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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.