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YALE- TULANE ESF-8 SPECIAL REPORT 
WEST AFRICA - EBOLA 
NEW CONFIRMED PROBABLE SUSPECTED TOTALS 
CASES 
142 1528 733 354 2...
BACKGROUND 
SITUATION: EBOLA OUTBREAK - WEST AFRICA. 
COUNTRIES WITH ACTIVE LOCAL TRANSMISSION: GUINEA, LIBERIA, NIGERIA, ...
WEST AFRICA: REGIONAL EBOLA CRISIS MONITORING 
(AS OF 23 AUG 2014) 
SOURCE http://reliefweb.int/sites/reliefweb.int/files/...
RESOURCES & CONFIRMED & PROBABLE CASES OF EBOLA 
SOURCE: VSHOC/WHO – 21 AUG 2014
RESOURCES & CONFIRMED & PROBABLE CASES OF EBOLA 
SOURCE: VSHOC/WHO – 21 AUG 2014
WHAT IS EBOLA? 
Starts with: 
• Sudden onset of fever (greater than 38.6°C or 101.5°F) 
• Intense weakness, muscle pain 
•...
• Early diagnoses difficult because symptoms are nonspecific to Ebola 
• Definitive diagnoses made through laboratory test...
BIOSECURITY MEASURES 
• Human-to-human transmission of the Ebola virus is 
associated with direct or indirect contact with...
SITUATION 
• In the four countries (Guinea, Liberia, Nigeria, Sierra Leone) cases have 
not only affected rural areas but ...
SITUATION 
• The EVD outbreak is impacting national health care systems, according to MSF. 
Many health facilities in Libe...
SITUATION 
GUINEA 
GUINEA 
NEW CONFIRMED PROBABLE SUSPECT TOTALS 
Cases 28 443 139 25 607 
Deaths 10 264 139 3 406 
SOURCE...
SITUATION 
LIBERIA 
LIBERIA 
NEW CONFIRMED PROBABLE SUSPECT TOTALS 
Cases 110 269 554 259 1082 
Deaths 48 222 267 135 624 ...
SITUATION 
LIBERIA 
• CDC experts are assisting GoL authorities in screening passengers arriving and 
departing from Rober...
SITUATION 
LIBERIA 
CUMULATIVE CASES OF THE EBOLA VIRUS DISEASE AMONG HEALTHCARE WORKERS IN 
LIBERIA SINCE MAY 29 TO AUGUS...
SITUATION 
NIGERA 
NIGERIA 
NEW CONFIRMED PROBABLE SUSPECT TOTALS 
Cases 1 12 0 4 16 
Deaths 1 5 0 0 5 
EBOLA VIRUS DISEAS...
SIERRA LEONE 
NEW CONFIRMED PROBABLE SUSPECT TOTALS 
Cases 3 804 40 66 910 
Deaths 18 353 34 5 392 
• An outbreak of Ebola...
RESPONSE ACTIVITIES 
WORLD HEALTH ORGANIZATION (WHO) / UNITED NATIONS CHILDREN ‘S FUND (UNICEF) 
FOOD: WHO is working with...
RESPONSE ACTIVITIES 
MÉDECINS SANS FRONTIÈRES (MSF) - DOCTORS WITHOUT BOARDERS 
GUINEA 
• In Guinea, MSF is running two Eb...
RESPONSE ACTIVITIES 
MÉDECINS SANS FRONTIÈRES (MSF) - DOCTORS WITHOUT BOARDERS 
LIBERIA 
• Doctors Without Borders/Médecin...
SITUATION 
US GOVERNMENT RESPONSE 
DECLARATIONS: 
• On August 4, the U.S. Ambassador to Liberia declared a disaster due to...
USG PROGRAMS FOR EBOLA OUTBREAK IN WEST AFRICA 
http://www.usaid.gov/sites/default/files/documents/1866/OFDA-CDC_EbolaMap_...
RESPONSE ACTIVITIES 
US CENTER FOR DISEASE CONRTOL 
CDC has activated its Emergency Operations Center (EOC) to help coordi...
HEATHCARE WORKERS INFECTED WITH EBOLA 
• On 12 August, Dr Margaret Chan, Director General of 
the World Health Organizatio...
HEATHCARE WORKERS INFECTED WITH EBOLA 
WHY HAVE SO MANY HEALTHCARE WORKERS BEEN INFECTED? 
• Capital cities as well as rem...
GENERAL INFORMATION 
 This is the first Ebolavirus outbreak in Western Africa but the origin of 
this outbreak is current...
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Yale - Tulane Special Report - West Africa - Ebola 26 AUG 2014

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In light of the of the Ebola outbreak in West Africa the Yale-Tulane ESF-8 Planning and Response Program has produced this special report.

Since most of our student are not back yet from summer break I reached out to past alumni and members of Team Rubicon to assist in putting this report together.

The report was compiled entirely from open source materials. Please feel free to forward the report to anyone who might be interested.

Any students, past alumni, or volunteers who would like to work on future slides let me know. Assistance is always welcome.

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Yale - Tulane Special Report - West Africa - Ebola 26 AUG 2014

  1. 1. YALE- TULANE ESF-8 SPECIAL REPORT WEST AFRICA - EBOLA NEW CONFIRMED PROBABLE SUSPECTED TOTALS CASES 142 1528 733 354 2,615 DEATH 77 844 440 143 1,427 BACKGROUND WHAT IS EBOLA? CURRENT SITUATION 26 AUGUST 2014 BIOSECURITY MEASURES LIBERIA • MINISTRY OF HEALTH AND SOCIAL WELFARE NIGERIA • NIGERIA MINISTRY OF HEALTH SIERRA LEONE • MOHS • MINISTRY OF HEALTH AND SANITATION INTERNATIONAL ORGANIZATIONS • RELIEF WEB • HUMANITARIAN RESPONSE • UNICEF • UN NEWS CENTER WHO • WORLD HEALTH ORGANIZATION - AFRICA • WHO AFRP EPR OUTBREAK NEWS • DISEASE OUTBREAK NEWS • GLOBAL ALERT RESPONSE - EBOLA • WHO – EBOLA • IFRC NGO • MSF • ACT ALLIANCE • CATHOLIC RELIEF • SAMARITAN'S PURSE US GOVERNMENT • US EMBASSY MONROVIA – LIBERIA • US EMBASSY – CONAKRY, GUINEA. • US EMBASSY – SIERRA LEONE • US EMBASSY – NIGERIA RESPONSE ACTIVITIES GUINEA | LIBERIA NIGERIA| SIERRA LEONE CDC • CDC EBOLA HEMORRHAGIC FEVER • CDC – OUTBREAK OF EBOLA IN WEST AFRICA • USAID PORTALS, BLOGS, AND RESOURCES • CIDRAP • PROMED MAIL • EBOLA ALERTS ON HEALTHMAP • OPENSTREETMAP WEST AFRICA EBOLA RESPONSE • MEDBOX EBOLA TOOLBOX • VIROLOGY DOWN UNDER BLOG • H5N1 • DISASTER INFORMATION RESEARCH CENTER NEW SOURCES • ALERTNET • NY TIMES • WASHINGTON POST EBOLA VIRUS DISEASE, WEST AFRICA – UPDATE 22 AUGUST 2014 SITUATION MAPS GUINEA LIBERIA NIGERIA SIERRA LEON ON AUGUST 8, THE WORLD HEALTH ORGANIZATION (WHO) DECLARED THAT THE CURRENT EBOLA OUTBREAK IS A PUBLIC HEALTH EMERGENCY OF INTERNATIONAL CONCERN (PHEIC). IMPACT ON HCW RISK
  2. 2. BACKGROUND SITUATION: EBOLA OUTBREAK - WEST AFRICA. COUNTRIES WITH ACTIVE LOCAL TRANSMISSION: GUINEA, LIBERIA, NIGERIA, SIERRA LEONE. The outbreak is the largest Ebola virus disease (EVD) outbreak ever reported, both in terms of cases and the geographical spread, it is also the first time EVD has spread to large cities DEVELOPMENT OF THE OUTBREAK: On 22 March 2014, the Guinea Ministry of Health notified WHO about a rapidly evolving outbreak of EVD. Retrospective epidemiological investigations indicate that the first case of EVD probably occurred as early as December 2013 when a two-year-old girl from Guéckédou prefecture in the forested region of south-eastern Guinea died from symptoms compatible with EVD. Researchers confirmed that the virus is a member of the Zaire species, which kills most of its victims. Strains of that virus have caused outbreaks previously in Gabon and the Democratic Republic of Congo. HOWEVER, THIS STUDY DEMONSTRATES THE EMERGENCE OF A NEW EBOV STRAIN IN GUINEA. Further epidemiologic investigations are ongoing to identify the presumed animal source of the outbreak. It is suspected that the virus was transmitted for months before the outbreak became apparent because of clusters of cases in the hospitals of Guéckédou and Macenta in Guinea. This length of exposure appears to have allowed many transmission chains and thus increased the number of cases of Ebola virus disease. SOURCE: THE NEW ENGLAND JOURNAL OF MEDICINE. CDC WHO KEY POINTS – EBOLA VIRUS DISEASE, WEST AFRICA ECDC SUBSEQUENT SPREAD LIBERIA: In Liberia, the disease was reported in Lofa and Nimba counties in late March and by mid-April, the Ministry of Health and Social Welfare had recorded possible cases in Margibi and Montserrado counties. SIERRA LEONE: The outbreak progressed rapidly in Sierra Leone. The first cases were reported on 25 May in the Kailahun District, near the border with Guéckédou in Guinea. By 20 June, there were 158 suspected cases, mainly in Kailahun and the adjacent district of Kenema, but also in the Kambia,Port Loko and Western districts in the north west of the country. By 17 July, the total number of suspected cases in the country stood at 442, and had overtaken those in Guinea and Liberia. By 20 July, additional cases had been reported in the Bo District the first case in Freetown, Sierra Leone's capital. NIGERIA: There have been two confirmed and six other suspect cases in Nigeria as of 5 August 2014. The first one was an imported case of a Liberian-American, Patrick Sawyer, who traveled by air from Liberia and became violently ill upon arriving in the city of Lagos. On 20 July, Sawyer flew into Nigeria via Lomé and Accra from Liberia, and he died five days later in Lagos. This is the first outbreak of EVD in West Africa and the largest EVD outbreak ever documented. The current outbreak marks the first time that Ebola virus transmission has been reported in capital cities (Conakry, Monrovia and Freetown). THIS OUTBREAK IS WORSENING. shows the trend in the occurrence of new cases in the affected countries. It shows a bimodal curve with an increase of cases up until week 16 of 2014, with 25 cases reported as an average over the previous five weeks. The moving average decreases to 11 cases in week 21 and then increases to 127 in week 30 of 2014, a five-fold increase over the earlier peaks, (ECDC)
  3. 3. WEST AFRICA: REGIONAL EBOLA CRISIS MONITORING (AS OF 23 AUG 2014) SOURCE http://reliefweb.int/sites/reliefweb.int/files/resources/WA_A4_L_140825_Ebola_Epidemic.pdf
  4. 4. RESOURCES & CONFIRMED & PROBABLE CASES OF EBOLA SOURCE: VSHOC/WHO – 21 AUG 2014
  5. 5. RESOURCES & CONFIRMED & PROBABLE CASES OF EBOLA SOURCE: VSHOC/WHO – 21 AUG 2014
  6. 6. WHAT IS EBOLA? Starts with: • Sudden onset of fever (greater than 38.6°C or 101.5°F) • Intense weakness, muscle pain • Headache, sore throat Followed by: • Vomiting, diarrhea, rash • Impaired kidney and liver function • Internal and external bleeding Ebola creates holes in blood vessels, often causing bleeding and shock. It does this by killing endothelial cells, which form the blood vessels’ lining and other partitions in the body. When those cells die, blood and other fluids can leak out. Organs shut down. The virus replicates very quickly, before most people’s bodies can mount an attack. People often have massive bleeding 7 to 10 days after infection. It effectively disables the immune system by hampering the development of antibodies and T cells that would target the virus. Scientists are not certain exactly how. (Washington Post) WHAT IS EBOLA? • Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever, is a severe, often fatal illness in humans, caused by a filovirus. • EVD outbreaks have a case fatality rate of up to 90%. • First appeared in 1976 in Sudan and Democratic Republic of Congo. The latter was in a village situated near the Ebola River, from which the disease takes its name. HOW IS IT TRANSMITTED SIGNS AND SYMPTOMS • Direct contact of blood, organs, or other bodily fluids of infected people • People are infectious as long as their blood and secretions contain the virus ‐ Infective after death ‐ Infective after recovery • Natural reservoir is unknown • Experts hypothesize that first patient comes in contact with an infected animal RISK OF EXPOSURE • Healthcare providers caring for Ebola patients and the family and friends in close contact with Ebola patients are at the highest risk of getting sick because they may come in contact with the blood or body fluids of sick patients. • People also can become sick with Ebola after coming in contact with infected wildlife. For example, in Africa, Ebola may be spread as a result of handling bushmeat (wild animals hunted for food) and contact with infected bats. WAYS IN WHICH THE VIRUS IS TRANSMITTED. SOURCE: THE HERALD SOURCE : CDC WHO KEY POINTS – EBOLA VIRUS DISEASE, WEST AFRICA INCUBATION: The incubation period is usually four to ten days but can vary from two to 21 days.
  7. 7. • Early diagnoses difficult because symptoms are nonspecific to Ebola • Definitive diagnoses made through laboratory testing: ‐ PCR ‐ ELISA ‐ Virus isolation ‐ IgM and IgG antibodies • No specific vaccine or medicine (e.g., antiviral drug) has been proven to be effective against Ebola. • Symptoms of Ebola are treated as they appear. The following basic interventions, when used early, can significantly improve the chances of survival. o Providing intravenous fluids and balancing electrolytes (body salts) o Maintaining oxygen status and blood pressure o Treating other infections if they occur • Experimental treatments have been tested and proven effective in animals but have not yet been tested in humans. • Avoid all contact with blood or fluids of infected people • Isolation of Ebola patients • Basic infection control measures ‐ Equipment sterilization ‐ Routine disinfection ‐ Hand hygiene WHAT IS EBOLA? • Prompt and safe burial of dead • There is no vaccine for Ebola. • If you must travel to an area affected by the Ebola outbreak, make sure to do the following: o Practice careful hygiene. Avoid contact with blood and body fluids. o Do not handle items that may have come in contact with an infected person’s blood or body fluids. DIAGNOSIS TREATMENT PREVENTION SOURCE : CDC WHO KEY POINTS – EBOLA VIRUS DISEASE, WEST AFRICA o Avoid funeral or burial rituals that require handling the body of someone who has died from Ebola. o Avoid contact with bats and nonhuman primates or blood, fluids, and raw meat prepared from these animals. o Avoid hospitals where Ebola patients are being treated. The U.S. Embassy or consulate is often able to provide advice on healthcare facilities. o Seek medical care immediately if you develop fever, headache, muscle pain, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding. • Limit your contact with other people when you go to the doctor. Do not travel anywhere else SOURCE: THE LANCET STUDENT
  8. 8. BIOSECURITY MEASURES • Human-to-human transmission of the Ebola virus is associated with direct or indirect contact with blood and body fluids. • Close physical contact with Ebola patients should be avoided. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. • Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home. • People who have died from Ebola should be promptly and safely buried. World Health Organization • Health-care workers caring for patients with suspected or confirmed Ebola virus should apply, in addition to standard precautions, other infection control measures to avoid any exposure to the patient’s blood and body fluids and direct unprotected contact with the possibly contaminated environment. • When in close contact (within 1 meter) of patients, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures). • Ebola viruses are considered Risk Group 4 Pathogens by WHO, requiring Biosafety Level 4 equipment in laboratories. World Health Organization The World Health Organization has just released an Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola. If carefully implemented, infection prevention and control (IPC) measures will reduce or stop the spread of the virus and protect health-care workers (HCWs) and others. Liberian nurses bury the body of an Ebola victim. Photo: EPA
  9. 9. SITUATION • In the four countries (Guinea, Liberia, Nigeria, Sierra Leone) cases have not only affected rural areas but also large cities (i.e. Conakry, Freetown, Monrovia and Lagos). • The outbreak is rapidly evolving with a noticeable and constant increase in the number of EVD cases since early July 2014 (ECDC 22 AUG 2014). • While Liberia and Sierra Leone continue to report increasing numbers of EVD cases, the U.N. World Health Organization (WHO) reports generally improving or stable situations in Guinea and Nigeria. • Transmission continues to be very high in Liberia and Sierra Leone. In the 2014 Ebola outbreak, nearly all of the cases of EVD are a result of human-to-human transmission. The incubation period from time of infection to symptoms is 2 to 21 days. (WHO) • 47% survive - In this Ebola outbreak, the survival rate has been higher than previous outbreaks. (WHO) • On 1 Aug, WHO and the government of Sierra Leone, Guinea and Liberia launched a new joint US$ 100 million response plan as part of an intensified international, regional and national campaign to bring the outbreak under control. • On 8 Aug, WHO declared the Ebola outbreak in West Africa a Public Health Emergency of International Concern (PHEIC) (WHO, 8 Aug 2014). • The U.N. World Food Program (WFP) declared a Level 3 emergency—the highest alert level for WFP—in Guinea, Liberia, and Sierra Leone and is providing food assistance to EVD patients, quarantined communities, and other vulnerable populations. • Médecins Sans Frontières (MSF) continues to manage EVD treatment units (ETUs) in the three affected countries in coordination with government officials and other stakeholders. However, MSF reported on August 15 that it lacked the capacity to further scale up staffing and stressed the need for increased international support to the region, including donor funding to organizations active in the response and the deployment of medical and disaster relief specialists. • On August 18, WHO publicly requested that EVD-affected countries conduct exit screenings of all individuals at international airports, seaports, and land border crossings. Any individual expressing symptoms consistent with EVD should be denied travel, with the exception of appropriate medical evacuations, according to WHO. However, WHO does not recommend international travel or trade bans. • The African Union Support to Ebola Outbreak (Operation ASEOWA) is expected to deploy civilian and military volunteers from across the continent to ensure that Ebola is put under control. The mission will comprise medical doctors, nurses and other medical and paramedical personnel. The operation is expected to run for six months with monthly rotation of volunteers. The operation will cost more than USD25 million and the US government and partners have pledged to support the African Union with a substantial part of this amount. The operation aims at filling the existing gap in international efforts and will work with WHO, OCHA, US CDC, EU CDC and others agencies already on the ground. (AFRICAN UNION 21 AUG 2014)
  10. 10. SITUATION • The EVD outbreak is impacting national health care systems, according to MSF. Many health facilities in Liberia and Sierra Leone remain closed. Fears of EVD have resulted in people with other non-EVD health needs not seeking care, or doctors and nurses refusing to work. In Monrovia, all five major hospitals remained closed, with only three health clinics operating as of August 15, according to the International Medical Corps, which also reports that almost all private hospitals in Sierra Leone have closed. • Organizations involved in the response also note a need for psychosocial support, particularly for children orphaned by EVD. In Sierra Leone, UNICEF is supporting efforts to identify and assist EVD-affected children. In Liberia, the International Federation of Red Cross and Red Crescent Societies (IFRC)—through USAID/OFDA support—recently trained 19 participants from the Liberian Red Cross Society, the MoHSW, and other NGOs to provide emotional support to EVD-affected families and community member CHALLENGES: During the meeting of the International Health Regulations Emergency Committee Regarding the 2014 Ebola Outbreak in West Africa, several challenges were noted for the affected countries: • Their health systems are fragile with significant deficits in human, financial and material resources, resulting in compromised ability to mount an adequate Ebola outbreak control response. • Inexperience in dealing with Ebola outbreaks; misperceptions of the disease, including how the disease is transmitted, are common and continue to be a major challenge in some communities. • High mobility of populations and several instances of cross-border movement of travelers with infection • Several generations of transmission have occurred in the three capital cities of Conakry (Guinea); Monrovia (Liberia); and Freetown (Sierra Leone) • A high number of infections have been identified among health-care workers, highlighting inadequate infection control practices in many facilities. The number of EVD cases could change in the coming weeks due to retrospective epidemiological investigation, laboratory confirmation, and data consolidation by local health authorities. The difference in case-fatality rates between countries may reflect differences in specificity of the diagnostic test used and the collection and reporting of data, and does not necessarily reflect an actual differences in case-fatality rates.
  11. 11. SITUATION GUINEA GUINEA NEW CONFIRMED PROBABLE SUSPECT TOTALS Cases 28 443 139 25 607 Deaths 10 264 139 3 406 SOURCE: OCHA 21 AUG 2014 EBOLA VIRUS DISEASE, WEST AFRICA – UPDATE 22 AUGUST 2014 • Affected districts include Conakry, Guéckédou, Macenta, Kissidougou, Dabola, Djingaraye, Télimélé, Boffa, Kouroussa, Dubreka, Fria, Siguiri, Pita, Nzerekore, and Yamou; several are no longer active areas of EVD transmission • 11-13 August: Guinea imposed health checks at its borders with Sierra Leone and Liberia (ECHO) while Guinea-Bissau also decided to close its border with Guinea in a bid to prevent the entry of the virus (Reuters). • The Government of Guinea (GoG) declared a public health emergency on August 14 and announced the implementation of preventive measures, including travel restrictions and a ban on transporting human remains between towns, according to international media. Guinean President Alpha Condé also stated that health authorities would hospitalize anyone suspected of EVD infection pending laboratory test results. The GoG has implemented strict border controls, with health care workers checking individuals—and isolating any suspected EVD cases—at points along Guinea’s borders with Liberia and Sierra Leone, international media report. (USAID – 20 AUG) • U.S. Chargé d’Affaires Ervin Massinga declared a disaster due to the magnitude of the EVD outbreak in Guinea on August 15. DART staff in Conakry are coordinating with government officials, U.N. agencies, and other stakeholders to assess the situation and identify gaps where USG assistance will be most effective. (USAID – 20 AUG) • A shortage of trained health workers who can treat Ebola victims and prevent further spread of the deadly disease is hampering response efforts in the region (IRIN, 31/07/2014). • WHO noted a surge in EVD cases in some areas of Guinea on August 19. However, the new cases occurred in villages previously resistant to health interventions, according to WHO. • Health workers, coordinating with community leaders, recently gained access to 26 villages and are working to identify previously concealed EVD cases and people at risk of infection due to contact with EVD patients. (USAID – 20 AUG)
  12. 12. SITUATION LIBERIA LIBERIA NEW CONFIRMED PROBABLE SUSPECT TOTALS Cases 110 269 554 259 1082 Deaths 48 222 267 135 624 EBOLA VIRUS DISEASE, WEST AFRICA – UPDATE 22 AUGUST 2014 • On 19 August 2014, in response to the growing number of cases, the Liberian president declared a quarantine of the two most affected areas, including West Point (Monrovia). • The U.N. Children’s Fund (UNICEF) reports a steep increase in EVD patients seeking care in ETUs in Liberia, rising from 61 patients to 175 patients between August 6 and August 13. • The Liberian government has recently instituted enhanced measures to combat the spread of Ebola, many of which will likely make travel to, from, and within the country difficult. The government has taken the following steps: • Closed all borders except major entry points (Roberts International Airport, James Spriggs Payne Airport, Foya Crossing, Bo Waterside Crossing, and Ganta Crossing). • Instituted prevention and screening measures at entry points that remain open. This new travel policy will affect incoming and outgoing travelers. • Instituted restrictions on public and other mass gatherings. • Instituted quarantine measures for communities heavily affected by Ebola; travel in and out of those communities will be restricted. • Authorized military personnel to aid in enforcing these and other prevention and control measures. SOURCE: CDC- 20 AUG 14 USAID 20 AUG 14 • A group of protesters armed with clubs and knives raided an isolation center in West Point on August 16, international media report. Some protesters expressed anger that EVD patients from other neighborhoods had traveled to West Point for care, while others participating in the attack reportedly claimed that EVD did not exist. The group looted food and equipment, including mattresses and sheets used by EVD patients, from the facility, which holds patients until authorities can transfer them to an ETU. Health officials expressed concern that the looted supplies—likely infected with the virus—could result in the further spread of EVD, according to media. In addition, the attack resulted in 17 patients with confirmed cases of EVD fleeing the isolation center. Community leaders said that the facility would reopen in the coming days, according to the Government of Liberia (GoL). • MSF recently opened a new ETU—named ELWA Three—with a 120-bed capacity in Monrovia. MSF admitted nine initial patients on August 18 and reports plans to increase patients as ELWA Three staff members complete safety training. MSF had 19 international and 250 national staff members in Monrovia as of August 18. The GoL also opened a new ETU at the John F. Kennedy Hospital in Monrovia; the ETU held 32 patients with suspected cases of EVD as of August 17. Suffles break out as quarantined residents of the West Point slum wait for food aid (John Moore/Getty Images)
  13. 13. SITUATION LIBERIA • CDC experts are assisting GoL authorities in screening passengers arriving and departing from Roberts International Airport in Monrovia. By strengthening screenings at the airport, CDC aims to restrict the geographic spread of EVD while also bolstering the confidence of air carriers servicing Liberia. • The GoL Ministry of Health and Social Welfare (MoHSW) has turned over management of the Liberian Institute of Biomedical Research laboratory, which conducts testing to confirm EVD presence in suspected cases, to CDC. CDC—in coordination with DoD, the U.S. National Institutes of Health, and WHO—will oversee the lab’s operations and is working to bolster the facility’s testing capacity. • USAID/OFDA recently committed approximately $760,000 to Global Communities in Liberia. With USAID/OFDA assistance, Global Communities is educating individuals and community leaders on safe and hygienic methods to reduce the risk of exposure to EVD. Focusing on Bong, Lofa, and Nimba counties, Global Communities is also supporting the development of local EVD response plans, distributing radios to facilitate access to public messaging in remote areas, and providing support to health officials and burial management teams active in the three counties. SOURCE: CDC- 20 AUG 14 USAID 20 AUG 14 SOURCE: OCHA 21 AUG 2014
  14. 14. SITUATION LIBERIA CUMULATIVE CASES OF THE EBOLA VIRUS DISEASE AMONG HEALTHCARE WORKERS IN LIBERIA SINCE MAY 29 TO AUGUST 20, 2014 SOURCE: LIBERIA MINISTRY OF HEALTH AND SOCIAL WELFARE - 20 AUG 2014
  15. 15. SITUATION NIGERA NIGERIA NEW CONFIRMED PROBABLE SUSPECT TOTALS Cases 1 12 0 4 16 Deaths 1 5 0 0 5 EBOLA VIRUS DISEASE, WEST AFRICA – UPDATE 22 AUGUST 2014 CHALLENGES • Nigeria is experiencing Ebola for the first time and thus has limited knowledge of mode of transmission and preventive measures. In some places, false information about the Ebola virus is being spread therefore, there is a clear need for training of volunteers to support the Ebola operation in Nigeria. • At the moment the human resource capacity is inadequate to fully support the efforts of the Federal and State governments. The doctors are currently on strike coupled with the fear of workers to attend to both confirmed and suspected cases of Ebola virus, the government is appealing for more volunteers both clinical and those that can do dissemination of information as well as conducting contact tracing. • There is inadequate Personal Protection Equipment (PPE) for the health workers and volunteers. • To limit the spread of the outbreak, it is necessary to provide timely and accurate information to the population in Nigeria through leaflets, posters, in markets schools, to religious and community leaders. • On 25 July 2014, the Ministry of health of Nigeria reported an imported probable case of EVD. The case, a 40-year-old American National library and origin who had a history of contact with a previously reported EVD case in Liberia, travel by plane from the Monrovia, Liberia to Lagos, Nigeria via Lomé, Togo, and Accra, Ghana. Individual subsequently died. • Nigerian officials confirmed two new cases of Ebola on Friday, bringing the number of people who have been stricken with the disease in Africa’s most populous nation to 16. Five have died, five have recovered and six are in isolation and being treated. • Nigeria has now recorded the first two (2) cases of Ebola Virus Disease in secondary contacts of the index case, the Liberian-American. The two new cases are the spouses of medical workers who took care of the Liberian American who brought Ebola to Nigeria in July. Prior to this all of the cases in Nigeria were primary contacts.(NIGERIA MOH – 22 AUG) SOURCE: IFRC ECDC WASHINGTON POST
  16. 16. SIERRA LEONE NEW CONFIRMED PROBABLE SUSPECT TOTALS Cases 3 804 40 66 910 Deaths 18 353 34 5 392 • An outbreak of Ebola has been ongoing in Sierra Leone since May 2014. • Affected districts in Sierra Leone include Bo, Bombali, Bonthe, Kailahun, Kambia, Kenema, Kono, Moyamba, Port Loko, Pujehun, Tonkolili, and Western Area, including the capital of Freetown. • On August 13, U.S. Chargé d’Affaires Kathleen FitzGibbon declared a disaster due to the effects of the EVD outbreak in Sierra Leone. DART staff in Freetown are coordinating with government officials, U.N. agencies, and other stakeholders to assess the situation and identify gaps where USG assistance will be most effective. • Sierra Leonean President Ernest Bai Koroma announced the construction of new ETUs in Sierra Leone on August 15, international media report. Acknowledging that Sierra Leone’s two existing ETUs—in Kenema and Kailahun districts—lack the capacity to respond to the current caseload, the president reported that health actors had begun construction on a new ETU outside of Kenema. MSF, which manages the 80-bed Kailahun ETU, reports the arrival of between five and 10 new patients per day, with 50 patients in the ETU as of August 15. MSF is constructing a 35-bed isolation center in Bo District, while continuing to manage a transit center in the village of Gondama, Pujehun District, where suspected EVD cases are isolated and then transferred for further care. SOURCE: OCHA 21 AUG 2014 EBOLA VIRUS DISEASE, WEST AFRICA – UPDATE 22 AUGUST 2014 SITUATION SIERRA LEONE SOURCE: CDC- 13 AUG 14
  17. 17. RESPONSE ACTIVITIES WORLD HEALTH ORGANIZATION (WHO) / UNITED NATIONS CHILDREN ‘S FUND (UNICEF) FOOD: WHO is working with the United Nations World Food Programme (WFP) to ensure people in the quarantine zones receive regular food aid and other non-medical supplies. WFP is now scaling up its programs to distribute food to the around 1 million people living in the quarantine zones in Guinea, Liberia and Sierra Leone. Food has been delivered to hospitalized patients and people under quarantine who are not able to leave their homes to purchase food. Providing regular food supplies is a potent means of limiting unnecessary movement. (WHO – 19 AUG) SURVEILLANCE: WHO, the Global Alert and Response Network (GOARN), and its partners are providing guidance and support and have deployed teams of experts to West African countries, including epidemiologists to work with the countries in surveillance and monitoring of the outbreak and laboratory experts to support mobile field laboratories for early confirmation of Ebola cases. DEPLOYED ASSETS: WHO has deployed clinical management experts to help health-care facilities treat affected patients, infection and prevention control experts to help the countries stop community and health-care facility transmission of the virus, and logisticians to dispatch needed equipment and materials. EXPERIMENTAL MEDICINES AND VACCINES • WHO has advised that the use of experimental medicines and vaccines under the exceptional circumstances of this outbreak is ethically acceptable. However, existing supplies of all experimental medicines are either extremely limited or exhausted. • WHO welcomes the decision by the Canadian government to donate several hundred doses of an experimental vaccine to support the outbreak response. A fully tested and licensed vaccine is not expected before 2015.( WHO - 15 AUG) WHO STRATEGIC ACTION PLAN • Provide leadership in coordinating the international partners at global, regional, and country levels in support of national plans. • Urgently establish a sub‐regional operations coordination center located in Guinea to act as a coordinating platform to consolidate and harmonize the technical support to West African countries by all major partners and assist in resource mobilization. • Mobilize and deploy needed WHO staff, experts, and consultants, in collaboration with the technical institutions and networks of the Global Outbreak Alert and Response Network (GOARN) to support the response to the ongoing EVD outbreak. • Regularly disseminate updated information and risk assessments on the EVD outbreak to stakeholders. • Develop and disseminate information, education, and communication materials for the public and additional training materials for health professionals, on matters of EVD prevention and control. • Facilitate cross-border and inter‐country collaboration. • Continue to provide the necessary support to strengthen core capacities that are most essential to responding to serious public health events. • Work closely with countries and lead an international effort to identify and prioritize key gaps and promote the required research to address EVD and other haemorrhagic fevers. SOURCE: EBOLA VIRUS DISEASE OUTBREAK RESPONSE PLAN IN WEST AFRICA
  18. 18. RESPONSE ACTIVITIES MÉDECINS SANS FRONTIÈRES (MSF) - DOCTORS WITHOUT BOARDERS GUINEA • In Guinea, MSF is running two Ebola case management centers—one in the capital, Conakry, and one in Guéckédou, in the southwest of the country, where the outbreak began. After a lull in new cases in Guinea, recent weeks have seen an increase in new infections and deaths from Ebola. • In Macenta transit center in southwest Guinea, near the Liberian border, MSF is supporting the Ministry of Health by transferring Ebola patients by ambulance for case management in either Conakry or Guékédou. Patients are arriving from a wide area, including the region around Nzerekore. • In Guinea, the situation has stabilized in some areas and MSF has closed its Ebola treatment center in Telimélé, in the west of the country, after no new cases were reported for 21 days. • In the capital Conakry, MSF is reducing its activities as far fewer cases are appearing. • In Guéckédou, in the southeast—the original epicenter of the epidemic—the number of patients in MSF’s center has declined significantly, with currently just two patients admitted. It is very unlikely, however, that this reflects an end to the outbreak; instead it suggests that infected people may be hiding in their communities rather than coming for treatment. • There continues to be significant fear surrounding Ebola amongst local communities and MSF teams have been prevented from visiting four villages due to hostility. SOURCE: MSF- 8 AUG 2014 MSF-15 AUG 2014 SIERRA LEONE • In Sierra Leone—now the epicenter of the epidemic MSF teams are rapidly scaling up the response, with 22 international and 250 Sierra Leonean staff. • Between five and ten new patients are being admitted each day to MSF’s 80-bed Ebola treatment center in Kailahun, near the border with Guinea. There are currently 50 patients in the center. • MSF is building a 35-bed isolation center in Bo Town. Near the village of Gondama, MSF also runs a transit capacity center where people suspected to be infected with Ebola are isolated and then transferred for further care. • An MSF psychologist is providing support and counseling to patients and their families, as well as to our staff. • 300 community health workers are running health promotion activities in the region to increase people’s knowledge about Ebola and infection prevention measures. MSF teams still hear of many dead in the communities, and of new communities being infected, although there are no concrete numbers available. MSF continues to prioritize this activity, and is increasing the number of health promotion staff. MSF currently has 676 staff working in Guinea, Sierra Leone and Liberia, but warns that it has reached its limit in terms of staff, and urges the WHO, health authorities and other organizations to scale up their response.
  19. 19. RESPONSE ACTIVITIES MÉDECINS SANS FRONTIÈRES (MSF) - DOCTORS WITHOUT BOARDERS LIBERIA • Doctors Without Borders/Médecins Sans Frontières (MSF) admitted nine patients today into its newly constructed ELWA 3 Ebola Management Center in Monrovia, Liberia, beginning a process of scaling up operations at the 120-bed facility. • An Ebola outbreak continues to rage virtually unchecked in this city of approximately one million people, far exceeding the capacity of the few medical facilities accepting Ebola patients. Much of the city’s health system has shut down over fears of Ebola among staff members and patients, leaving many people without treatment for other conditions. staff members in Monrovia. • The situation in the Liberian capital, Monrovia, is “catastrophic,” according to Lindis Hurum, MSF emergency coordinator in Liberia. There are reports of at least 40 health workers being infected with Ebola over recent weeks. Most of the city’s hospitals are closed, and there are reports of dead bodies lying in streets and houses. • MSF teams are providing technical support for an Ebola case management center in Monrovia in conjunction with the Ministry of Health, and has started construction of a new case management center. • An MSF team based in Guékédou, Guinea, has recently launched a response in Liberia’s Lofa region, alongside the Guinean border, which has been badly affected by Ebola. SOURCE: MSF- 8 AUG 2014 • MSF is reinforcing its current team of nine international staff and 10 Liberian staff, but the organization is reaching the limits of its capacity, and there is a dire need for the WHO, Ministry of Health, and other organizations to rapidly and massively scale up the response in Liberia. • In Liberia, the situation is deteriorating rapidly, with cases now confirmed in seven counties, including in the capital Monrovia. • There are critical gaps in all aspects of the response, and urgent efforts are needed to scale up. • Already stretched beyond capacity in Guinea and Sierra Leone, MSF is able to provide only limited technical support to the Liberian Ministry of Health (MoH). • The MSF team has set up an Ebola treatment center in northern Liberia, where cases have been increasing since the end of May. • After the initial set up, the center was handed over to Samaritan’s Purse on July 8. There are currently six patients and MSF experts continue to provide technical support and training. • The team will now shift its efforts to Voinjama, in Lofa county, where there are reports of people dying of Ebola in their villages. • The team will set up a referral unit so suspected Ebola patients can be isolated and transferred to the treatment center. • In Monrovia, an MSF emergency team is building a new tented treatment center with capacity for 40–60 beds. It is scheduled to open on July 27 and will also be run by Samaritan’s Purse. • A 15 bed MSF treatment unit set up at Monrovia’s JFK hospital was handed over to the MoH in April. However, the unit has since been closed and all patients are currently cared for at ELWA hospital in Paynesville until the new center is open at the same site.
  20. 20. SITUATION US GOVERNMENT RESPONSE DECLARATIONS: • On August 4, the U.S. Ambassador to Liberia declared a disaster due to the effects of the Ebola outbreak. In response, USAID has activated a Disaster Assistance Response Team (DART). • On August 13, U.S. Chargé d’Affaires Kathleen FitzGibbon declared a disaster due to the effects of the EVD outbreak in Sierra Leone. U.S. Chargé d’Affaires Ervin Massinga declared a disaster due to the magnitude of the EVD outbreak in Guinea on August 15. USAID DART • The USAID-led Disaster Assistance Response Team (DART)—comprising disaster response and public health experts from USAID/OFDA, CDC, and the U.S. Department of Defense (DoD)—continues to operate in Monrovia, Liberia. USAID/OFDA and CDC have deployed additional DART staff to Conakry, Guinea, and Freetown, Sierra Leone, to support the U.S. Government (USG) regional EVD response. • USAID/OFDA recently committed approximately $760,000 through the non-governmental organization (NGO) Global Communities to conduct public outreach, educate households and community leaders, and support county health teams to safely remove and bury bodies of deceased EVD patients in Liberia. • USAID airlifted more than 16 tons of medical supplies and emergency equipment to Monrovia, Liberia on August 24 as part of its ongoing efforts to combat the West Africa Ebola outbreak. The shipment came from USAID’s warehouse in Dubai, United Arab Emirates, and included 10,000 sets of personal protective equipment (PPE), two water treatment systems, two portable water tanks capable of storing 10,000 liters each, and 100 rolls of plastic sheeting, which can be used in the construction of Ebola treatment centers. The critical commodities will be distributed to affected areas throughout Liberia. FDA: August 5, 2014 – FDA authorized the use of a diagnostic test developed by the U.S. Department of Defense (DoD) to detect the Ebola Zaire virus in laboratories designated by the DoD to help facilitate effective response to the ongoing Ebola outbreak in West Africa. • The test is designed for use in individuals, including DoD personnel and responders, who may be at risk of infection as a result of the outbreak. • Specifically, the test is intended for use in individuals with signs and symptoms of infection with Ebola Zaire virus, who are at risk for exposure to the virus or who may have been exposed to the virus. (See also: August 12, 2014 Federal Register notice from HHS: Declaration Regarding Emergency Use of In Vitro Diagnostics for Detection of Ebola Virus) DOD • U.S. Army Medical Research Institute of Infectious Diseases, or USAMRIID, is in Liberia as part of a larger U.S. interagency response to the world’s worst outbreak of the Ebola virus which continues to spread in West Africa • USAMRIID has established diagnostic laboratories in Liberia and Sierra Leone, two of three countries where the outbreak has been spreading in recent months. (DOD 4 AUG) SOURCE: USAID Airlifts Medical Supplies, Emergency Equipment for Ebola Response West Africa – Ebola Outbreak Fact Sheet #2 West Africa – Ebola Outbreak Fact Sheet #1
  21. 21. USG PROGRAMS FOR EBOLA OUTBREAK IN WEST AFRICA http://www.usaid.gov/sites/default/files/documents/1866/OFDA-CDC_EbolaMap_08.20.2014%20copy.pdf
  22. 22. RESPONSE ACTIVITIES US CENTER FOR DISEASE CONRTOL CDC has activated its Emergency Operations Center (EOC) to help coordinate technical assistance and control activities with partners. • On August 6, CDC elevated the EOC to a Level 1 activation, its highest level, because of the significance of the outbreak. • CDC is in regular communication with other U.S. government agencies that are participating in the response, the ministries of health of the affected countries, the World Health Organization (WHO), and other international partners. CDC has deployed several teams of public health experts to the West Africa region. As of August 22, more than 60 CDC staff deployed in Guinea, Liberia, Nigeria, and Sierra Leone are assisting with various response efforts, including surveillance, contact tracing, database management, and health education. • CDC plans to send additional public health experts to the affected countries to expand current response activities. • CDC staff are assisting with setting up an emergency response structure, contact tracing, providing advice on exit screening and infection control at major airports, and providing training and education in the affected countries. As of August 22, eight health communicators are deployed to Guinea, Liberia, and Sierra Leone. • CDC health communicators in Sierra Leone, Guinea, and Liberia are working closely with country embassies, UNICEF, and ministries of health to develop public health messages and plan social mobilization activities. • Africell, a telecommunications company in Sierra Leone, is broadcasting radio programs on Ebola supported by CDC, the US Embassy, and the nongovernmental organization, BBC Media Action. • In Kenema, Sierra Leone, CDC and the international non-governmental organization GOAL are conducting a 2-day training for police and security personnel on Ebola risk mitigation and response activities. CDC is working closely with U.S. Agency for International Development (USAID), Office of Foreign Disaster Assistance (OFDA), on deployment of a Disaster Assistance Response Team (DART), which is overseeing the U.S. government’s Ebola response in West Africa. Officials with a Centers for Disease Control and Prevention in Atlanta lay in on a discussion call about Ebola with CDC organization members deployed in West Africa on Tuesday, Aug 5. CDC, in partnership with the Global Outbreak Alert and Response Network and the U.S. National Institutes of Health, shipped a mobile testing laboratory to Liberia to increase the number of specimens being tested for Ebola. The partners then worked together to set up the laboratory at the ELWA campus. The team is now focused on bringing the laboratory to full operational capacity over the next few days. CDC is working with airlines, airports, and ministries of health to provide technical assistance for the development of exit screening and travel restrictions in the affected areas. This includes: • Assessing the capacity of Ebola-affected countries and airports to conduct exit screening • Assisting with development of exit screening protocols • Training staff on exit screening protocols and appropriate PPE use • Training in-country staff to provide future trainings CDC has issued a Warning, Level 3 notice for U.S. citizens to avoid nonessential travel to the West African nations of : • Guinea • Liberia • Sierra Leone CDC also has issued an Alert, Level 2 travel notice to advise about enhanced precautions for people traveling to Nigeria
  23. 23. HEATHCARE WORKERS INFECTED WITH EBOLA • On 12 August, Dr Margaret Chan, Director General of the World Health Organization briefed the United Nations member states on Ebola. During her brief, she highlighted the fact that the number of healthcare workers who have been infected during this outbreak is unprecedented. (WHO 12 AUG 2014) • In previous outbreaks The transmission of Ebola to healthcare workers ended after the virus was identified in measures of infection control were put in place. This is not been the case with the current outbreak. • Among the fatalities is Samuel Brisbane, a former advisor to the Liberian Ministry of Health and Social Welfare • Two American aid workers at a treatment center in Monrovia run by Serving In Mission /Samaritan's Purse were infected. On 2 August, Kent Brantley, one of the two workers, was flown into Atlanta's Emory University Hospital for treatment, making him the first patient infected with Ebola virus disease in the United States. Nancy Writebol, his college arrived on 5 Aug. Both were successfully treated and released. • On 29 July, leading Ebola doctor Sheik Umar Khan from Sierra Leone died in the outbreak and Dr Modupe Cole, a senior physician at the country`s main referral facility, Connaught Hospital, was infected after treating a patient who died and was later found to have had the virus • Three more doctors: Zukunis Ireland, Abraham Borbor from Liberia and Aroh Cosmos Izchukwu from Nigeria have contracted the virus. Dr. Abraham Borbor succumbed to the disease on Sunday 24 August.. • A British health care worker, William Poolley, who tested positive for Ebola in Sierra Leone was on Sunday , 24 Aug 2014, was flown to London, where doctors battled to save his life. • As of 25 August, 240 healthcare workers have been infected and more than 120 have died. (WHO, 25 AUG 2014) • The infection and death healthcare worker has had three major consequences: 1. It has diminished one of the most important assets for response 2. It has led to closure of hospitals in isolation wards, especially when staff refuses to come to work. 3. It drives fear, already very hard to new extremes. The general public is asking this question: If well trained and equipped doctors and nurses are getting affected what hope is there for us?
  24. 24. HEATHCARE WORKERS INFECTED WITH EBOLA WHY HAVE SO MANY HEALTHCARE WORKERS BEEN INFECTED? • Capital cities as well as remote rural areas are affected, vastly increasing opportunities for undiagnosed cases to have contact with hospital staff. • Neither doctors nor the public are familiar with the disease. • Several infectious diseases endemic in the region, like malaria, typhoid fever, and Lassa fever, mimic the initial symptoms of Ebola virus disease. • Patients infected with these diseases will often need emergency care. Their doctors and nurses may see no reason to suspect Ebola and see no need to take protective measures. • Some documented infections have occurred when unprotected doctors rushed to aid a waiting patient who was visibly very ill. • In many cases, medical staff are at risk because no protective equipment is available – not even gloves and face masks. Even in dedicated Ebola wards, personal protective equipment is often scarce or not being properly used. • Personal protective equipment is hot and cumbersome, especially in a tropical climate, and this severely limits the time that doctors and nurses can work in an isolation ward. • Some doctors work beyond their physical limits, trying to save lives in 12-hour shifts, every day of the week. Staff who are exhausted are more prone to make mistakes. SOURCE: WHO, 25 AUG 2014 In this photo provided by Samaritan's Purse, Dr. Kent Brantly, left, treats an Ebola patient in Monrovia. On July 26, the North Carolina-based group said Brantly tested positive for the disease. Days later, Brantly arrived in Georgia to be treated at an Atlanta hospital, becoming the first Ebola patient to knowingly be treated in the United States.
  25. 25. GENERAL INFORMATION  This is the first Ebolavirus outbreak in Western Africa but the origin of this outbreak is currently unknown.  Currently, four countries are affected.  Control measures, such as isolation of cases and active monitoring of contacts should be able to control this outbreak and prevent further spread of the disease. RISK OF HUMAN TO HUMAN TRANSMISSION RISK ASSESSMENT  Transmission of EVD requires direct contact with blood, secretions, organs or other bodily fluids of dead or living infected persons or animals or with material or utensils heavily contaminated with such fluids. This includes unprotected sexual contacts with patients who have recently recovered from the disease.  The upsurge in the number of new EVD cases over the last weeks, the existence of urban transmission cycles, and the fact that not all chains of transmission are known, increase the likelihood for residents and travelers of being exposed to infected or ill persons.  However, the risk of infection for residents and visitors to the affected countries through exposure in the community is still considered very low if they adhere to the recommended precautions.. INCREASED RISK OF INFECTION IN HEALTHCARE FACILITIES Options for prevention and control of this risk include: • Avoiding unessential travel to affected countries • Identify appropriate in-country healthcare resources in advance of travelling, through local business contacts, friends or relatives • Ensure that in the event of any illness or accident, medical evacuation is covered by travel insurance, to limit exposure in local health facilities. PREVENT EXPORTATION OF CASES TO OTHER COUNTRIES, LOCAL AUTHORITIES MAY CONSIDER TO: • Prevent known EVD cases from leaving an affected country; this should also include their contacts for a period of 21 days (maximum duration of the incubation period). This measure can only be implemented in the country of departure and implies communicating contact details of these people to immigration authorities or airline companies; and • Prevent infectious febrile EVD cases from leaving an affected area by the screening all passengers at the time of departure. THREE RISK ASSESSMENT HAVE BEEN PUBLISHED: • European Centre for Disease Prevention and Control (1 August 2014) • European Centre for Disease Prevention and Control (8 April March 2014) • European Centre for Disease Prevention and Control (23 March 2014)

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