This document provides an overview of the Ebola virus outbreak in West Africa as of April 18, 2014. It summarizes the situation in Guinea and Liberia, where confirmed Ebola cases have been reported. In Guinea, there have been a total of 197 clinical cases and 122 deaths reported. In Liberia, there have been 27 clinical cases and 13 deaths reported. The response has included contact tracing, case isolation and management, training for health workers, and social mobilization efforts. Challenges include limited health resources, infection control issues, and the need to improve community awareness as the outbreak continues.

1. BACKGROUND
SITUATION
18 APRIL 2014
AS OF : 4:00 PM EST
RISK ASSESSMENTS
BIOSECURITY MEASURES
LIBERIA
 MINISTRY OF HEALTH AND SOCIAL WELFARE
 MINISTRY OF FOREIGN AFFAIRS
INTERNATIONAL ORGANIZATIONS
 RELIEF WEB
 HUMANITARIAN RESPONSE
 UNICEF
 UN NEWS CENTER
WHO
 WORLD HEALTH ORGANIZATION - AFRICA
 DISEASE OUTBREAK NEWS
 GLOBAL ALERT RESPONSE - EBOLA
 WHO – EBOLA
 INTERNATIONAL FEDERATION OF RED CROSS RED
CRESCENT
NGO
MSF
ACT ALLIANCE
CATHOLIC RELIEF
US GOVERNMENT
 CDC – OUTBREAK OF EBOLA IN GUINEA AND LIBERIA
US EMBASSY MONROVIA – LIBERIA
US EMBASSY – CONAKRY, GUINEA
PORTALS, BLOGS, AND RESOURCES
 CIDRAP
 HEALTH MAP
 PROMED MAIL
NEW SOURCES
 ALERTNET
 NY TIMES
 WASHINGTON POST
YALE- TULANE ESF-8 SPECIAL REPORT
GUINEA | LIBERIA EBOLA
RESPONSE ACTIVITIES
AS OF 18 APRIL 2014
LABORATORY
CONFIRMATION
DEAD
224
197|27
135
122|13
CLINICAL
DIAGNISIS
107
101|6
WHAT IS EBOLA?
Ebola Virus Disease (EVD) Outbreak, Guinea and Liberia 2014
Guinea | Liberia

2. BACKGROUND
GUINEA
• On 24 March, Guinea’s Ministry of Health notified the WHO of a fast-
spreading outbreak of deadly Ebola virus disease in the country since early
February. Thirteen of the cases tested positive for Ebola virus by PCR (six at
the Centre International de Recherche en Infectiologie (CIRI) in Lyon, France,
and seven at the Institut Pasteur Dakar, Senegal), confirming the first Ebola
hemorrhagic fever outbreak in Guinea.
• On 28 March, Guinea's government confirmed for the first time four cases of
the deadly Ebola virus in the capital city of Conakry. The spread of the
disease from the southeastern forest districts of Macenta, Gueckedou,
Nzerekore and Kissidougou to the capital, where some two million people
live, marked a significant escalation in the spread of the disease. (ACAPS -
Global Emergency Overview)
• By 5 April, the total number of suspected and confirmed cases amounted to
151, including 98 deaths. All age groups have been affected but most of the
cases are adults aged 15–59 years.
DISTRIBUTION OF CASES BY AGE GROUP IN GUINEA - 7 APRIL
LIBERIA
On 31 March, the Ministry of Health and Social Welfare (MoHSW) of Liberia
reported confirmed cases of Ebola in Lofa District and 8 suspected cases,
including 6 deaths, in individuals who had recently traveled to Guinea.
On 1 April the U.S. Embassy in Monrovia was advised that a woman confirmed
to have Ebola had traveled to the Firestone Plantation Camp in Monrovia. The
woman subsequently died.
An outbreak of Ebola virus disease (EVD) with onset in early February 2014
continues to evolve in West Africa. This is the first such outbreak in the region.
Two countries, Guinea and Liberia, have reported confirmed cases. The first
cases were reported from the forested region of south-eastern Guinea in
Guéckédou prefecture near the border with Liberia and Sierra Leone.
AS OF 7 APRIL

3. BACKGROUND
LABORATORY SUPPORT/RESULTS
• The Institut Pasteur in Lyon, France, the Institut Pasteur in Dakar, Senegal, the
European Consortium mobile laboratory, and the Metabiota/Tulane University
laboratory in Kenema, Sierra Leone, and CDC Atlanta, and are some of the
laboratories collaborating to test samples
• A team of EU scientists have set up a field laboratory to test suspect cases, working
alongside Médecins Sans Frontières at an isolation center near the borders with
Sierra Leone and Liberia. (ECDC 11 APR)
• Results from sequencing done by CIRI showed strongest homology of 98% with
Zaire Ebolavirus last reported in 2009 in Kasai-Occidental Province of e Democratic
Republic of Congo. This Ebolavirus species has been associated with high mortality
rates during previous outbreaks. (WHO, 25 Mar 2014)
SOURCE: WHO - 10 APR
CONTROL ACTIVITIES
• Control activities supported by WHO, UNICEF, Médecins Sans Frontières
and other stakeholders are being implemented, including contact
tracing, enhanced surveillance and strengthening of infection control
practices, free-of-charge access to healthcare for suspected cases, case
isolation and management, and social mobilization.
• Information and education materials have been developed and
distributed, intensive multimedia communications are underway and
psychosocial support is being provided to patients, their families and
the affected communities.
• There is ongoing training for carriers in safe practices and for members
of local communities in safe burials.
Health workers in Conakry, Guinea, teach people about the Ebola virus and how to prevent
infection (AP / YOUSSOUF BAH)
Experts from the European Union Mobile Laboratory (EMLab) ready to support Ebola samples
testing's in Guéckédou, Guinea. Photo: WHO/S. Hugonnet

4. BACKGROUND
• The strain of Ebola virus that has killed 121 people in West Africa
may have been circulating there undetected for some time,
according to a new study by The New England Journal of Medicine.
• Epidemiologic investigation linked the laboratory-confirmed cases
with the presumed first fatality of the outbreak in December 2013.
• Researchers confirmed that it is a member of the Zaire species,
which kills most of its victims. Strains of that virus have caused
outbreaks previously in Gabon and the Democratic Republic of
Congo.
• However, this study demonstrates the emergence of a new EBOV
strain in Guinea.
• The study shows the emergence of EBOV in Guinea. The high
degree of similarity among the 15 partial L gene sequences, along
with the three full-length sequences and the epidemiologic links
between the cases, suggest a single introduction of the virus into
the human population.
• This introduction seems to have happened in early December 2013
or even before.
• Further epidemiologic investigation is ongoing to identify the
presumed animal source of the outbreak. It is suspected that the
virus was transmitted for months before the outbreak became
apparent because of clusters of cases in the hospitals of
Guéckédou and Macenta. This length of exposure appears to have
allowed many transmission chains and thus increased the number
of cases of Ebola virus disease.
The area of the outbreak is highlighted in red. The main road between the
outbreak area and Conakry, the capital of Guinea, is also shown. The map
was modified from a United Nations map.(New England Journal of
Medicine)
SOURCE: The New England Journal of Medicine.

5. Starts with:
• Sudden onset of fever
• Intense weakness, muscle pain
• Headache, sore throat
Followed by:
• Vomiting, diarrhea, rash
• Impaired kidney and liver function
• Internal and external bleeding
Ebola creates holes in blood vessels, often causing bleeding and
shock. It does this by killing endothelial cells, which form the
blood vessels’ lining and other partitions in the body. When those
cells die, blood and other fluids can leak out. Organs shut down.
The virus replicates very quickly, before most people’s bodies can
mount an attack. People often have massive bleeding 7 to 10 days
after infection.
It effectively disables the immune system by hampering the
development of antibodies and T cells that would target the virus.
Scientists are not certain exactly how. (Washington Post)
WHAT IS EBOLA?
HOW IS IT TRANSMITTED
SIGNS AND SYMPTOMS
SOURCE : CDC WHO
WHAT IS EBOLA?
• Direct contact of blood, organs, or other bodily fluids of infected people
• People are infectious as long as their blood and secretions contain the
virus
‐ Infective after death
‐ Infective after recovery
• Natural reservoir is unknown
• Experts hypothesize that first patient comes in contact with an infected
animal
• Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever,
is a severe, often fatal illness in humans, caused by a filovirus.
• EVD outbreaks have a case fatality rate of up to 90%.
• First appeared in 1976 in Sudan and Democratic Republic of Congo. The
latter was in a village situated near the Ebola River, from which the
disease takes its name.
SOURCE: THE LANCET STUDENT

6. • Avoid all contact with blood or fluids of infected people
• Isolation of Ebola patients
• Basic infection control measures
‐ Equipment sterilization
‐ Routine disinfection
‐ Hand hygiene
• Prompt and safe burial of dead
DIAGNOSIS
TREATMENT
PREVENTION
SOURCE : CDC WHO
WHAT IS EBOLA?
• No specific treatment or vaccine is available for use in people or animals
• Only treatment is to provide intensive supportive care
• Patients frequently dehydrated and will require oral rehydration therapy
• Early diagnoses difficult because symptoms are nonspecific to Ebola
• Definitive diagnoses made through laboratory testing:
‐ PCR
‐ ELISA
‐ Virus isolation
‐ IgM and IgG antibodies
RISK OF EXPOSURE
• All confirmed human cases occurred in Africa
‐ Have been historically reported in: Democratic Republic of Congo,
Gabon, South Sudan, Ivory Coast, Uganda, South Africa, Guinea,
Liberia, Sierra Leone
• High Risk Individuals:
‐ Friends and Family
‐ Health workers
• Proper Personal Protective equipment (PPE) helps mitigate risk of
exposure
Ebola first appeared in 1976 in 2 simultaneous outbreaks, in Nzara, Sudan, and
in Yambuku, Democratic Republic of Congo. The latter was in a village situated
near the Ebola River, from which the disease takes its name.
(WASHINGTON POST)

7. SITUATION
GUINEA
As of 18:00 on 16 April, the Ministry of Health (MOH) of Guinea has reported a
cumulative total of 197 clinical cases of Ebola Virus Disease (EVD), including 122
deaths. To date, 101 cases have been laboratory confirmed, including 56 deaths, 43
cases ( 33 deaths) meet the probable case definition for EVD and 53 cases (33 deaths)
are classified as suspected cases.
HEALTH CARE WORKERS: Twenty- four (24) health care workers have been affected
with 13 deaths
LABORATORY INVESTIGATIONS continue at the Institut Pasteur (IP) Dakar laboratory
in Conakry (66 samples tested, of which 39 are positive by PCR for ebolavirus) and at
the European Union Mobile Laboratory (EMLab) team in Guekedou (55 samples
tested/36 positive).
CONTACT TRACING ACTIVITIES continue in all affected areas including new contacts
generated by a HCW who passed away 3 days ago. In Conakry, 60 community
volunteers are assisting the MOH and response partners in following up the 221
contacts currently under medical observation. Seven contacts who developed
symptoms have been placed in isolation as a precautionary measure. A total 249
contacts are being followed in Guekedou, 54 in Macenta 17 in Kissidougou, 63 in
Dabola and two (2) in Dingaraye.
HOSPITALIZED: A total of 36 patients are currently in isolation; 23 in Conakry, 12 in
Guéckédou and 1 in Macenta. .
SUPPORT:
• Clinical teams from WHO, the Global Outbreak Alert and Response Network
(GOARN) and Médecins Sans Frontières (MSF) are supporting national medical and
nursing staff at the Donka Hospital to strengthen patient triage, case management
and infection prevention and control (IPC).
• Training on the safe handling of patients with EVD and the deceased was
conducted jointly by the IPC and Logistics teams at the Donka hospital for staff
working at the morgue, and for drivers and staff transporting patients in
stretchers.
• A training of trainers activity for the directors of all 20 Centres de Santé in Conakry
on 17 April as well as IPC training at two community health centers
IMPACTED DISTRICTS (AS OF 16 APRIL)
• Conakry - 47 cases, including 16 deaths
• Guekedou -117cases/80 deaths
• Macenta - 22 cases/16 deaths
• Kissidougou - 6 cases/5 deaths
• Dabola - 5 cases/1 deaths
• Djingaraye - 1 case /1 death
CHALLENGES:
• Guinea recently experienced measles outbreak and is currently undergoing a
cholera outbreak
• The meningitis season in Guinea will remain until the rain period concludes.
Current seasonal infection disease already burdens resources and capacity of
the National Society
• Seasonal rains due to start within the next 6 weeks will potentially limit
transportation and access to remote areas
• In Conakry, contact tracing currently of concern. Red Cross to mobilize
resources and volunteers to scale up contact tracing
• Guinea has the lowest ratio of hospital beds per capita in a World Bank survey
of 68 nations in 2011, with just 0.3 hospital beds per 1,000 people
SOURCE: WHO- EBOLA VIRUS DISEASE, WEST AFRICA (SITUATION AS OF 16 APRIL 2014)
IFRC- GUINEA – EBOLA VIRUS OUTBREAK 11 APRIL 2014

8. SITUATION
LIBERIA
As of 16 April, the Ministry of Health and Social Welfare (MOHSW) of Liberia has
reported a cumulative total of 27 clinical cases of EVD (6 laboratory confirmed,
and 21 probable and suspected cases of EVD), including 13 deaths. The most
recent clinical case was identified on 11 April while the date of admission of the
most recent laboratory confirmed case is 4 April.
HOSPITALIZED: 2 patients are currently hospitalized.
UNDER MEDICAL OBSERVATION: At present 35 contacts remain under medical
observation and 32 have been released from follow-up.
IMPACTED COUNTIES
• Lofa County - accounts for 38% of the clinical cases reported to date , 4
laboratory confirmed and 6 suspected cases
• Margibi County - accounts for 23%, 1 confirmed and 5 suspected cases
• Bong County - 5 suspected cases
• Nimba County - 3 suspected cases
• Montserrado County - 1 suspected case
• Grand Cape Mount County - 1 suspected case.
DEAD: A cumulative number of 13 deaths are being attributed to EVD; Lofa (9),
Nimba (1), Margibi (2) and Montserrado (1). All 6 laboratory confirmed cases have
died; this includes 3 health care workers (HCW).
SOURCE: WHO Ebola virus disease, West Africa (Situation as of 14 April 2014)
Ministry of Health and Social Welfare (MOHSW) of Liberia SITREP 11 - 13 APRIRL 2014
CHALLENGES
• Limited health promotion materials
• Inadequate isolation units established in affected counties
• Information campaign is still inadequate, not reaching all parts of the
community.
• Poor infection control and facilities does not have the necessary capacity to
manage cases in isolation unit
• Community norms and practices has the potential to increase number of
contacts
• Re-enforcement of universal precaution and adherence to basic infection
control measures
• Number of contact tracers is very limited and in some counties nonexistent:
‐ Need to identify volunteers who will be providing support to
vulnerable communities in tracing and follow-ups of the contacts
of the suspected/probable cases.
• No or limited Inter Personal Communication (IPC) activities in the
communities
PLANNED ACTIVITIES
• Improve in-country laboratory capabilities to conduct both Lassa and Ebola
test
• Rehabilitate Foya proposed isolation unit
• Provision of Ambulance and MSF plan to concentrate on case management,
infection control and waste management services
• Reproduction and distribution of SOPs for Health Workers and awareness
posters and flyers
• Strengthen contact tracing and follow up activities to interrupt
transmission.
• Increase support to isolation units and psychosocial interventions
SOURCE: LIBERIA SITREP 16 APR

9. RESPONSE ACTIVITIES
• Currently more than 65 public health experts are working with WHO and its Global
Outbreak Alert and Response Network (GOARN) partners are working with WHO
on the ground supporting Ministries of Health and other partners in the two
countries to provide clinical management of patients, contact tracing, disease
surveillance, laboratory work, logistics, as well as communications and sharing of
information to help people living in communities protect themselves from the
disease.(17 APR)
• OPERATIONS CENTER: WHO has established an operation center for alert and
response activities within the Guinean Ministry of Health (MoH) to centralize the
coordination of all activities linked to detection, search, transportation,
hospitalization and burial of suspect cases.
• GOARN: WHO is working with technical partners in the Global Outbreak Alert and
Response Network (GOARN), has deployed field lab support, as well as a number of
experts in anthropology, epidemiology, logistics, clinical case management and
infection prevention and control and outbreak coordination to support the
emergency response efforts in Guinea.
• TRAINING
‐ WHO continues to support Healthcare Workers (HCW) in training in case
management and infection prevention and control
‐ To strengthen contact tracing in Conakry, WHO organized an intensive training
for a first group of 70 trainees on 9 APRIL 2014. They will go into the
communities to follow up on specific persons who had close contacts
with patients with a confirmed Ebola infection. (WHO – 9 APR)
‐ Training for HCW on infection control began on 8 APRIL in different departments
of the Donka National Teaching Hospital and will also take place in other health
facilities in coming days.
• LOGISTICS: The United Nations Humanitarian Response Depot (UNHRD) has
helped WHO’s response to an Ebola virus outbreak in West Africa by delivering
protective equipment from the UNHRD depot in Dubai. Gloves, masks and other
infectious control gear arrived in Guinea, Sierra Leone and Liberia beginning 1 APR
WHO delivers disposable personal protection equipment to isolation ward at
the China-Guinea Friendship Hospital in Conakry, Guinea. Photo: WHO/T.
Jasarevic
On 8 April, WHO said that it expects to have to confront an outbreak
of the highly contagious disease in West Africa for the next two to
four months, across a region where health systems are ill-equipped
to cope.
UNICEF
• UNICEF is working closely with partners to design culturally-sensitive
communications strategies and raise awareness of Ebola among
communities and health workers in Guinea, Liberia, Sierra Leone, Cote
d'Ivoire, Senegal, Mali and Guinea Bissau. (UNICEF -10 APR)
• UNICEF deployed two field coordinators and a 10 person team
specialized in interpersonal communications to Lofa County, Liberia
where they will work with communities to increase awareness of Ebola.
(UNICEF -16 APR)
• With logistical support from Samaritan’s Purse, UNICEF air-lifted
urgently needed tarps, sprayers, chlorine and other supplies to Lofa
County, for use in completing the isolation unit at Foya Hospital.
(UNICEF -16 APR)
WORLD HEALTH ORGANIZATION (WHO) / UNITED NATIONS CHILDREN ‘S FUND (UNICEF)

10. RESPONSE ACTIVITIES
THE INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESCENT SOCIETIES (IFRC)/INTERNATIONAL COMMITTEE OF THE RED CROSS (ICRC)
THE INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESCENT
SOCIETIES (IFRC)
FIELD ASSESSMENT COORDINATION TEAM (FACT)
• The International Federation of Red Cross and Red Crescent Societies
(IFRC) has deployed a FACT to Guinea assist in the response.
• FACT includes an infectious disease specialist from the French Red
Cross Society, as well as a psychosocial support delegate. Together they
will assess the situation on the ground and help inform a
comprehensive response plan. (IFRC – 25 MAR)
LOGISTICS ERU (SWISS RED CROSS): two-person team supporting the
mobilizing of local procurement and support to incoming teams deployed
Guinea forestière and for the operation hub in Guéckédou. Support to the
National Society logistics personnel.(IFRC – 15 APR 2014)
HEALTH ERU (FRENCH RED CROSS)
• Three-person team (team leader, admin / finance, and nurse) arrived in
Conakry on 8 April and deployed to Guéckedou on 10 April to begin
support to the National Society branches in Guéckédou and
surrounding areas affected by Ebola.
• A senior medical officer arrived in Conakry on 13 April 2014 to support
the Guinea Red Cross Health Department(IFRC – 15 APR 2014)
Red Cross volunteers in
Guinea learn how to use
protective gear to prevent
them from contracting the
Ebola virus. Photo: Panu
Saaristo/IFRC
RED CROSS SOCIETY OF GUINEA
• With support from IFRC, the Red Cross Society of Guinea is working
closely with the Ministry of Health, WHO and Médecins Sans
Frontières to stop the spread of the deadly virus.
• Volunteers with the Red Cross Society of Guinea are already involved
in the collection and removal of dead bodies. (IFRC – 25 MAR)
• Trained Red Cross volunteers are working in affected areas,
identifying and tracking those who have come into contact with
suspected cases, disinfecting the homes of Ebola victims, and raising
awareness among communities on how to protect themselves from
becoming infected. (IFRC - 1 APR )
INTERNATIONAL COMMITTEE OF RED CROSS( ICRC)
• ICRC is the lead agency for the Movement in Guinea, and has
welcomed the IFRC’s involvement and collaboration in the Ebola
operation and support of the Guinea Red Cross.
• Weekly coordination meetings are taking place with the ICRC, the
IFRC, and the Guinea Red Cross to take stock of the evolving situation,
address areas of concern (ie. volunteer protection), and to adjust the
operation to the actual caseload situation (IFRC – 15 APR 2014)
SOURCE: IFRC – 25 MAR 2014
IFRC - 1 APR 2014
IFRC – 15 APR 2014
Guinea Red Cross volunteers preparing
personal protection kits (PPE’s) at the NS
HQ in Conakry, 9 April 2014, to be
despatched to Guéckedou where the
French Red Cross health ERU is operational.
Photo courtesy of the Swiss Red Cross ERU

11. RESPONSE ACTIVITIES
MÉDECINS SANS FRONTIÈRES (MSF) - DOCTORS WITHOUT BOARDERS
GUINEA
• An outbreak of Ebola in Guinea prompted Médecins Sans Frontières (MSF) to
launch an emergency response. (22 MAR)
• Twenty-four MSF doctors, nurses, logisticians and hygiene and sanitation experts
are already in the country.
• MSF has set up an isolation unit for suspected cases in Guéckédou, in
collaboration with the Ministry of Health, and is currently doing the same in the
town of Macenta, also in the Nzérékoré region in the south of the country.
• In Macenta, in southeast Guinea, MSF activities were temporarily suspended for a
4 days following an incident where local people threw stones at buildings and
vehicles, under the mistaken impression that the disease had been brought into
the country by MSF. None of the MSF team was injured in the incident. (11 APR)
• MSF has currently sent some 33 tons of supplies to Guinea on two charter planes
leaving from Belgium and France, containing medicines, medical equipment and
the supplies necessary for isolating patients, putting sanitation measures in place
and protecting its teams.
LIBERIA
• After Ebola cases were reported in neighboring Liberia, MSF sent an Ebola
specialist to provide training and improve the small isolation unit set up by
Liberia’s ministry of health at JFK hospital
• On April 6, MSF flew in medical supplies and isolation materials from Brussels to
the capital, Monrovia, while an MSF team arrived on the ground on April 7 to
provide further support.
• On 16 April, with the logistical support of Samaritan’s Purse, UNICEF air-lifted a
new batch of urgently needed supplies of chlorine, plastic tarpaulins, sprayers
and other materials to Lofa, where MSF is providing support for emergency
health services at the isolation unit in Foya Hospital. The delivery came a day
after MSF requested this support at the NTF meeting on 15 April. (UNICEF – 16
APR)
Battle: Health specialists work in an isolation ward for patients at the Médecins
Sans Frontières facility in Guekedou, southern Guinea
MSF and WHO personnel consult at Donka Hospital.
SOURCE: WHO

12. RESPONSE ACTIVITIES
EUROPEAN MOBILE LAB PROJECT (EMLab)
On 26 March six European specialists of the European Mobile Lab project (EMLab)
for dangerous infectious disease arrived in Gueckedou, Guinea, with a mobile
laboratory unit. This consists of easily transportable equipment for high security virus
manipulation packed in boxes.
It will substantially enhance the available capacity for rapid analyses of samples and
confirmation of Ebola cases, reducing the number of undiagnosed cases and
preventing the further spread of the disease, the statement said.
CDC ATLANTA
• CDC has sent a 5 person team to Guinea to assist Guinea MOH and WHO led
international response to the Ebola outbreak.
• An outbreak-management software program developed by the US Centers for
Disease Control and Prevention will soon be deployed to the area. The software
package, called Epi-Info, collects outbreak information into a single database that
produces statistical and visual reports.
• CDC Atlanta has sent a 2 person team to Liberia to assist Liberia’s Ministry of
Health and Social Welfare (MOHSW) and the WHO led international response to
the Ebola outbreak
USAID
• Along the Liberia-Guinea border, where six suspected Ebola cases have occurred,
the United States Agency for International Development (USAID) funded
Improved Water, Sanitation and Hygiene (IWASH) Program is delivering materials
to prevent potential spread of the disease.
• Materials have been distributed to health facilities that are in the “front line” in
responding to the Ebola outbreak in the Foya District border region, in Lofa
county.
DoD
U.S. Department of Defense on 14 April opened a laboratory on the outskirts of
Monrovia to test the rising number of samples of suspected cases in Liberia. It will
eliminate the need to send samples overland into Guinea's remote southeast, where
the disease was first confirmed and tests from Liberia are now being carried out.
(Reuters – 15 April)
• Samaritan’s Purse (SP) Liberia is responding by conducting public awareness
health campaigns in Lofa, River Gee, Gbarpulu, and Nimba counties and
Monrovia, providing emergency medical supplies to a partner hospital, and
transporting medical response personnel and supplies to various parts of the
country.
• CATHOLIC RELIEF AGENCY - CRS’ local partners have sent 30 teams to the
affected areas of Guinea-Conakry and CRS will be supporting its Caritas partners
in awareness campaigns, prevention, diagnosis and treatment, and alerting
health officials of suspected cases for diagnosis and treatment.
• ACT: The Lutheran Development Service in Liberia has been holding meetings to
plan how to intervene in the situation to save lives. Moreover, the Phebe
Hospital and School of Nursing in Bong County and the Curran Memorial
Hospital in Lofa County are preparing to respond to possible cases of Ebola
whenever they are brought to their attention despite the risk involved. This is
why it is critical that they are well prepared and protected as they strive to save
lives.

13. RISK OF HUMAN TO HUMAN TRANSMISSION
 Ebola viruses are highly transmissible by direct contact with blood,
secretions, organs or other body fluids of dead or living infected
persons.
 No transmission has been reported without direct physical contact.
 Risk of transmission may increase with transition to later stages of
the disease.
 Healthcare workers can become infected through close contact with
infected patients, but risk for infection can be significantly reduced
through appropriate use of infection control precautions.
RISK OF FURTHER CASES
 As the incubation period can be up to three weeks, it is likely that
the Guinean health authorities will identify additional cases in the
coming weeks.
 Additional cases may be identified in neighboring regions.
 Of particular concern is the spread of the disease to countries with
no previous experience in managing outbreaks.
RISK OF INTERNATIONAL SPREAD
 It is unlikely, but not impossible, that travellers infected in Guinea
could arrive in the EU while incubating the disease and develop
symptoms while in the EU.
 WHO does not recommend that any travel or trade restrictions be
applied to Guinea.
OTHER MODES OF TRANSMISSION
 Transmission through sexual contact may occur up to seven weeks
after clinical recovery, as observed for Marburg filovirus.
 Transmission can also occur by contact with dead or living infected
animals, e.g. monkeys, chimpanzees, forest antelopes and bats.
 Airborne transmission has never been documented.
RISK ASSESSMENT
TWO RISK ASSESSMENT HAVE BEEN
PUBLISHED:
European Centre for Disease
Prevention and Control
(23 March 2014)
European Centre for Disease
Prevention and Control
(8 April March 2014)
GENERAL INFORMATION
 This is the first Ebolavirus outbreak in Western Africa but the origin of
this outbreak is currently unknown.
 Currently, four prefectures in Guinea are suspected to be affected,
including the capital Conakry. Also, one district in Sierra Leone
reported suspected cases.
 Control measures, such as isolation of cases and active monitoring of
contacts should be able to control this outbreak and prevent further
spread of the disease.

14. BIOSECURITY MEASURES
• Human-to-human transmission of the Ebola virus is
associated with direct or indirect contact with blood and
body fluids.
• Close physical contact with Ebola patients should be
avoided. Gloves and appropriate personal protective
equipment should be worn when taking care of ill patients
at home.
• Regular hand washing is required after visiting patients in
hospital, as well as after taking care of patients at home.
• People who have died from Ebola should be promptly and
safely buried. World Health Organization
• Health-care workers caring for patients with suspected or
confirmed Ebola virus should apply, in addition to standard
precautions, other infection control measures to avoid any
exposure to the patient’s blood and body fluids and direct
unprotected contact with the possibly contaminated
environment.
• When in close contact (within 1 meter) of patients,
health-care workers should wear face protection (a face
shield or a medical mask and goggles), a clean, non-sterile
long-sleeved gown, and gloves (sterile gloves for some
procedures).
• Ebola viruses are considered Risk Group 4 Pathogens by
WHO, requiring Biosafety Level 4 equipment in
laboratories. World Health Organization
Doctors without Borders staff carry the body of a person killed by bola virus disease at a center for
victims of the Ebola virus in Guinea, on April 1, 2014. SOURCE: SEYLLOU AFP/Getty Image
TRAINING
• In Conakry, public health experts from WHO, GOARN and Médecins
Sans Frontières (MSF) are supporting national medical and nursing staff
at the Donka Hospital to strengthen patient triage and care, case
management and infection prevention and control.
• Training on the safe handling of patients with Ebola and the deceased is
also organized for staff working at the morgue, and for drivers and staff
transporting patients. A training of trainers activity for the directors of
all 20 health Centres in Conakry is planned this week as well as for
health workers from non-affected regions of Guinea (Lola, Yomou,
Beyla et Nzérékoré).
• Similar work is underway in Liberia, where the WHO and the GOARN
team has conducted visits to two hospitals in Montserrado County, and
trainings in patient triage and care and infection prevention and
control.