Epidemiological data

There was one positive Ebola Virus Disease (EVD) case reported in Sierra Leone’s Kambia district during Epi-week 36 same as reported in epi-week 35. The case from Sella Kafta village is a close family member who was on a contact list linked to the index case that was swab positive during Epi-week 35. During the same reporting period, there was only 1 transmission chain nationwide. All other districts continued to report zero cases during Epi-week 36. During the same period, a total of 73 suspected cases were reported as compared to 66 reported in Epi-Week 35. There were no EVD confirmed deaths reported during Week 36, same as the previous week.

 Enhanced Contact Tracing & Active Case Finding indicators:

• Contact tracing and monitoring activities are ongoing in Kambia linked to the only chain of transmission in the country. As of 8 September 2015, a total of 848 contacts were being followed up.

 Laboratory

• On 29 August 2015, a swab from Tonko Limba chiefdom tested EVD positive at the Nigerian Mobile lab in Kambia. The positive specimen was sequenced at the University of Cambridge lab in Makeni following the emergency operations policy for all new positive cases. The phylogenetic analysis revealed that the virus is similar to recent viruses detected in Kambia.

• The EU Hastings mobile lab closed down on 4 September 2015. Samples have been re-routed to the other EVD labs in the Western Area.

 Case management

 Maintaining and intensifying EVD vigilance:

•  The revised Ebola screening form has been finalised, sent for approval and endorsement by the Ministry of Health and Sanitation. The screening form is intended to be used by staff at all health facilities following a one-day training programme.

• Refresher training will be provided for over 1000 health workers already trained in Western, Port Loko and Kambia districts. Training will then be rolled out nationwide. In addition,  monitoring the implementation and impact of training in mainstream hospitals using newly developed Internal and External Assessment Tools will be conducted.

• In addition, care is being provided on management of pregnant women in quarantined households, including provision of on-site (mobile) antenatal care and arrangements for pregnant women approaching term to be cared for in specialised mother-baby units where appropriate obstetric and neonatal care can be provided in a risk managed environment.

• Giving additional information based on experience from the field, the generic VHF clinical management pocket guide for Sierra Leone is being updated.

Other clinical team activities:

• Planned the merger of an adapted Integrated Management of Adolescent and Adult Illness (IMAI) Clinician’s Role in Surveillance training module with the Integrated Disease Surveillance and Response (IDSR)  clinicians sensitization training.

• Technical visit to Laka Hospital in Western Area to assess screening and triage procedures and provide mentoring as necessary.

• provided technical support  to EVD Holding Centers including: Military 34 Hospitaland Ola During Paediatric Hospital

Integrated Disease Surveillance and Response (IDSR)

•   Field visit was organized by donors from Multi-Partner Trust Fund (MPTF) to evaluate WHO contributions to EVD response in Tonkolili and Bombali districts.

• As part of the IDSR revitalization in Sierra Leone, an integrated supportive supervision checklist for districts and health facility levels was developed. Aconcept note on the implementation of eIDSR in the country was also jointly developed  with  CDC and e-health Africa

•  During the week the ministry of health was supported to developed the second IDSR weekly bulletin

 Infection Prevention and Control (IPC)

•  IPC assessment was conducted in the village where the last case was reported. Hygiene kits for all Peripheral Health Units (PHU) around the village were provided and provided training for the Health Care Workers on screening and triaging of the suspected/probable cases and required usage of PPE. However shortage of IPC materials is still a challenge. District IPC team extended their support to 16 PHUs close to the Tonko Limba Chiefdom in collaboration with partner organizations 
• WHO and MoHS IPC Teams conducted assessments for PHUs in Koinadugu Diang, Wara Wara Bafodia, Mongo Kasonko, Neini, Dembelia Sinkunia Chiefdoms. Challenges were reported on logistics management, waste segregation, staffing, triage and isolation.

Mental and Psychosocial Support

•  Mental Health and Psychosocial Support meeting was held at the Kissy Psychiatry Hospital in Kambia District where Psychological First Aid support was provided to the social mobilization team.

• Also district planning meeting on Survivors was held from 3-4September.

• The Ministry of Health and Sanitation and the Ministry of Social Welfare, Gender and Children’s Affairs  were supported to develop a two year comprehensive care plan for EVD survivors.

Community Engagement

  Community engagement continued in both low and high priority districts across the country.

•  In Kambia, focus group discussions with key stakeholders on the ring vaccination trial in the targeted communities were conducted to solicit their support for the WHO vaccination team to proceed with the ring vaccination trails activities. The stakeholders included local chiefs, district health authorities, religious and other traditional leaders.

• Conducted house to house sensitization in the affected communities to inform residents at household level of the vaccine trail and it intended purpose

• Conducted follow up interpersonal engagement with vaccine trial participants (the day after the vaccination) as part of on-going psychosocial support to them.

• A month long ambulance exhibition started in Tonkolili district targeting all eleven chiefdoms in in the districts. The exhibition is aimed at restoring public confidence in ambulance service which has been affected by the Ebola outbreak.

• Social mobilisation activities continue in the other districts focussing on Ebola and other health related messages. 

Note that epidemiological weeks start on Mondays and ends on Sundays. The cases being stated in this report are therefore cases confirmed on or before Sunday. Therefore,the three additional cases linked to this cluster reported on Monday 7 Sept will be reported in Week 37 which ends on Sunday 13 Sept.