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Combatting Ebola in Sierra Leone

 - Friday 4 April 2014.

By Oswald Hanciles, Freetown, Sierra Leone.

As of today, 4 April 2014, there are NO laboratory confirmed cases of Ebola virus in Sierra Leone. The Ministry of Health & Sanitation is closely collaborating with the World Health Organization and Metabiota to provide rapid diagnostics and case investigations by MOHS personnel.

In order to effectively manage this emergency The MOHS has established National Outbreak Response task force and the following actions have been taken in response to the potential for spread of the epidemic:

* The office of the Chief Medical Officer (CMO) is coordinating all operations involving suspected cases of Ebola as well as the follow-up investigation.

* Active surveillance of suspected cases meeting the WHO case definition for either Ebola or Lassa fever is ongoing and on an as-needed basis.

* National Taskforce biweekly meetings are being held, bringing together all senior officials of national and international health institutions to provide them with relevant information in real time.

* The MOHS, the UN, foreign governments, NGOs and other National and International stakeholders are currently positioning support funds and other resources to aid in sensitization, distribution of PPE and care guidelines, educational campaigns by radio and television, and other support.

* The MOHS has established a central reporting "hotline" for the reporting of suspected VHF cases.

* Radio and television "jingles" have been developed in local languages to sensitize the community to this disease.

* Daily press conferences are being held by the MOHS to inform the public and prevent panic initiated by the spread of rumors.

Metabiota Inc., working under the MOHS and with the WHO Country Office, had previously installed Zaire Ebola-specific PCR, which was used to screen the first cases reported to PROMED. The laboratory team has installed and are currently running a full suite of Ebola specific and differential diagnostics, including: WHO recommended Zaire Ebola-specific RT-PCR, Zaire Ebola-specific antigen and IgM capture ELISAs, pan-filovirus RT-PCR, as well as published PCR assays for the detection of Lassa fever, yellow fever and other confounding, locally endemic pathogens. WHO, Metabiota, and other partners are providing the recommended full personal protection equipment (PPE) for health workers exposed to suspected cases.

On March 30th 2014, the MOHS of Sierra Leone has carried out 4 epidemiological investigations with multidisciplinary field teams to investigate suspected cases reported by local health centers. Over 15 suspected cases (contact with confirmed from a suspected infected patient from Guinea) have been investigated by the field team, at which time blood samples were collected, tested negative by RT-PCR for all existing known five Ebola virus species. Samples from two patients from Guinea, collected by the Guinean authorities (border proximity of the investigation field teams) were also referenced to the Kenema laboratory and were found to negative for Ebola, Marburg, Yellow Fever and Lassa fever by RT-PCR.

Since that time, 2 additional suspected cases from Sierra Leone were tested and found to be Negative.

The MOHS National Task Force, working with Metabiota, Tulane University and other partners, is continuing to actively conduct surveillance for Ebola virus, as well as Lassa fever, and the Kenema Government Hospital has been designated as the central treatment facility for anyone suspected of contracting either Ebola or Lassa fever. This facility specializes in the treatment and management of Viral Hemorrhagic Fever. A specialized infectious disease ambulance previously provided by Metabiota for the transport of acutely ill Lassa fever patients is being used to transport suspected cases and every precaution made to protect both health care workers and local populations from the risk of spread of the diseases.

Just-in-time, hands-on clinical management training for district healthcare workers, including how to set up local isolation wards will be conducted in the next week. Additional training and VHF sensitization will also be provided to National level and District level surveillance officers, as well as border checkpoint health surveillance workers. Each training event will be used as a distribution opportunity for up to date materials, as well as the recommended PPE and instructions on its use. The training of trainers for clinical personnel is being managed by Dr. Sheik Humarr Khan, Chief Physician of the Lassa fever ward at the Kenema Government Hospital, and Dr. Jean-Paul Gonzalez, Metabiota Senior Scientist and physician, according to the WHO manual on the control of viral hemorrhagic fevers.

Photo: Ebola patients in Uganda, 2001.

Photo credit: BBC News.