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1 [1] (October 6, 2015)

handle is hein.crs/govccyx0001 and id is 1 raw text is: FF.ri E~$~ & October 6, 2015 Ebola in West Africa: Issues with Elimination In January 2014, an Ebola outbreak began in Guinea, West Africa. As of September 20, 2015, more than 28,000 people have been sickened by the disease, including over 11,000 deaths. Nearly all of those cases and deaths have occurred in Guinea, Liberia, and Sierra Leone. Cases have also been discovered and contained in Mali, Nigeria, Senegal, as well as Britain, Italy, Spain, and the United States. The outbreak is ongoing, but at a significantly decelerated pace (Error! Reference source not found.). Since July 2015, weekly incidence has remained below 10 cases and in the week ending on October 4, 2015, no new cases were detected for the first time since March 2014, The World Health Organization (WHO) announced that the outbreak had ended in Liberia on September 3, 2015, and that no new cases had been detected in Sierra Leone since September 13, 2015. Figure I. Weekly Ebola Cases: 0112014-1012015 (Guinea and Sierra Leone) :.... :;:............................................................. 'C' Source: WHO, Ebola Situation Report, April 29, 2015 and October 7, 2015. Notes: The April 29, 2015, Ebola Situation Report was the last one that included a graphic of weekly Ebola cases in Liberia, so Liberia is not included in Figure I. End4n ,e West Afi ka E .. ...>.r.. ak WHO considers an Ebola outbreak to have ended after 42 days have passed since the last confirmed case has tested negative twice. After an outbreak ends, WHO advises countries to maintain a system of heightened surveillance for a further 90 days to detect reemergence of the virus or undiagnosed cases. The West Africa Ebola outbreak will have ended after the 42-day period has elapsed in the last affected country. An Ebola-Free declaration does not necessarily remain permanent. For example, WHO announced that the Ebola outbreak had ended in Liberia in May 2015 and again in September 2015 after health workers detected the disease in a 17-year-old male who died on June 28, 2015. According to WHO, successive outbreaks can occur due to human contact with infected animals, sexual transmission, or a missed transmission chain. Four (Congo, Democratic Republic of Congo, Gabon, and Sudan) out of six countries (the aforementioned four and Uganda and Cote d'Ivoire) that had previously had an Ebola outbreak experienced a second one within three years. Although no new Ebola cases were detected in the week ending on October 4, 2015, new cases may emerge because over 500 people known to have had contact with an Ebola patient have been lost to follow-up in Guinea. Several other high-risk contacts in Sierra Leone have also been lost to follow-up. A number of other key factors raise prospects that Ebola may emerge again in the region, including: * Persistence of Ebola virus in survivors. Health experts do not yet know how long the virus can survive in the body, and one of the cases that occurred in Sierra Leone in mid-September appears to have resulted from contact with a survivor (though epidemiologists are still investigating the source of that case). Due to possible sexual transmission of Ebola, WHO warns that Ebola reemergence can occur beyond the 42 days. WHO advises health workers in the three affected countries to test semen samples of all male Ebola survivors monthly until two negative results are obtained, and to advise Ebola survivors either to abstain from sex or to use condoms while engaging in sex until two negative results are obtained. Pregnant women are also advised to be tested for Ebola. It is unclear, however, whether these tests are being conducted, as Sierra Leone and Guinea both use post-mortem testing as the primary method of diagnosis. * Heavy reliance on post-mortem diagnoses. In Sierra Leone and Guinea, 77% and 87% of diagnostic tests, respectively, are conducted on corpses. This means that cases are detected after death, requiring field workers to identify all previous contacts of the deceased. Heavy reliance on post-mortem diagnosis and inadequate access to rapid diagnostic tests heightens the likelihood that Ebola cases are being missed and that transmission chains may be forming without notice. * Inadequate access to rapid diagnostic tests (RDTs). Heavy reliance on post-mortem diagnosis is linked, in part, to inadequate access to rapid diagnostic tests, particularly in private facilities. One of the cases that 'O 'T gognko 'pop\qm ggmm g 'S a X

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