Situation Report

PLOS  Current Outbreaks  by Nadia Wauquier and others                                             April 20, 2015

The initial steps of emergence and spread of a virus are critical in the development of a potential outbreak and need to be thoroughly dissected and understood in order to improve on preventative strategies. In the current West African outbreak of EVD, a unique index case has been identified, pinpointing the geographical origin of the epidemic in Guinea.

Herein, we provide an accounting of events that serve as the footprint of EVD emergence in Sierra Leone and a road map for risk mitigation fueled by lessons learned....

...Continuous active surveillance is needed and must be organized by specialized centers joined in local, regional, and international networks. Surveillance centers must be connected to public health systems and also to research teams for increased understanding and awareness to permit identification and implementation of rapid intervention strategies....

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NEW YORK TIMES by Pam Belluck and William J. Broad     April 20, 2015

A growing body of scientific clues — some ambiguous, others substantive — suggests that the Ebola virus may have lurked in the West African rain forest for years, perhaps decades, before igniting the deadly epidemic that swept the region in the past year, taking more than 10,000 lives.

Around 2004 at a government hospital in Kenema, Sierra Leone, a team of American scientists and West African medical personnel found what appeared to be Ebola antibodies in nearly 9 percent of blood samples. Credit Carl De Souza/Agence France-Presse — Getty Images

PLOS     by Paul Richards and others                                                          April. 17,  2015                  
The current outbreak of Ebola Virus Disease in Upper West Africa is the largest ever recorded. Molecular evidence suggests spread has been almost exclusively through human-to-human contact.

 Social factors are thus clearly important to understand the epidemic and ways in which it might be stopped, but these factors have so far been little analyzed.

 The present paper focuses on Sierra Leone, and provides cross sectional data on the least understood part of the epidemic—the largely undocumented spread of Ebola in rural areas. Various forms of social networking in rural communities and their relevance for understanding pathways of transmission are described. Particular attention is paid to the relationship between marriage, funerals and land tenure.

 Funerals are known to be a high-risk factor for infection. It is suggested that more than a shift in awareness of risks will be needed to change local patterns of behavior, especially in regard to funerals, since these are central to the consolidation of community ties.

http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003567

REUTERS   by Tom MIles                                                                     April 19, 2015

GENEVA--The World Health Organization has admitted serious failings in its handling of the Ebola crisis and pledged reforms to enable it to do better next time, its leadership said in a statement seen by Reuters on Sunday.

"We have learned lessons of humility. We have seen that old diseases in new contexts consistently spring new surprises," said the statement, attributed to the WHO Director-General Margaret Chan and the deputy director-general and regional directors.

"We have taken serious note of the criticisms of the Organization that, inter alia, the initial WHO response was slow and insufficient, we were not aggressive in alerting the world ... we did not work effectively in coordination with other partners, there were shortcomings in risk communications and there was confusion of roles and responsibilities...," it said.

The statement listed eight lessons learned, including areas where the WHO's response to Ebola could have been better, such as information sharing and communication....

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