERIA
• CDC EBOLA HEMORRHAGIC
FEVER
• CDC – OUTBREAK OF EBOLA
IN WEST AFRICA
• USAID
EU
• ECDC
• NaTHNac
PORTALS, BLOGS, AND
RESOURCES
• CIDRAP
• PROMED MAIL
• EBOLA ALERTS ON --
HEALTHMAP
• OPENSTREETMAP WEST
AFRICA EBOLA RESPONSE
• MEDBOX EBOLA TOOLBOX
• VIROLOGY DOWN UNDER
BLOG
• H5N1
• DISASTER INFORMATION
RESEARCH CENTER
• INTERNATIONAL SOS
• MAPACTION
NEW SOURCES
• ALERTNET
• NY TIMES
• WASHINGTON POST
IMPACT ON HCW
VACCINE DEVELOPMENT
GUINEA | LIBERIA
NIGERIA| SIERRA LEONE
CONFIRMED PROBABLE SUSPECTED TOTALS
CDC
CASES
3,953 1,863 1341 7157
DEATH
1999 871 460 3330
EBOLA VIRUS DISEASE, WEST AFRICA – UPDATE 1 OCT 2014
UNITED NATIONS
UNITED STATES
INTERNATIONAL COMMUNITY
EXPERIMENTAL THERAPIES
PROJECTIONS
http://www.esf-8-university.org/

2. CONFIRMED AND PROBABLE CASES OF EBOLA VIRUS DISEASE IN
GUINEA, LIBERIA, AND SIERRA LEONE
• Upward epidemic trend continues in Sierra Leone and in Liberia although there is evidence that there is under-reporting of new cases.
• In Liberia, the previously uninfected area of Grand Kru, near the border with Cote d’Ivoire, has now reported six confirmed cases of EVD. (WHO –
1 OCT)
Data are based on official information reported by Ministries of Health. These numbers are subject to change due to ongoing
reclassification, retrospective investigation and availability of laboratory results.
(WHO – 1 OCT)

3. GEOGRAPHICAL DISTRIBUTION OF NEW CASES AND TOTAL CASES IN
GUINEA, LIBERIA, AND SIERRA LEONE
(WHO- 1 OCT )
The map shows the location of cases throughout the
countries with widespread and intense transmission.
The cumulative number of cases to date in each area is
shown (grey circles), together with the number of cases
that have occurred within the 21 days (red circles) up to
28 September.
Ten districts in which previous cases were confirmed
have reported no cases during the 21 days prior to the
end of 28 September (nine districts in Guinea, one in
Sierra Leone).
In Guinea, there has been one confirmed case reported
in the newly affected Beyla district, on the border with
Côte d’Ivoire.
In Liberia, the previously uninfected area of Grand Kru,
near the border with Côte d’Ivoire, has now reported six
confirmed cases of EVD.

4. SITUATION
DISTRIBUTION OF REPORTED CASES OF EVD BY WEEK IN GUINEA, SIERRA
LEONE, LIBERIA, NIGERIA AND SENEGAL WEEK 48/2013 TO 39/2014 (DATA
AS OF 21 SEPTEMBER 2014)
NOTE: This is the largest ever documented outbreak of EVD with a number of
reported cases and deaths that exceeds the case and death number of all
historical outbreaks. It is also the largest outbreak in terms of geographical
spread. THE OUTBREAK HAS NOT YET REACHED ITS PEAK AND IT IS
CURRENTLY IN A PHASE OF RAPID SPREAD. Community resistance,
inadequate treatment facilities and insufficient human resources in affected
areas are among the challenges currently faced by the countries in responding
to the EVD outbreak. (ECDC – Sept 26)
CASES AND DEATHS OF EVD BY COUNTRY, AS OF WEEK 39/2014:
• The Ebola virus disease (EVD) outbreak continues to grow, doubling in size
approximately every 3 weeks. The latest WHO figures report a total of 7,178
cases and 3,338 deaths up to September 28.
• The current EVD outbreak is unprecedented in scale, geographical reach, and
impact on the health care systems of the countries involved.
• The present West Africa outbreak has a higher caseload than all other
previous Ebola crises combined.
• An estimated 22.34 million people are living in areas where active EVD
transmission has been reported, with 4.29 million people living in areas
where twenty or more fatalities have been reported.
• The large number of cases in high-population density settings and
simultaneously in remote, hard-to-access villages makes the outbreak
particularly difficult to contain.
• The concerning trend of infections among health care workers (HCWs)
persists, with 377 cases of which 216 have resulted in death. Of the total
cases of EVD-infected HCWs, almost 50% have occurred in Liberia. Because of
their role as caregivers, women are experiencing the brunt of the disease,
making up 75% of all cases.
• A recent study published by the WHO Ebola Response Team forecasts more
than 20,000 (5,740 in Guinea, 9,890 in Liberia and 5,000 in Sierra Leone) by
beginning of November 2014.
• In addition to the cases in Guinea, Liberia, Nigeria, Sierra Leone, and one
imported case in Senegal (a Guinean citizen who arrived from Guinea), there
has now been a documented case in the Unites States of America, of a man
returning to the US after visiting his home country of Liberia.
• Travel restrictions and quarantines have been employed by governments
across the region, in attempts to reduce disease transmission.
(ECDC – Sept 26 ; UNMEER – Oct 2)

5. SITUATION
LOCAL EFFORTS AGAINST STEEP ODDS
• Foreign investors and companies have scaled down operations as
expatriates depart the country; public and private institutions have also
scaled down operations. The IMF predicts that Liberia and Sierra Leone’s
economies could decline by 3.5% due to Ebola’s effect on the agriculture,
services, and mining sectors. (CPI – SEP 25).
• Fear, misunderstanding, and economic hardship continue to drive
tensions within affected populations, even as lack of education and
access to hygienic precautions continues to drive virus transmission.
• Burial teams from the Liberian Red Cross have been mobilized across
Liberia to provide safe disposal of contagious bodies, which often
includes cremation. They face obstacles ranging from broken roads and
curfews, to disease and poor care, to direct animosity and violence.
• In southeast Guinea, a team of journalists and health care workers was
attacked by villagers and eight people murdered. Outsiders and “visitors”
including health workers have been blamed for causing or bringing in the
disease to remote communities. (WP – SEP 25)
• Sierra Leone conducted a three-day nation-wide lockdown in an attempt
to stem the transmission of disease. Although widely criticized in the
country due to limiting citizens’ access to food and employment for three
days, the measure was declared “a success” by the government. More
than a million households were reported surveyed during it, and 130 new
cases discovered. (BBC – SEPT 22)
• At least 3,700 children in Guinea, Liberia and Sierra Leone have lost one
or both parents to Ebola since the start of the outbreak in West Africa,
according to preliminary UNICEF estimates, and many are being rejected
by their surviving relatives for fear of infection. An estimated 2.5 million
children under the age of five living in areas affected by the Ebola virus.
(UNICEF – Sep 30)
A peacekeeper with the UN Mission in Liberia in Monrovia. (UNMEER)
Military road block in Sierra Leone (BBC)

6. SITUATION
GUINEA
GUINEA
CONFIRMED PROBABLE SUSPECT TOTALS
Cases 950 170 37 1157
Deaths 535 170 5 710
SOURCE: WHO – 1 OCT
(WHO – AS OF 28 OCT)
CASE FATALITY RATE: 61%
BACKGROUND
• Guinea was the first nation to report cases in the current West African Ebola
outbreak. The first likely occurred in late 2013, though it was not
confirmed/reported to international authorities until March 2014. During that
lag, control measures were not enacted and the outbreak was able to spread
internationally into Liberia and Sierra Leone.
• The Government of Guinea (GoG) declared a public health emergency on
August 14 and announced the implementation of preventive measures,
including travel restrictions and a ban on transporting human remains between
towns, according to international media. (USAID – 20 AUG)
• Several times, the outbreak looked like it might be under control but then
would flare again in a different part of the country or would resurge in an area
that previously had cases. WHO officials believe the outbreak in Guinea has
been re-ignited several times in part due to re-importation from people coming
from Liberia and Sierra Leone. (ISOS – 23 SEP)
CURRENT SITUATION
• Cases have been identified in 19 of Guinea’s 34 prefectures. Ongoing spread
of Ebola is occurring in Beyla, Conakry, Coyah, Dabola, Dalaba, Dubreka,
Forecariah, Gueckedou, Kerouane, Kindia, Kissidougou, Macenta, Nzerekore,
and Yomou. (ISOS – 2 OCT)
• The situation in Guinea remains stable, though it must be emphasized that in
the context of an outbreak of EVD, a stable pattern of transmission is still of
grave concern, and could change quickly. (WHO – 1 OCT)

7. http://reliefweb.int/sites/reliefweb.int/files/resources/GIN_A4_L_140929_Ebola_3W_Reponse_0.pdf

8. SITUATION
GUINEA
CASE MANAGEMENT AND INFECTION PREVENTION AND CONTROL
• Reports from Guinea show a slight fall in the number of new cases reported
compared with each of the past five weeks (figure 2). This fall is largely
attributable to a drop in the number of new cases reported from Macenta
district, which had seen a surge in the number of new cases over the past five
weeks. (WHO – 1 OCT)
• CDC is working closely with the Guinean Ministry of Health to strengthen
contact tracing efforts in the capital city of Conakry. Contact tracing efforts
supported by CDC have recently identified cases in Conakry among known
contacts, indicating that contact tracing efficacy in Conakry is improving.
(USAID – 1 OCT)
• In Guinea, a door-to-door campaign including the delivery of hygiene kits
(soap, chlorine) and flyers has reached 71,000 households composed of
486,000 people. The campaign’s messages were reinforced with radio
programmes and religious activities. (WHO – 1 OCT)
• The World Bank is helping Guinea-Bissau implement an emergency plan to
prevent Ebola from spreading in the country. (ISOS – 30 SEP)
FOOD
• In September, WFP delivered 627 mt of food to more than 24,700 people
through targeted and general distributions in Gueckedou, Kissidougou,
Macenta and Conakry. (WFP – 30 SEP)
SAFETY AND SECURITY
• In Forécariah, about 100 km from Conakry, a hostile youth protest
degenerated into a riot after the Guinean Red Cross sprayed a mortuary.
Further, the Prefectural Department of Health was ransacked, causing
many injuries. This violent episode demonstrates the resistance against
the spraying of homes and villages. UNICEF is currently holding
discussions with the national authorities to develop local skills for spraying
home. (UNICEF – 26 SEP)
• In the village of Womey, a team of health officials were attacked by a
group of local residents with knives and rocks. Eight of the health officials
were killed in the attack (AP – 19 SEP)
• Insecurity recently prevented a group of medical students—originally
from Guékédou, Macenta, and Yomou prefectures—from returning to
their areas of origin to conduct EVD awareness activities, according to the
Government of Guinea (USAID – 1 OCT)
RUMORS AND CHALLENGES
• The reluctance of rural communities continues, but social mobilization
efforts have helped overcome resistance in the villages of Tonata and
Yekini in Yomou and Boffossou in Macenta. (WHO – 1 OCT)
• Community resistance to EVD response efforts continues to inhibit the
implementation of comprehensive contact tracing activities and other
EVD-related humanitarian assistance, particularly in Macenta, Nzérékoré,
and Yamou prefectures. (USAID – 1 OCT)
RISK COMMUNICATIONS
• In an effort to reduce resistance and end violence in some Ebola affected
areas, influential nationals will be deployed to their home regions and
villages for social mobilization activities. A group of 30 people has been
deployed in the area of Macenta and 589 others will be deployed in 12
prefectures. (UNICEF – 26 SEP)
• In addition to the door-to-door campaign, messages were reinforced with
radio programmes and religious activities. (WHO – 1 OCT)

9. SITUATION
LIBERIA
LIBERIA
CONFIRMED PROBABLE SUSPECT TOTALS
Cases 927 1656 1113 3696
Deaths 280 687 672 1639
SOURCE: WHO – 28 SEPT
GOVERNMENT OF LIBERIA
• An international non-governmental organization, Global Communities, has
started to support the Ministry of Health in training to facilitate the safe
handling of dead bodies and management of safe burials in the districts of
Bomi, Nimba, and Sinoe. EU – 1 OCT
• Surveillance: daily contact tracing achievement was under 90% on average
during the week to 28 September in the districts of Grand Cap Mount,
Grand Gedeh, Grand Kru, River Ghee, Margibi, Maryland, and Rivercess. EU
– 1 OCT
• 97.5 million euros has been promised which is intended to be spent in
Budget Support (BS) operations to Liberia and Sierra Leone, to reinforce
those governments' capacity to deliver public services - in particular health
care - and macro-economic stability, and a further 5 million euros towards
providing mobile laboratories for the detection of the virus and training
health workers as part of the Instrument contributing to Stability and
Peace, IcSP. EU – 1 OCT
• The Ministry of Health and Social Welfare has established hotlines that the
public can call to get basic Ebola information: 1333, 4455, 0886229641,
0886397381, and 0776547437. ISOS – 1 OCT
• The Ministry of Health Sit Rep 134 for cases upto 26 September added
nearly 70 clinical cases, including 3 suspected cases in a previously
unaffected county, Grand Gedeh and a single suspected case in Gbarpolu. If
confirmed, these cases will mean that every county in Liberia has reported
at least one case of Ebola. ISOS – 29 SEPT
• News sources report that a physician in rural Liberia administered an HIV
drug (Lamivudine) to 15 Ebola patients, of which 13 people recovered.
The two patients who died had received the drug five days or later after
falling ill unlike others who got the medication within first five days of
their illness. ISOS – 28 SEPT
• Media sources report that a doctor who is also a deputy health minister
has been quarantined after exposure to a confirmed case. The case was
one of the doctor's assistants and has died of the disease. ISOS – 28 SEPT
• Few reports state that a confirmed case has been detected in Grand
Gedeh county, however this is yet to be confirmed by official
sources. ISOS – 28 SEPT
Medical staff members of the Croix Rouge NGO remove the
corpse of an Ebola victim from a house in Monrovia, on Sept. 29
(Pascal Guyot/AFP/Getty Images)
CASE FATALITY RATE: 44.3%

10. SITUATION
LIBERIA
CASE MANAGEMENT AND INFECTION PREVENTION AND CONTROL
• Last week there were no new reported confirmed cases from the capital,
Monrovia, which in previous weeks had reported a surge in cases. This week,
five new confirmed cases have been reported in Monrovia, but there remains
compelling evidence obtained from responders and laboratory staff in the
country that there is widespread under-reporting of new cases, and that the
situation in Liberia, and in Monrovia in particular, continues to deteriorate.
WHO – 1 OCT
• The numbers of probable and suspected cases, together with those confirmed,
may be a more accurate reflection of case numbers in Liberia. The counties of
Bong, Grand Bassa, Margibi and Nimba continue to report high numbers of
new cases. There has been little change in the number of new cases reported
in Lofa, which borders Gueckedou in Guinea, for the past three weeks, with 38
confirmed and probable cases reported this week. WHO – 1 OCT
• The previously uninfected area of Grand Kru, near the border with Côte
d’Ivoire, has now reported six confirmed cases of EVD. WHO – 1 OCT
• A site has been identified by the Ministry of Health for a referral unit in Grand
Kru district 7 (Maryland county): an area in the south of the country which
only recently reported its first confirmed cases of EVD. WHO – 1 OCT
• An estimated 1500 beds are required in addition to those in place or soon to
be in place; in Sierra Leone, an additional 450 beds are needed. WHO – 1 OCT
• Two US Navy mobile laboratories have now arrived in Liberia. One team will be
based in Gbarnga (Bong county), with the other based in Montserrado (the
district containing the capital, Monrovia). Both teams will be operational by 5
October. WHO – 1 OCT
• In Liberia, rituals to prepare bodies for burial are contributing to the rapid
spread of the virus. The dead body is typically washed and dressed by multiple
people before being carried to a grave — a ripe situation for the virus to
spread. To stop the spread of Ebola, burial teams have been mobilized across
Liberia to provide safe disposal of contagious bodies, which often includes
cremation. With the epidemic on the rise, every dead body is now considered
an Ebola body. USAID - 1 OCT
HOSPITAL RESPONSE AND ISOLATION/TREATMENT CENTERS
Lofa, Margibi, Bong and Nimba, all have isolation facilities established. As at
5 September, the country has 314 treatment beds, and WHO estimates
many more are required (additional 760 beds required in Monrovia).
FOYA, LOFA COUNTY: Borma Hospital Ebola Treatment Unit (ETU) being run
by Medecins Sans Frontieres (MSF) has a capacity of 100 beds. A "mid-level
isolation unit" has been established in Telewowan Hospital, Voinjama,
managed by MSF. The centre will expand to 40 beds although no estimated
date for completion has been set.
MONROVIA: ELWA hospital ETU is being run by MSF. The new 120-bed
facility opened on 17 August and there are plans to expand to 300 beds. The
facility in JFK Hospital is functioning as a full ETU. WHO advised on 5
September an additional 40 beds had been opened in Monrovia. There is a
Holding Unit at Redemption Hospital. A 150-bed unit has been opened in the
western suburb of Duala. A 120-bed Ebola Treatment Centre run by the
MoH and WHO opened on 22 September at the Old Island Clinic on the
Bushrod Island.
MONTSERRADO:West Point holding unit has been established.
NIMBA: Renovation of the holding facilties at G. W. Harley is underway as at
20 August. Ganta Hospital is functioning.
BONG: A 70-bed Ebola Treatment Unit is functional as at 25 September. A 7-
bed Isolation Centre has been added to the Phebe Hospital in Suakoko.
BOMi: Bomi County Health Team (CHT) opened three, two-room quarantine
units with a 12-bed capacity for Ebola patients. There is a holding centre in
Tubmanburg.
MARGIBI: The United States military has begun construction of a 25-bed
hospital for infected healthcare workers.
SOURCE: ISOS – 1 OCT

11. http://reliefweb.int/sites/reliefweb.int/files/resources/LBR_A4_3W_Ebola_20140929.pdf

12. SITUATION
LIBERIA
SOURCE: UNOCHA – 1 OCT

13. SOURCE: WHO – 1 OCT
SITUATION
LIBERIA

14. SIERRA LEONE
CONFIRMED PROBABLE SUSPECTED TOTALS
Cases 2,155 37 215 2,407
Deaths 527 37 11 575
SITUATION:
• An outbreak of Ebola has been ongoing in Sierra Leone since May 2014. New
cases have been increasing each week for the past 6 weeks (OCT 2).
• Affected districts in Sierra Leone include Bo, Bombali, Bonthe, Kailahun, Kambia,
Kenema, Kono, Moyamba, Port Loko, Pujehun, Tonkolili, and Western Area,
including the capital of Freetown.
• The situation continues to deteriorate. Port Loko, Bombali and Moyamba have
been quarantined following a surge in new cases. Tonkolili has also reported an
increase in the number of new cases. The number of cases reported from
Kailahun and Kenema has been low. However, it is not clear if this is a genuine
fall in case numbers or due to under reporting. An additional 450 beds are
needed. Three isolation units in Bombali district have been opened (ISOS – 1
OCT)
GOVERNMENT OF SIERRA LEONE
• MoH officials expressed their satisfaction at the outcome of the three-day
lockdown. The campaign achieved 75% of the planned target and Port Loko,
Bombali and Moyamba districts have been identified as hot spots for Ebola
respons. Reports say the campaign spread Ebola education to over 80% of target
households.(GoSL- 24 SEP)
Guinea
12%
Liberia
24%
Nigeria
1%
Cumulative (confirmed, probable,
suspected) cases
Total deaths in confirmed, probable,
suspected cases
579
463
254
236
312
264
240
178
19
13
111
11
17
89
67
62
4
5
7
3
Kailahun
Kenema
Port Loko
Western Area Urban
Bombali
Western Area Rural
Bo
Tonkolili
Moyamba
Kono
1169
714
3826
2058
Guinea
2407
575
Liberia
SOURCEOCHA 2 OCT
SITUATION
SIERRA LEONE
GoSL Situation Report--30 Sept
Case Fatality Rate: 24.5%
Sierra Leone
Ebola Virus Disease
(EVD) Outbreak
Funding as of 02 October 2014
C O N T RIBUTION
$
55 Million
Total amount earmarked for
Sierra Leone *
220 Million
total requirement for Sierra
Leone
346 Million
total contribution for Ebola
crisis*
48,538
(In thousand $)
3,632
3,000
315
HEALTH
COORDINATION AND
SUPPORT SERVICES
FOOD
SECTOR NOT YET
SPECIFIED
EVD Sierra Leone: cumulative figures as of 29 September 2014
Sierra Leone
16%
Region
47%
Cases 2407 Deaths 575 CFR(1) 25%
Most affected districts
Port Loko
Moyamba Bo
Kenema
Koinadugu
Kono
Bombali
Tonkolili
Bonthe
Pujehun
WA
Urban
WA
Rural
EVD cumulative cases and deaths across the region
Liberia cases
Sierra Leone cases
Liberia deaths
Guinea cases
Guinea deaths
Sierra Leone deaths
4,500
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
0
25-Mar 26-Apr 28-May 29-Jun 31-Jul 01-Sep 03-Oct
Sierra Leone
* Funding as per FTS. Other appeals have been launched, the details will be updated when the figures are available .
** Funds not earmarked to specific country
(1) Approximate case fatality rate for confirmed cases. Humanitarian actors believe the CFR to be higher than declared as deaths continue to be
under reported.
Creation Date : 02 October 2014 | Data source: Sierra Leone Ministry of Health and Sanitation; World Health Organization (WHO);CDC
Feedback : ocharowca@un.org | For more on the EVD Outbreak go to http://bit.ly/1oRJwI1

15. SITUATION
SIERRA LEONE
• The Government of Sierra Leone placed Bombali, Moyamba, and Port Loko
districts—which have a total population of approximately 1.2 million people,
according to international media—under quarantine on September 25 (See
Press Release Below), raising the total number of districts quarantined in
Sierra Leone to five. The GoSL has maintained quarantines around Kailahun
and Kenema districts since early August.
The Government of Sierra Leone issued a press release on 24 September
detailing several measures to assist in the containment of the Ebola disease
including:
• New quarantine restrictions have commenced around the country.
Port Loko, Bombali and Moyamba Districts are under immediate
isolation. Corridors for travel to and from non-quarantined areas have
been established; travel must be between 09:00 and 17:00 and
vehicles and passengers must not alight within the quarantine areas
• Any location where the Ebola disease is identified will be quarantined
• The Ministry of Health and Sanitation will work with the Ministries of
Local Government and Rural Development, Education, Science and
Technology, and Youth Affairs to activate the involvement of
Paramount Chiefs, Local Government Authorities, Teachers and Youth
Groups within the affected districts in contact tracing and community
surveillance activities. (GoSL- - 24 SEP)
ISOLATION / TREATMENT CENTERS (ISOS ASF OF 3 OCT)
• KENEMA: The Red Cross isolation facility in Kenema Government Hospital
was relocated outside of the Kenema township, a few miles from Hanga.
The facility has 60 beds and was operational as of September 12.
Admissions initially staggered to keep healthcare workers safe.
• KAILAHUN: There is an 80-bed facility, operated by MSF. The villages of
Koindu and Buedu have "referral units", where patients who have
symptoms of Ebola are isolated and evaluated. If they are determined to
have Ebola they are then transferred to the isolation facility.
• FREETOWN: An isolation unit has been established at Connaught Hospital,
with assistance from a medical team from King's Health Partners, UK.
• BO: The 35-bed MSF isolation unit is now functional. A transit centre in
Gondama is run by MSF. Construction has begun on an isolation ward at Bo
government hospital.
• PORT LOKO: On September 12, officials announced a holding center would
be established at the St John of God Hospital and should be “operational
anytime”. The hospital reopened September 13 after a 21-day closure.
International Medical Corps to establish new Ebola Treatment Unit in
Lunsar, Port Loko.
• WESTERN AREA: The Lakka holding facility is currently being used as a
treatment center. The Kerry town facility remains under construction.
Maculy Street Hospital treatment center opened 15 September. Newton
and Hasting police 50-bed isolation centers are open.
• BOMBAll: ADDAX is assisting in the construction of a holding center.
Expected completion by the first week of October. Holding centers at
Paramedical School, Arab Hospital, and Regional Government Hospital
began receiving patients 21 September. Three isolation centers opened at
the start of October.
• Ministry of Energy committed to providing electricity to EVD lab in Lakka
and Solar Street lights to Kerry Town treatment center
As Government continues
to intensify its efforts in
the fight against the
Ebola virus disease (EVD),
President Ernest Bai
Koroma on Friday
26th September 2014,
commissioned the BSL-3
mobile laboratory at the
Sierra Leone-China
Friendship Hospital at Jui.
(SL- 26 SEP)

16. http://reliefweb.int/sites/reliefweb.int/files/resources/SLE_A4_L_140929_Ebola_3W_Reponse%281%29.pdf

17. SITUATION
SIERRA LEONE
• At the request of the Government of Sierra Leone, the UK is leading an
international mission that aims to control, contain and ultimately defeat the
disease. At the heart of the plan is a promise to provide and staff 700
treatments beds – tripling current capacity in the country (DIFID – 30 SEP)
• Construction of the first treatment center is well underway in Kerry Town,
not far from the country's capital. UK aid is supporting local builders,
humanitarian advisers, military engineers and its partner, +Save the Children
UK, to get the center up and running as soon as possible
:https://www.flickr.com/photos/dfid/sets/7215764756340364
Military engineers from the UK provide expertise treatment center in
Kerry Town, (DIFID – 30 SEP)
Source: International SOS 2 OCT WHO 16 SEPT 2014 GoSL 12 SEPT 2014 WHO 1 OCT
CASE MANAGEMENT
• Nationally, the situation in Sierra Leone continues to deteriorate, with an
increase in the number of new confirmed cases reported over each of the past
six weeks.
• The neighboring districts of Port Loko, Bombali, and Moyamba, which are
adjacent to the capital, Freetown, have now been quarantined after a surge in
new cases over the past four weeks.
• Tonkolili has also reported a rise in the number of new cases this week.
• By contrast, a very low number of new cases have been reported from
Kailahun and Kenema for the past two weeks.
These areas had previously reported high levels of transmission. Further
investigation will be required to confirm whether this fall is genuine, or a result
of under-reporting. At present, the latter appears more likely. (WHO – 1 OCT)
FOOD
Ebola first struck in Sierra Leone during May, the peak season for farm labor.
To curb contagion risks, the government of Sierra Leone has restricted
movement in five districts, which include centers of food production in the
country. “
Key export crops such as coco will be highly impacted. Control measures
curtailed the movement of goods and services, including food items,
resulting in panic buying, food shortages and soaring food prices. Labor
shortages are threatening the impending harvest
In talks hosted by U.S. President Barack Obama last week, FAO Director-
General warned that the Ebola epidemic had the potential to cause long-term
food insecurity in West Africa, as a result of prolonged disruption of
crop harvesting and subsequent planting. (FAO 1-OCT)
ASSITANCE:

18. HEALTHCARE WORKERS
• Exposure to HCW remains a persistent concern and insufficient numbers of qualified staff.
• Both foreign and local health care workers have been affected as this continues to be a global
fight. 12,750 healthcare workers from the African Union, Canada, China, Cuba, DRC, EU,
France, Russia, South Africa, UK, US, and Uganda are committed to helping perform mission
critical actions. (Ebola Crisis Response - 30 SEPT)
HEALTHCARE WORKERS ARRIVING
• Cuba pledged to train and deploy 165 health professionals to Sierra Leone
• Norway pledges to provide physicians and nurses and is considering other support to Sierra
Leone
• The Philippines is considering the provision of healthcare workers to Sierra Leone
• 26 volunteers are being trained in Geneva to staff an ETC being opened in Sierra Leone
(Defeating Ebola in Sierra Leone - 2 OCT )
• The Government’s National AIDS Control Program plans to send 26 teams to 114 health
facilities throughout Liberia starting 15 October
• UNICEF supported the MoHSW to hire an additional 60 social workers and 50 mental health
clinicians, who are being trained to provide psychosocial care and support services to children
affected by Ebola in Liberia. (UNICEF - 26 SEPT)
• Cuba announced that it will send a further 300 doctors and nurses to Sierra Leone, Guinea
and Liberia to help fight the Ebola epidemic (UN Ebola Crisis Center - 27 SEPT)
• Over the next 6 months more than 2,500 Ebola survivors – now immune to the disease – will
be trained in Sierra Leone to provide care and support to quarantined children in treatment
centers. (UNICEF - 30 SEPT)
• CDC experts are being deployed to non-affected border countries, including Cote d’Ivoire, to
conduct assessments of Ebola preparedness in those countries (CDC - 2 OCT)
• 2000 Germans will join the German Red Cross in providing assistance to Sierra Leone, Guinea,
and Liberia. They began airlifts to transport volunteers on 25 September (ReliefWeb - 25 SEPT)
As part of a comprehensive and coordinated response, the CDC is continuing to develop an
introductory training course for licensed clinicians intending to work in an Ebola Treatment
Unit (ETU) in Africa. This will be a 3-day course held Monday through Wednesday each week
beginning on October 6, 2014 in Atlanta, GA in the United States. (CDC - 24 SEPT)
• In Liberia, an International non-governmental
organization, Global Communities, has started to
support the Ministry of Health in training to facilitate
the safe handling of dead bodies and management of
safe burials in the districts of Bomi, Nimba, and Sinoe
(WHO - 1 OCT)
• the Red Cross is opening the Ebola treatment center to
relieve pressure on the local government hospital in
Sierra Leone, where several doctors and nurses have
fallen victim to the virus. Before admitting an estimated
60 patients over the next few weeks, the clinic’s
volunteers will undergo a rigorous training in Geneva,
Switzerland. (ReliefWeb - 1 OCT)
• The American Red Cross has deployed 2 IT specialists to
Sierra Leone to work with the Humanitarian
OpenStreetMap team to provide accurate maps to relief
agencies working on the ground (ReliefWeb - 1 OCT)
• UNICEF is currently holding discussions with the national
authorities in Guinea to develop local skills for reducing
violent episodes while spraying homes (UNICEF - 26
SEPT)
• UNICEF provided technical support to the MoHSW for
the finalization of “no-touch guidelines” for Community
Health Volunteers (UNICEF - 26 SEPT)
• When safe alternatives to breastfeeding and infant care
exist, mothers with probable or confirmed Ebola virus
disease should not have close contact with their infants
(including breastfeeding). (CDC - 19 SEPT)
• As the death toll from Ebola continues to rise,
preliminary reports from Guinea, Liberia and Sierra
Leone suggest that the 3,700 children orphaned by
Ebola is likely to double by mid-October. (UNICEF - 30
SEPT

19. UPDATES ON HCW CONDITIONS
GUINEA
HEALTHCARE WORKERS
• In an effort to reduce resistance and end violence in some
Ebola affected areas, influential nationals will be deployed to
their home regions and villages for social mobilization
activities. A group of 30 people has been deployed in the area
of Macenta and 589 others will be deployed in 12 prefectures
starting next week. (UNICEF - 26 SEPT)
• In Forécariah, about 100 km from Conakry, a hostile youth
protest degenerated into a riot after the Guinean Red Cross
sprayed a mortuary. Further, the Prefectural Department of
Health was ransacked, causing many injuries. This violent
episode demonstrates the resistance against the spraying of
homes and villages.
• Community members attacked a group of six Red Cross
volunteers attempting to safely collect the body of a deceased
person in Forecariah town, western Guinea, on September 23;
the attack resulted in at least one injury that required
hospitalization(USAID - 1 OCT)
LIBERIA
• As of September 28, all components of the DoD-supported 25-
bed field hospital had arrived in Monrovia. A three-person U.S.
Public Health Service team plans to assist with establishing the
hospital. The hospital will be used specifically to care for HCW
(USAID - 1 OCT)
• Soldiers at the Edward Beyan Kesselley Barrack have been
quarantined and the facility has been closed for 21 days. The
step was initiated after at least seven soldiers from the
Liberian army were infected with Ebola. (INTERNATIONAL SOS
- 1 OCT)
SIERRA LEONE
• the Chinese mobile laboratory team based in
Freetown started testing samples on 29 September
2014, with a testing capacity of 20 samples per day.
(WHO - 1 OCT)
• The Government of Sierra Leone has mobilized
nearly 200 volunteers to deliver EVD prevention
messages in densely-populated areas of the capital
city of Freetown, aiming to reach 500,000 people by
early October. (USAID - 1 OCT)
• Emergency USA, a nonprofit group that builds
medical and surgical centers in war zones, recently
opened a 22-bed Ebola treatment center in Sierra
Leone. The nonprofit wants to open another 90-bed
facility, and is worried about finding enough local
health workers. (WSJ- 2 OCT)
DEATHS AND NEW INFECTIONS AMONG
HCWS
Following the death of her office assistant
to Ebola, Liberia’s chief medical officer, a
deputy health minister, placed herself
under quarantine for 21 days to ensure
that she was not infected. While
asymptomatic, she also instructed her
office staff to remain at home for three
weeks. (UN Ebola Crisis Center - 29 SEPT)
A member of EMERGENCY's international
staff has contracted the Ebola virus in
Sierra Leone. The patient is a Ugandan
paediatrician who works at EMERGENCY's
Centre for treatment of Ebola patients in
Lakka, in the area around the capital
Freetown. He has begun the treatment at
the Lakka Centre and his overall
conditions are stable. He has been
transferred today to Germany to continue
the treatment
(EMEREGENCY – 2 OCT )
In Sierra Leone The impact on "first
responders", healthcare workers who
attended early cases, was severe with
many doctors and nurses dying from
Ebola, including the head of the Lassa
Fever Programme, Dr Sheik Humarr Kahn.
This has critically impaired the nation's
capacity to respond. Many more beds are
needed in safer treatment centers and
teams to undertake contact tracing and
safe burial are in desperately short
supply.(ISOS – 22 SEP)
NOTICE TO HCWs AND TRAVELLERS
The CDC encourages all persons traveling from
Ebola outbreak areas to:
• Monitor your health for 21 days
• Seek medical care IMMEDIATELY if you
develop a fever and additional symptoms
• Call the doctor in advance and inform of
recent travel to allow facility preparation
• If you get symptoms of Ebola, stay away
from other people and call your doctor right
away.
CDC - 2 OCT

20. HEALTHCARE WORKERS
The above table indicates the total number of probable, confirmed, and suspected
cases in healthcare workers in Guinea, Liberia, Sierra Leone, and Nigeria as of 28
September 2014 (WHO Ebola sitrep – 1 OCT)
This sharp increase in HCW cases in Sierra Leone reflects the integration of the
results of the retrospective investigation into the official national data. It is
important to emphasize that the additional HCW infections and deaths occurred
throughout the course of the outbreak. Any cases of EVD in HCWs are of great
concern, but there is currently no evidence to suggest a recent increase in the
incidence of infections of HCWs. (WHO - 24 SEPT)
FIRST CASE DIAGNOSED IN THE UNITED STATES
• On September 30 the CDC confirmed the first
case of Ebola to be diagnosed in the United
States. A man travelled from West Africa to
Dallas, Texas and began displaying symptoms
on 24 September, approximately 5 days after
arrival. The patient sought medical care on 26
September and was admitted to isolation on
28 September at Texas Health Presbyterian
Hospital in Dallas, Texas.
• CDC confirmed positive results for Ebola virus
from sample testing the patient. Identification
of persons with close contact to the patient is
under way to provide daily monitoring for 21
days . (WHO - 1 OCT)
• For further guidance on CDC recommended
control practices to prevent the transmission
of infectious agents in healthcare settings go
to
http://www.cdc.gov/hicpac/2007IP/2007ip_p
art2.html#e
WHO will convene a meeting of the
Guideline Development Group on 6–7
October, which will discuss the
development of new guidelines on the use
of personal protective equipment to control
health-care associated Ebola transmission,
and to allow satisfactory working
conditions in the context of EVD outbreak
response (WHO - 1 OCT)

21. RESPONSE ACTIVITIES
UNITED NATIONS
BACKGROUND
• In identical letters dated 17 September to the Presidents of the
General Assembly and the Security Council, the Secretary-General
stated his intention to establish the United Nations Mission for Ebola
Emergency Response (UNMEER) and set forth the Mission’s five
objectives, six guiding principles and 12 mission critical actions deemed
necessary to stop the outbreak in the affected countries and prevent
its further spread. Those steps are estimated to cost almost $1 billion
over the next six months.
• On 18 September 2014, the Security Council determined that the
outbreak is a "threat to international peace and security" and
unanimously adoptedResolution 2177 which was co-sponsored by 134
Member States, the highest number of co-sponsors of any Security
Council resolution and only the third time the Council has taken such
action on a public health crisis.
• On 19 September 2014, the General Assembly unanimously
adopted resolution 69/1 welcoming the Secertary-General's intention
to establish UNMEER, and called on all Member States, relevant United
Nations bodies and the United Nations system to provide their full
support to the United Nations Mission for Ebola Emergency Response
(UNMEER).
• Immediately thereafter, the Secretary-General established UNMEER
and deployed advance teams to the mission headquarters in Accra,
Ghana as well as to the most-affected countries, Guinea, Liberia and
Sierra Leone, to accelerate international and regional efforts to support
national efforts.
• On 23 September 2014 United Nations Secretary-General Ban Ki-moon
announced the appointment of David Nabarro as his Special Envoy for
Ebola and Anthony Banbury as his Special Representative and Head of
the United Nations Mission for Ebola Emergency Response (UNMEER).
• The first-ever UN emergency health mission, the UN Mission for Ebola
Emergency Response (UNMEER) is being set up in response to the
unprecedented outbreak.TheMission will be temporary and will
respond to immediate needs related to the fight against Ebola.
• RAPID ACTION:
• Under the strategic guidance of the SG's Special Envoy,
David Nabarro, and the operational direction of the SG's
Special Representative, Anthony Banbury, the mission will
harness the capabilities and competencies of all the relevant
United Nations actors under a unified operational structure
to reinforce unity of purpose, effective ground-level
leadership and operational direction, in order to ensure a
rapid, effective, efficient and coherent response to the crisis.
• THE SINGULAR STRATEGIC OBJECTIVE AND PURPOSE: to
work with others to stop the Ebola outbreak.
• STRATEGIC PRIORITIES OF THE MISSION: 1) stop the spread
of the disease 2) treat the infected 3) ensure essential
services, preserve stability and prevent the spread to
countries currently unaffected.
• IN PARTNERSHIP: UNMEER will work closely with governments and
national structures in the affected countries, regional and
international actors, such as the African Union (AU) and the Economic
Community of West African States (ECOWAS), and with Member
States, the private sector and civil society.
• UNITING EXPERTISE: The World Health Organization (WHO) will be
responsible for overall health strategy and advice within the Mission,
while other UN agencies will act in their area of expertise under the
overall leadership and direction of a single Head of Mission. The
Mission will leverage the existing presence and expertise of UN
country teams, international partners including NGOs on the ground
to minimize gaps and ensure leadership.
(UNMEER 30 SEP 2014)

22. RESPONSE ACTIVITIES
UNMEER
PRIORITY REQUESTS (FOR MEMBER STATES)
• Air lift, particularly helicopters, and maritime transport capabilities, fuel, vehicles
• Mobile laboratory facilities capable of movement throughout affected countries;
• Static non-Ebola medical clinics;
• Emergency medical evacuation capability for movement of international aid
workers potentially exposed to Ebola to locations for appropriate medical care;
• 3.3 million items of high quality personal protective equipment;
• Training
• Provision of Ebola Treatment Centers.
PRIORITY REQUESTS FOR PRIVATE SECTOR ENGAGEMENT
(For details see UNMEER-Ebola Business Engagement Guide)
• 2 October 2014- SRSG Anthony Banbury met with UN, national, and
operational partners in Liberia on the first part of an introductory visit
to affected at the National Emergency Operations Centre in Accra,
Ghana.
• UNMEER is set to establish operational capacities by providing
transportation vehicles, supplies for the health workers, and meeting
other needs identified by the national governments.
• Mr. Banbury applauded the work being done by both district health
officials and the frontline workers of NGOs such as Médecins Sans
Frontières and Samaritan’s Purse. But, he noted, patients continued to
arrive in the field hospitals, and the threat of transnational contagion
from bordering States remained alive. (UN NEWS CENTER – 2 OCT)
“70 per cent of infected people need to be under treatment, 70
per cent of burials need to be done in a
safe way in order to turn this around and we need to do it in 60
days.” SRSG Banbury

23. RESPONSE ACTIVITIES
WORLD FOOD PROGRAM
According to WFP’s most recent update, it has delivered 5971 metric tons of food
for 430,369 people in Guinea, Liberia and Sierra Leone since April 2014.
Meanwhile, UN Humanitarian Response Depots (UNHRD) in Dubai and Accra
dispatched 224 metric tons of protective gear, emergency health kits, relief items
and equipment to the region thus far.
WFP’s response to the Ebola outbreak includes:
• WFP’s food assistance is provided to patients in Ebola treatment centres,
survivors of Ebola discharged from treatment centres and communities with
widespread and intense transmission – including the families of people
infected with Ebola who are in treatment, deceased, or recovering. This helps
to stabilize affected communities by enabling them to limit unnecessary
movement.
• Food distributions are ongoing in all three countries, in both urban and rural
areas, often house-to-house, one family at a time -- and more food is on the
way. WFP has contracted a ship that is currently in Cotonou, Benin, loading
7,000 metric tons of rice to be transported to Monrovia and Freetown.
• The United Nations Humanitarian Air Service (UNHAS), managed by WFP, has
opened a new air corridor between Dakar, Accra, Freetown, Monrovia and
Conakry to facilitate the rapid deployment of humanitarian staff to the field.
UNHAS was already operating between the affected countries and has
transported 497 passengers and 6.6 metric tons of light cargo for 25
organizations (NGO, UN, donors, government partners and media), using two
fixed-wing aircraft and one helicopter.
• WFP is providing unprecedented logistics support to help medical services to
treat and prevent the spread of the virus. In Liberia’s capital Monrovia, WFP
field engineers are setting up four Ebola Treatment Units with a capacity of
400 beds.
A WFP distribution center in Monrovia, Liberia. WFP/Rein Skullerud
• WFP is helping to quantify the impact of the health crisis on
household food security through an innovative technique called
“mVAM,” using mobile phones for surveys that are normally done
in person. In Sierra Leone, data collection via SMS has been
completed for a sample of 800 households. In Guinea and Liberia,
WFP is preparing data collection through interactive voice
response.
• The UN Humanitarian Response Depot (UNHRD), managed by WFP,
continues to support the response efforts of the World Health
Organization, WFP, Irish Aid and Japan International Cooperation
Agency. UNHRD depots in Dubai (UAE), Accra (Ghana), and Las
Palmas (Spain) have so far dispatched 224 metric tons, worth US$
1.9 million, of protective gear, emergency health kits and
equipment to the region. Weekly dispatches are ongoing.
SOURCE: WFP- 3 OCT

24. RESPONSE ACTIVITIES
UNITED NATIONS CHILDREN'S FUND
USAID Morgana Wingard)
In collaboration with partners such as the Red Cross and the
WHO, UNICEF is stepping up efforts to design culturally-sensitive
communication strategies and raise awareness of Ebola, at the
grassroots level, across the seven at-risk or affected countries in
West Africa.
In Guinea, Liberia, Sierra Leone, Cote d'Ivoire, Senegal, Mali and
Guinea Bissau, mass and digital media and inter-personal
communication activities are being carried out to prevent people
contracting the Ebola virus amongst communities and health
workers in mosques, churches, schools, health centers and
markets.
EVD ORPHANS
UNICEF reported on September 30 that the EVD outbreak has orphaned at least 3,700
children in Guinea, Liberia, and Sierra Leone. Many of the children face rejection from
extended families. UNICEF reports the number of orphaned children could double by
mid-October. (UNICEF -30 SEP)
As it accelerates its Ebola response, UNICEF is looking at traditional and new ways to
help provide children with the physical and emotional healing they need:
• In Liberia, UNICEF is helping the government train 400 additional mental health and
social workers. UNICEF is also working with local authorities in the most affected
counties to help strengthen family and community support to children affected by
Ebola and provide care to those who have been rejected by their communities or
whose families have died.
• Over the next 6 months more than 2,500 Ebola survivors – now immune to the
disease – will be trained in Sierra Leone to provide care and support to quarantined
children in treatment centres. UNICEF is also working with partners to reunite
separated children with their families through an extensive family tracing network
across the country which also provides children with psychosocial support.
• In Guinea, UNICEF and partners will provide about 60,000 vulnerable children and
families in Ebola-affected communities with psychosocial support.
HOUSEHOLD PROTECTION KITS
UNICEF has sent over 9,000 kits to Liberia. This is the first in a series of airlifts that will
see a planned total of 50,000 kits for distribution. Each kit contains protective gowns,
gloves and masks, as well as soap, chlorine and a sprayer, along with instructions on the
use and safe disposal of materials Along with USAID, funding for the kits is being
provided by US-based Paul G. Allen Family Foundation, which has committed a US$3.6
million matching contribution to UNICEF to support the airlift.
(UNICEF - 25-SEP)
SCHOOL REOPENINGS
In view of a possible reopening of schools in Guinea in October, al
though a date has yet to be determined, UNICEF is supporting the
Ministry of Education to develop school plans and protocols for
referral, teacher training, and a health and wash supply package,
thus creating the conditions for a return to school in safe and
protective learning environments. (UNECC 1-OCT)

25. RESPONSE ACTIVITIES
US GOVERNMENT
DECLARATIONS:
• On August 4, the U.S. Ambassador to Liberia declared a disaster due to the
effects of the Ebola outbreak. In response, USAID has activated a Disaster
Assistance Response Team (DART).
• On August 13, U.S. Chargé d’Affaires Kathleen FitzGibbon declared a disaster
due to the effects of the EVD outbreak in Sierra Leone.
• On August 15. U.S. Chargé d’Affaires Ervin Massinga declared a disaster due to
the magnitude of the EVD outbreak in Guinea
• The Ebola outbreak afflicting West African countries is now an epidemic of
unprecedented proportions. President Obama has made combating Ebola a top
national security priority and on 25 September, at the United Nations, he called on the
world to join the United States in this effort. (WHITE HOUSE -25 SEP)
• The President noted how the public health systems in Sierra Leone, Liberia, and Guinea
have collapsed, making the outbreak a regional and potentially global threat. Health
workers on the front lines are in desperate need of more aid – from beds, to supplies,
to more helping hands. (WHITE HOUSE -25 SEP)
• The Centers for Disease Control and Prevention (CDC) is launching the largest
international response in its history. President Obama has also directed the U.S.
military to establish a command in Liberia which is now up and running, moving in
personnel, equipment, and supplies. The U.S. is working with Sierra Leone to create an
air bridge that will get health workers and medical supplies to the region faster, and
we’re setting up new treatment centers, a field hospital, and a training facility to help
bolster the number of health workers on the ground. (WHITE HOUSE -25 SEP)
President Barack Obama delivers remarks on the Ebola epidemic
during a meeting chaired by United Nations Secretary-General Ban
Ki-moon at the United Nations in New York, N.Y., Sept. 25, 2014.
(Official White House Photo by Pete Souza)
• A high-level USG delegation—including Assistant Administrator for
USAID’s Bureau for Democracy, Conflict, and Humanitarian Assistance
Nancy Lindborg and DoD Assistant Secretary of Defense Michael
Lumpkin—arrived in Liberia’s capital city of Monrovia on September 29
to assess ongoing EVD response efforts. While in Liberia, the 10-person
delegation is scheduled to meet with Liberian President Ellen Johnson
Sirleaf, Government of Liberia (GoL) and U.N. officials, other USG
partners, and EVD-affected community members. (USAID – 1 OCT)

26. http://reliefweb.int/sites/reliefweb.int/files/resources/10.01.14%20-%20USG%20West%20Africa%20Ebola%20Outbreak%20Program%20Map.pdf

27. RESPONSE ACTIVITIES
US GOVERNMENT
USAID
• CDC and USAID continue to support EVD-affected countries to establish national
and sub-national Emergency Operations Centers (EOC). USG experts have deployed
to Guinea, Liberia, and Sierra Leone to provide technical guidance on setting up
EOCs. All three countries currently have an incident manager, reporting to the
President of the country, to lead EVD response efforts. (USAID – 24 SEP)
• USAID and the U.S. Department of State formalized a $10 million grant—
approximately $5 million from each—for the AU Commission to support the
deployment of more than 100 health care workers to assist with the ongoing EVD
outbreak response. With the USG funding, health personnel from AU member
states will receive EVD preparedness training and deployment assistance. The AU
Support to Ebola Outbreak in West Africa (ASEOWA) mission will augment on-going
efforts to control the outbreak. ASEOWA personnel will directly respond to medical
needs in Guinea, Liberia, and Sierra Leone in close cooperation with governments
in affected nations, the USAID-led Disaster Assistance Response Team (DART), CDC,
and other international responders. (USAID – 1 OCT)
CENTER FOR DISEASE CONTROLCONTROL
TRAINING COURSE FOR LICENSED CLINICIANS
• CDC has announced an introductory training course for licensed clinicians—
including nurses, physicians, and other health care providers—intending to deploy
to affected countries to support clinical care in ETUs. CDC plans to provide multiple
offerings of the three-day course in the U.S. for at least three months, beginning
the first week of October. The primary purpose of the course is to ensure that
clinicians intending to provide medical care to EVD patients have sufficient
knowledge of the disease and its transmission routes to work safely and efficiently
in a well designed ETU. (USAID – 1 OCT )
TECHNICAL ASSISTANCE FOR AIRPORT
• Since the beginning of August, CDC has worked with airlines, airports, ministries of
health, and other partners in EVD-affected countries to provide technical
assistance for airport exit screenings and travel restrictions. Exit screening is
recommended in countries with EVD outbreaks because the benefit of screening
for illness and exposures is much greater when conducted at or near the source of
the outbreak.
• Successful exit screening at the source lessens the need for entry screening in
other countries. A well-run exit screening system also aims to increase the
confidence of travelers, airline crews, and airline management, allowing affected-counties
to continue receiving goods, people, and services via ports. (USAID – 1
OCT )
DEPLOYMENTS
• Hundreds of CDC staff members have provided logistics, staffing, communication,
analytics, management, and other support functions for the response. CDC has
deployed several teams of public health experts to the West Africa region. CDC
staff are deployed to Guinea, Liberia, Nigeria, Senegal, and Sierra Leone to assist
with response efforts, including surveillance, contact tracing, data management,
laboratory testing, and health education. (CDC- 2 OCT)
• CDC is consulting with WHO to increase laboratory capacity in Cote D’Ivoire,
Ghana, Guinea Bissau, and Mali under a USAID cooperative agreement. CDC
epidemiologists are also working with teams in Cote d’Ivoire, Ghana, and Guinea
Bissau to assess and support preparedness for possible Ebola virus disease.
(USAID – 1 OCT)
The Centers for Disease Control and Prevention is sending Epidemic Intelligence
Service Officers or disease detectives to try and stop the outbreak of the Ebola virus.
And those workers admit there is a long road ahead to stop the disease.(CNN 29 SEP)

28. RESPONSE ACTIVITIES
CENTER FOR DISEASE CONTROL
MORBIDITY AND MORTALITY WEEKLY REPORT (MMWR)
• On September 26, CDC released an MMWR article, “Estimating the Future
Number of Cases in the Ebola Epidemic – Liberia and Sierra Leone, 2014-2015,”
which estimated the future number of Ebola cases if current trends continue.
The projected numbers were adjusted to account for estimated
underreporting of cases.
‒ Without additional interventions or changes in community behavior,
CDC estimates that by January 20, 2015, there will be a total of
approximately 550,000 Ebola cases in Liberia and Sierra Leone, or 1.4
million if corrections for underreporting are made.
‒ Cases in Liberia are currently doubling every 15-20 days, and those in
Sierra Leone and Guinea are doubling every 30-40 days.
‒ A Q&A on the report is available at
http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa-mmwr-
estimating-future-cases.html
FOOD AND DRUG ADMINSTRATION
• FDA has issued Warning Letters to three firms marketing products that claim to
prevent, treat or cure infection by the Ebola virus: Natural Solutions
Foundation, Young Living, and dōTERRA International LLC. There are currently
no FDA-approved vaccines or prescription or over-the-counter drugs to
prevent or treat Ebola. Individuals and companies promoting these
unapproved and fraudulent products must take immediate action to correct or
remove these claims or face potential FDA action. - FDA - 24 SEP
Experimental Ebola vaccines and treatments are in the early stages of product
development, have not yet been fully tested for safety or effectiveness, and
the supply is very limited. There are no FDA-approved treatments for Ebola
available for purchase on the Internet. A claim that a product prevents, treats,
or cures a disease requires prior approval by FDA. FDA - 24 SEP
From left, Dr. Joel Montgomery, a team leader with the U.S. Centers for Disease
Control and Prevention, adjusts a colleague's personal protective equipment
Sept. 17, 2014, before entering the Ebola virus treatment unit in Monrovia,
Liberia,.
• The U.S. Food and Drug Administration has authorized Tekmira
Pharmaceuticals Corp. to provide an experimental drug to people with
confirmed or suspected Ebola virus infections. In the FDA expanded-access
programs, drug developers may provide experimental drugs to
patients with serious or life-threatening diseases who don't have
satisfactory alternatives. The programs are intended for patients who
don't qualify for clinical trials of a drug.(WSJ- 22 SEP)

29. RESPONSE ACTIVITIES
US DEPARTMENT OF DEFENSE – OPERATION UNITED ASSISTANCE
The U.S. Africa Command, through U.S. Army Africa, provides coordination of logistics, training,
and engineering support to the U.S. Agency for International Development (USAID) in West Africa
to assist in the overall U.S. Government Foreign Humanitarian Assistance/Disaster Relief efforts to
contain the spread of the Ebola Virus/Disease, as part of the international assistance effort
supporting the Governments of Liberia, Sierra Leone and Guinea. Operation United Assistance
personnel also will set up a training facility for health care workers near Monrovia, as well as an
intermediate staging base in Senegal.
US MEMBERS IN MONROVIA
Currently there are 150 US service members in Liberia conducting a range of activities in support
of USAID. (DOD – 30 SEP)
EMEDS EBOLA TREATMENT FACILITY
• Airmen from the 633rd Medical Group partnered with representatives from the U.S. Public
Health Service on Sept. 26 to deliver a modular medical treatment center as part of the U.S.
whole-of-government effort to support humanitarian relief operations in Ebola-stricken African
nations. Airmen from the 633rd Medical Group accompanied the Expeditionary Medical
Support System, or EMEDS, to Africa. And while they will not be involved in treatment of
patients exposed to the virus, they will be supporting the overall effort by setting up the
facility and training international health care workers. (DOD – 26 SEP)
• 15 Seabees from the Naval Mobile Construction Bat talion 133 are handling site preparation
for the medical facility (Navy Times -25 SEP).
DEPLOYEMENTS
Deployments of U.S. troops to fight the Ebola outbreak in West Africa will accelerate during
October when 1,600 soldiers will be dispatched to Liberia. Half of the soldiers are from the
headquarters element of the 101st Airborne Division, based at Fort Campbell, Ky., and will form
the headquarters staff of a joint forces command led by Maj. Gen. Gary Volesky. The other 700
will include combat engineers from units around the United States, charged with overseeing the
construction of 17 Ebola treatment centers with a total of 1,700 beds. Officials with the 1st
Armored Division at Fort Bliss, Texas, and Joint Task Force Carson at Fort Carson, Colo., confirmed
troops from those installations would deploy this month to Liberia.(STAR-STRIPES – 1 OCT)
Airmen assigned to the 633rd Medical Group board a C-17 Globemaster at
Langley Air Force Base, Va., Sept. 26, 2014. The 633rd Medical Group
packaged and delivered a modular medical treatment center, as part of a
governmentwide effort to support humanitarian relief operations in Ebola-stricken
African nations. (SOURCE: U.S. Air Force photo by Senior Airman
Kayla Newman)
MOBILE LABORATORY
• Two US Navy mobile laboratories have now arrived in Liberia.
One team will be based in Gbarnga (Bong county), with the
other based in Montserrado (the district containing the capital,
Monrovia). Both teams will be operational by 5 October (WHO -
1 OCT)
• The two additional laboratories will provide quick testing
capabilities for ETUs at Bong and Island Clinic. Rapid testing is
vital to remove negative cases from facilities and open beds for
other suspected cases. (USAID – 1 OCT)

30. SITUATION
EUROPEAN UNION
EUROPEAN UNION (EU):
• The European Commission is establishing an operational hub from which
to coordinate and facilitate air transport for medical evacuations of health
workers, and has activated the EU Civil Protection Mechanism to facilitate
the provision of assistance on the ground and to coordinate the deliveries
of equipment and supplies. (EU – 25 SEP)
• The European Mobile Laboratory (EMlab) will work with the European
Commission to establish the European Union West Africa Mobile Lab
(EUWAM-Lab), to train more local and EU specialists as well as providing
additional equipment. (EU – 29 SEP)
IRELAND: Ireland has pledged 42 tons of supplies, including blankets,
tarpaulins, tents, mosquito nets, jerry cans and soap, to be airlifted from
Accra to the affected countries. Ireland has also deployed a member of its
Rapid Response Corps to Dakar, Senegal to work with WFP to establish an air
transit center to be used by the UN Humanitarian Air Service. (Ireland – 22
SEP)
DENMARK: Denmark has pledged maritime transport capacity to move
supplies, equipment and personnel to affected countries in West Africa.
Denmark will also provide accommodation to healthcare workers responding
to the Ebola outbreak, to ensure their accommodations have adequate
sanitation, security and opportunities for rest. (Denmark – 25 SEP)
GERMANY: 2,000 Bundeswehr (armed forces) soldiers have volunteered to
participate in Germany’s response to the crisis. These volunteers, along with
the German Red Cross and the Federal Agency for Technical Relief (THW) will
set up and run a mobile hospital in Liberia with 300 beds. The initial airliftof
supplies and personnel from Dakar, Senegal was expected to start on 25
September. (Germany – 25 SEP)
FRANCE: France has pledged to establish a 50-bed Ebola treatment center in
Guinea, to be run by the French Red Cross with a laboratory run by the
Pasteur Institute. (France – 2 OCT)
UNITED KINGDOM:
• On 2 October, the UK hosted the Defeating Ebola conference in
London. The conference resulted in additional pledges of funding and
other contributions from governments, NGOs, foundations and the
private sector, including: 165 health professionals from Cuba, medical
treatment facilities from Ireland, personal protection equipment kits
from Japan, and physicians and nurses from Norway. (DFID – 2 OCT)
• The UK will undertake rapid trials of community care units in Sierra
Leone. These units will give people who suspect they are infected with
Ebola to seek swift and accurate diagnosis and appropriate care. If
positive, they will be isolated at the center until they can be
transferred to a full Ebola treatment center. If the initial pilot is
deemed effective, it will be rolled out across the country.
• The Department for International Development (DFID) will partner
with Sierra Leone’s Ministry of Health and NGOs to help reduce the
risk of infection from traditional burial practices; this will ensure
bodies are buried safely while respecting local practices. (DFID – 2
OCT)
• More than 40 military personnel and humanitarian staff from the UK
arrived in Freetown to oversee construction of the UK’s medical
facility and assist with response to the Ebola crisis. (DFID – 23 SEP)
• DFID published its action plan to defeat Ebola in Sierra Leone, available
here.
• The UK has committed to deploying clinicians, epidemiologists and
infection control advisors from Public Health England and King’s
Health Partners. The UK will also provide vital medical supplies such as
chlorine, personal protection equipment and essential water and
sanitation facilities in Sierra Leone. (DFID – 1 OCT)

31. SITUATION
OTHER COUNTRIES
SWITZERLAND: The Swiss Agency for Development and Cooperation (SDC) is
supporting the Hospitals of the University of Geneva (HUG), which is supplying
medical personnel in Geneva and Liberia for treatment of the infected and for
prevention and training projects. (ReliefWeb – 30 SEP)
CANADA:
• Canada has deployed a mobile laboratory, along with a rotating team of
scientists, to Sierra Leone.
• Canada donated hundreds of doses of the experimental Ebola vaccine to
the WHO. (Canada – 25 SEP)
GHANA: Ghana is hosting the UN’s Mission on Ebola Emergency Response
(UNMEER) in Accra, which is deploying 250 UN personnel. (Ghana – 25 SEP)
This includes the establishment of an air bridge in Ghana, which will be vital in
transporting supplies to affected countries. (UNMEER – 30 SEP)
ECONOMIC COMMUNITY OF WEST AFRICAN STATES (ECOWAS):
• The ECOWAS Coordinating Ministerial Group has called for member states
to deploy armed and security forces, including medical personnel, logistics
staff and military engineers to help set up Ebola treatment centers in
Guinea, Liberia and Sierra Leone. (ECOWAS – 26 SEP)
CUBA
• Late Wednesday, 1 OCT , doctors and 103 nurses departed Cuba for Sierra
Leone, as part of the Cuban contribution to global efforts to curb the
spread of EVD. Prior to deployment, Cuban health professionals are
undergoing more than two weeks of training with international experts at
a Havana hospital specializing in tropical diseases.
• Another 296 Cuban doctors and nurses will deploy to Liberia and Guinea
once their training has been completed (UNECC- 3 OCT)
CHINA:
• The Chinese mobile bio-safety level III laboratory arrived in Sierra
Leone on 25 September (China – 25 SEP)
• SL-3 mobile laboratory has been set up at the Sierra Leone-China
Friendship Hospital at Jui. (SL- 26 SEP)

32. NGO RESPONSE ACTIVITIES
MÉDECINS SANS FRONTIÈRES (MSF) - DOCTORS WITHOUT BORDERS
GENERAL UPDATE
• MSF has been responding to the epidemic since March, and currently has
248 international and 2,800 locally hired staff on the ground in Guinea,
Sierra Leone and Liberia, treating a rapidly increasing number of patients.
• MSF is managing 549 beds in six different Ebola management centers, and
has sent more than 553 tons of supplies to the affected countries.
• MSF has admitted 3,299 patients, of whom 2,051 were confirmed cases of
Ebola, 650 of whom have survived. (MSF – 25 SEP)
Despite strict safety precautions to prevent the spread of infection in health
centers, medical and non-medical staff at these centers remain at risk of
infection. Risks of infection at work are as minimized as possible, but the risk
of staff becoming infected in their communities remains. The infection of 240
health workers, 120 of whom have died (MSF has had 14 infected and has lost
8 colleagues), makes responding to the crisis even more challenging. (MSF –
25 SEP)
GUINEA
• MSF’s team in Guéckédou has an average of 40 cases in its Ebola center.
• The MSF team in Macenta continues to manage the transfers from the
transit center to Guéckédou. Several deaths have been reported in and
around Macenta. (MSF – 25 SEP)
SIERRA LEONE
• MSF’s Ebola management center in Bo opened on 19 September and has
admitted 15 patients, 11 of whom were confirmed cases.
• In Kailahun, MSF continues to see a large number of patients from Makeni,
often arriving in overcrowded ambulances. (MSF – 25 SEP)
LIBERIA
• The number of people with Ebola in Monrovia continues to rise, with large
numbers seeking treatment at MSF’s ELWA Ebola center, but not all can be
accepted because the center is full. A new 120 bed clinic opened in
Monrovia, the Island clinic, run by the Ministry of Health and WHO brings
the total number of beds in the city to 360.
• MSF plans to start a mass distribution of 50,000 family protection and
home disinfection kits, targeting neighborhoods that have a large number
of cases over the next two months. The kits are designed to help people
protect themselves from infection and disinfect their homes to reduce the
risk of transmission should a family member become ill with Ebola.
• In Lofa county, MSF continues to operate a 100-bed Ebola management
center in Foya.
• A mental health team recently arrived to provide counselling for patients
and their relatives, and is hoping to provide support to negative discharged
and recovered patients who often face discrimination in local
communities. (MSF – 25 SEP)
Sylvain Cherkaoui/Cosmos

33. NGO RESPONSE ACTIVITIES
INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESCENT
SOCIETIES (IFRC)
• The Red Cross is opening a new health facility in Kenema district of
Sierra Leone, which will be staffed by 19 international staff and 80 local
workers. IFRC has more than 4,000 volunteers responding to the crisis,
working on disease prevention, provision of psychosocial support and
management of dead bodies. (IFRC – 23 SEP)
Five Pillars of the Red Cross Red Crescent Response:
(IFRC – 30 SEP)
EMERGENCY
• In early September, EMERGENCY opened an Ebola treatment center in
Lakka, Sierra Leone and continues to provide medical care at the
Surgical and Paediatric Center in Goderich, in Freetown. (EMERGENCY –
21 SEP)
INTERNATIONAL MEDICAL CORPS (IMC)
• IMC is running the Ebola treatment center in Bong county, Liberia, and
should be running at capacity soon with 60 beds and 200 staff.
• IMC plans to open a 70-bed Ebola treatment unit in Lunsar, Sierra
Leone, and is in discussions about opening a second Ebola treatment
unit in Freetown. (IMC – 29 SEP)
OXFAM
• Oxfam provides medical protective materials to case tracking and burial
teams in Sierra Leone and Liberia, and is disseminating educational
information via radio and posters on how to recognize and prevent
contamination of Ebola.
• Oxfam has provided 1,500 families with Ebola prevention kits and
educational materials in Monrovia. (Oxfam – 23 SEP)
INTERNATIONAL RESCUE COMMITTEE (IRC)
• In Liberia and Sierra Leone, the IRC is supporting surveillance and
contact tracing efforts, providing protective equipment to health
workers, and conducting community sensitization. (IRC – 23 SEP)
SAMARITAN’S PURSE
• On 1 October, Samaritan’s Purse airlifted 100 tons of personal
protective gear and supplies to Liberia.
• Samaritan’s Purse is launching a community-based care program and
plans to open 15 community care centers that will provide basic support
care, starting in Lofa county. Samaritan’s Purse staff will also train and
equip people, by distributing 3,000 care kits, to care for their loved ones
and protect themselves against infection. (Samaritan’s Purse – 2 OCT)
GOAL
• Since GOAL launched an emergency recruitment drive, the organization
has received over 500 applications for medical response team members
to staff isolation and treatment centers in Sierra Leone. (GOAL – 2 OCT)

34. NGO RESPONSE ACTIVITIES
WORLD VISION
• World Vision airlifted 4 million pairs of gloves, 8,000 gallons of chlorine
and personal protective equipment to Sierra Leone. (Sierra Leone – 24
SEP)
SAVE THE CHILDREN
• Save the Children is building and will manage an Ebola treatment center
in Sierra Leone, and is supporting an interim care center in Kailahun for
children who have lost families to Ebola. (Save – 1 OCT)
• Save the Children built a 70-bed Ebola treatment center in Bong county,
Liberia, that is now being run by IMC. Save the Children plans to open an
additional Ebola treatment unit in Margibi county, Sierra Leone, as well
as 10 additional care units in Liberia. (Save the Children – 27 SEP)
AMERICARES
• AmeriCares has staff in Liberia coordinating the delivery of humanitarian
assistance, including a recent shipment of 90,000 pairs of gloves, 88,000
face masks, and 28,000 sets of personal protective gear. AmeriCares has
is planning a shipment of similar supplies and medicines to Guinea.
(AmeriCares – 2 OCT)
DIRECT RELIEF
• Direct Relief sent its twelfth shipment of medicines and supplies to West
Africa. This 13-ton shipment was bound for Liberia, and included personal
protective gear, antibiotics, oral rehydration salts, beds, gurneys, IV
stands and prescription medications. Direct Relief’s 11th shipment, 100
tons of medical aid, was sent to Liberia and Sierra Leone.
• Direct Relief partners with AirLink on shipments of humanitarian aid,
creating an air bridge to affected countries. (Direct Relief – 29 SEP)
MEDICAL TEAMS INTERNATIONAL (MTI)
• In Liberia, MTI is training and supporting health workers, mobilizing
community health volunteers to educate communities about Ebola,
improving infection control measures at health centers and providing
personal protective equipment, gloves and body bags. (MTI)
MÉDECINS DU MONDE (MDM)
• MDM is supporting five health facilities in Monrovia. (MDM – 30 SEP)
A Direct Relief-chartered Boeing 747 departs John F. Kennedy International with 100 tons of emergency medical assistance for
communities gripped by Ebola. (Direct Relief)

35. VACCINE DEVELOPMENTS
COORDINATION OF EFFORTS
The World Health Organization on Sept 29-
30 organized an expert consultation on Ebola
vaccines. More than 70 experts attended the
meeting to assess the status of work to test and to
license two candidate Ebola vaccines. Experts from
both affected and neighboring countries in West
Africa also attended the event. All participants
agreed "to have a fully tested and licensed product
that can be scaled up for use in mass vaccination
campaigns” (ISOS – Oct 2)
Three strong themes that carried through the
meeting were allowing nothing to delay the
vaccine work, making sure the products are safe
and effective, and solidarity with the people of
West Africa (CIDRAP – 1 OCT)
VACCINE CANDIDATES
• Two prototype vaccines have been earmarked for Phase I trials to assess safety, immune response,
and side effects, in healthy volunteers.
• These trials will be conducted in small groups of volunteers at more than 10 sites in Africa, Europe
and North America, with funding provided by national governments as well as grants by the
Wellcome Trust and the Gates Foundation.
• Leading candidates heading into Phase I trials which are currently underway are:
1. cAd3-ZEBOV: Developed by British company GlaxoSmithKline (GSK) with the US National
Institute for Allergy and Infectious Diseases (NIAID). Based on a chimpanzee adenovirus to
which an Ebola virus gene has been added in a bid to stimulate an immune response. Trials
started in September, among 20 healthy adults in the United States and 60 in Britain. Two
groups of 40 people will be enrolled for Phase I trials in Gambia and Mali.
2. rVSV-ZEBOV: Developed by the Public Health Agency of Canada, with the commercial
license held by a US company, NewLink Genetics (of Ames, Iowa). Uses a weakened
unrelated virus for vesicular stomatitis, a livestock disease, in which one of the genes has
been replaced an Ebola virus gene. Trials to start in the United States early October.
• Phase II tests could start as early as January-February 2015. They will involve a larger group of
volunteers, and will serve to confirm formulations and doses, as well as identify the need for boosters
and intervals between doses.
• At least two other vaccine candidates are in the pipeline but lagging several months behind; they are
being developed by the companies Crucell and Inovio respectively. Human safety and efficacy data
for these is not yet known.
• If cAd3-ZEBOV passes trials, GSK estimates it could produce 10,000 doses of the vaccine by early
2015. Some doses could be available for a small number of frontline healthcare workers by
November, with wider use offered in early 2015.
(NPR – Sept 30; CNBC – Oct 1; AFP – Oct 1; TIME – Oct 1)

36. EXPERIMENTAL THERAPIES
ZMAPP
• ZMapp is the leading candidate for treatment of the current epidemic Ebola
strain. It is a cocktail of three antibodies against the virus, developed by
Mapp Biopharmaceutical, a tiny San Diego company, with funding from the
US and Canadian governments. It was highly effective in monkeys, however
had not yet gone through human clinical trials.
• At this time, ZMapp has been used to treat several patients, including the
American doctor and nurse who became infected while working for the
humanitarian organization Samaritan’s Purse in Liberia. Their treatment was
arranged privately by the organization and was not part of a medical trial.
• Overall, five out of seven patients treated with Zmapp recovered. It is
unclear whether it was the drug, additional therapeutics (including
transfusion of antibodies from convalescent patients), or supportive care
after evacuation to the US, that played the decisive role.
• At this time the supply of Zmapp remains exhausted. The small facility in
Kentucky where the original doses were produced is working, but is
expected to yield only 10 to 20 treatment courses by the end of the year.
• Plans to scale up production are in progress, likely by multiple
manufacturers, with financial backing from the US government, the Bill and
Melinda Gates Foundation, and the Wellcome Trust.
• One possibility is scaling up production in plants, which could potentially
yield hundreds of doses but is limited by growing conditions and season of
the tobacco plants in which they are grown.
• Another option is growing ZMapp in animal cell cultures, which can be
scaled up nearly indefinitely in biotechnology facilities. However, this
approach involves longer lag time, and may require re-testing for efficacy.
• Despite the new efforts, supplies of the drug are expected to be limited to
hundreds or thousands of treatment courses by early next year at best.
(NYT – Oct 1)
TKM-EBOLA
• TKM-Ebola (formerly known as Ebola-SNALP) is developed by
Vancouver-based Tekmira Pharmaceuticals. It is a combination of
small interfering RNAs (siRNAs) targeting Ebola’s replication.
• A Phase I trial of TKM-Ebola’s safety began in January 2014; it was put
on hold by the FDA in July 2014 after some subjects had flu-like
responses. More recently, the FDA changed its status to "partial hold",
and authorized its release for people infected with Ebola.
• Tekmira said the drug has been given to several patients under
emergency protocols and was well tolerated, however it is too early to
report recovery rates.
(WSJ – Sept 22)
OTHER NEW MEDICATIONS
• BioCryst Pharmaceuticals is developing BCX4430, a novel nucleoside
with broad spectrum antiviral activity including against Ebola. To date,
BCX4430 has shown efficacy in animal infection models for Ebola and
Marburg viruses. A Phase I trial is expected to begin in early 2015.
• Another drug, AVI-7537, developed by Sarepta Therapeutics in
Boston, has likewise showed promising results in monkeys. However,
further tests on this drug were stopped in 2012 due to budget cuts.
Between 25 and 150 doses of this drug could be available without
further scale-up of production.
(NPR – Sept 30)
REPURPOSING EXISTING TREATMENTS
• Avigan (favipiravir) is a viral polymerase inhibitor approved as a
seasonal influenza treatment in Japan. It was used in September to
treat a French MSF worker; the patient has been reported stable. If
effective against Ebola in trials, its developer Fujifilm Corporation
reports it may have enough doses for 20,000 patients.
• A clinic in Liberia has reported empirical use of the antiretroviral drug
lamivudine, with good outcomes in 13 of 15 Ebola patients. The NIH is
now investigating lamivudine and other nucleoside analogs.
(Bloomberg – Sept 29 ; WP – Oct 2)
OVERVIEW
At of this writing, a few candidate drugs are ramping up efforts for Phase I
trials. Use of unproven drugs is permitted on an experimental basis during the
epidemic, however drug availability remains miniscule.

37. EXPERIMENTAL THERAPIES
CONVALESCENT TREATMENTS
• Convalescent therapies involve transfusion of antibody-containing blood
products from patients who have recovered from Ebola virus into acutely ill
patients in the early stages of the disease.
• They have been used in a few patients, including two American doctors who
recovered and were declared free of disease. However, the numbers are
too small to support any conclusions about efficacy. In the case of the
American patients, results are confounded by multiple treatments and the
additional supportive care after evacuation to the US.
• The WHO has issued an interim guidance document on the use of
convalescent whole blood or plasma collected from patients recovered
from Ebola virus disease as an empirical treatment option.
• However, there remain major questions regarding the safety and efficacy of
convalescent therapies, and the feasibility of their scale-up in countries with
shattered health systems and an acute shortage of medical staff.
• In particular, blood product immunological compatibility and infection
control are the greatest obstacles to broader use of this treatment
modality. Further difficulties will include safe collection, storage, and
distribution of blood products. WHO – Sept 26)
PLANS FOR CLINICAL TRIALS
• In September, the Gates Foundation announced a $50 million
commitment in support of large-scale emergency efforts to contain
the Ebola epidemic. The funding is to be divided between public
health and medical relief efforts in affected areas, education, vaccine
research, and development of therapeutics.
• The Wellcome Trust is providing a further £3.2 million in grants to
multiple partners to quickly establish clinical trials at existing Ebola
treatment centers. Partners include the International Severe Acute
Respiratory and Emerging Infections Consortium (ISARIC), the
University of Oxford, Médecins Sans Frontières (MSF), the World
Health Organization (WHO), Institut Pasteur, Fondation Mérieux, and
the Global Health Network.
(Forbes – Sept 25; Wellcome Trust – Sept 23)
ETHICS AND OVERSIGHT
• Since August, a group of experts convened by the WHO agreed that
the use of experimental medicines and vaccines is ethically permissible
under the exceptional circumstances of the Ebola epidemic.
• The WHO will facilitate access to the treatments, rapid ethical review,
and implementation of clinical trials, in a way that is acceptable and
coordinated with national governments and local communities.
• Organizations with long-standing experience in the area and existing
treatment facilities, such as MSF, will continue to play a key role in
scaling up of efforts for treatment and containment of the epidemic.
• It is likely that decisions on prioritization of treatment will continue to
evolve as treatment and prevention options become available.
(WHO Sept 26; Wellcome Trust – Sept 23)
MSF treatment
center near
Monrovia (NPR –
Sept 30)

38. PROJECTIONS
• Epidemiologists tracking the spread of Ebola virus disease are
increasingly convinced that the current epidemic in West Africa has
been growing exponentially for at least 16 weeks, since May 2014 .
The number of new cases has been doubling every 20-30 days.
• Epidemiologists at WHO headquarters in Geneva undertook a major
re-assessment of all reported data coming from all sources at all
outbreak sites. Though confidence in data being reported by Guinea
is good, other significant problems were identified.
• In Liberia, for example, data were being reported from 4 different
and uncoordinated streams, resulting in several overlaps and
duplicated numbers. In other cases, a backlog of unreported cases
was detected, thus creating a distorted picture of how the outbreak
has been evolving. Many cases and deaths were not being properly
registered on standard reporting forms.
• These problems have now been corrected. The results of this data
clean-up and re-analysis were published online in the New England
Journal of Medicine (23 SEP).
• Nearly 1000 new cases were reported in the week ending 14
September alone – certainly an underestimate of the true burden of
disease. If the present rate of increase continues – if nothing is done
to intervene – somewhere between 2500 (black line) and 5000 cases
(blue line) will occur, each week, just four weeks from now. Affected
countries could be seeing more than 10 000 cases weekly by mid-
November (GAR - 22 SEP)
Notwithstanding the geographic variation in case incidence within
and among Guinea, Liberia, and Sierra Leone, the current
epidemiologic outlook is bleak. Forward projections suggest that
unless control measures — including improvements in contact
tracing, adequate case isolation, increased capacity for clinical
management, safe burials, greater community engagement, and
support from international partners — improve quickly, these three
countries will soon be reporting thousands of cases and deaths each
week, projections that are similar to those of the Centers for Disease
Control and Prevention. New England Journal of Medicine (23 SEP).