West Africa Ebola - 19 September 2014 Yale-Tulane Special Report

YALE- TULANE ESF-8 SPECIAL REPORT
WEST AFRICA – EBOLA 2014
CONFIRMED PROBABLE SUSPECTED TOTALS
CASES
3075 1432 828 5335
DEATH
1,583 713 326 2622
BACKGROUND
CURRENT SITUATION
QUALITY OF SERVICES
GUINEA
LIBERIA
SIERRA LEON
BIOSECURITY MEASURES
VACCINE DEVELOPMENT
19 SEPTEMBER 2014
LIBERIA
• MINISTRY OF HEALTH AND SOCIAL
WELFARE
NIGERIA
• NIGERIA MINISTRY OF HEALTH
• NIGERIA EMERGENCY
MANAGEMENT AGENCY
• EBOLA ALERT
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
RESPONSE ACTIVITIES
GUINEA | LIBERIA|
SIERRA LEONE
US GOVERNMENT
• US EMBASSY MONROVIA –
LIBERIA
• US EMBASSY – CONAKRY,
GUINEA.
• US EMBASSY – SIERRA LEONE
• US EMBASSY – NIGERIA
• CDC EBOLA HEMORRHAGIC
FEVER
• CDC – OUTBREAK OF EBOLA
IN WEST AFRICA
• USAID
EU
• ECDC
• NaTHNac
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
• INTERNATIONAL SOS
• MAPACTION
NEW SOURCES
• ALERTNET
• NY TIMES
• WASHINGTON POST
EBOLA VIRUS DISEASE, WEST AFRICA – UPDATE 18SEPTEMBER 2014
IMPACT ON HCW
CDC REFERENCE MATERIALS

BACKGROUND
SITUATION: EBOLA OUTBREAK - WEST AFRICA.
• An uncontrolled outbreak of Ebola virus is currently underway in
several countries in West Africa (Guinea, Liberia, and Sierra Leone, with limited
cases reported in Nigeria, and a single case reported in Senegal).
• This is the largest Ebola outbreak ever reported, both in terms of case numbers
and geographical spread. It's also the first time the disease has affected large
cities. Capital cities of these nations are affected. (Note that the Ebola cases in
the Democratic Republic of Congo, as of 26 August, appear unrelated to the
outbreak in Western Africa.)
• The disease is spreading person to person, causing significant international
concern and disrupting both the health and economy of these countries as well
as neighboring nations.
• In late July, the World Health Organization (WHO) declared the outbreak a Grade
3 emergency, its highest level of any emergency response. In early August, they
declared it a Public Health Emergency of International Concern, meaning it is
a serious public health event that endangers international public health
DEVELOPMENT OF THE OUTBREAK:
• GUINEA: 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.
SOURCE: THE NEW ENGLAND JOURNAL OF MEDICINE.
CDC WHO KEY POINTS – EBOLA VIRUS DISEASE, WEST AFRICA
ECDC, INTERNATIONAL SOS
• 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: At the end of July 2014, a symptomatic case travelled by air to
Lagos, Nigeria where he infected a number of healthcare workers and airport
contacts before his condition was recognized to be EVD. This cluster in Nigeria,
initiated by air travel of an infectious person, has now resulted in tertiary cases
in Nigeria and recently a new cluster in Port Harcourt, Rivers State with three
confirmed cases. Therefore, Rivers State is now considered as an affected area.
• SENEGAL: On 29 August, the Ministry of Health in Senegal reported a
confirmed case of EVD in a 21-year-old male native of Guinea. He arrived in
Dakar, by road, on 20 August and was hospitalized on 26 August after having
initially been treated for malaria. On 27 August 2014, the Ministry of Health
was informed that the patient was a contact of a known Ebola patient in
Guinea and the patient was immediately isolated
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.

COMBINED EPIDEMIOLOGICAL CURVES – WEST AFRICA
The total number of probable, confirmed and suspected cases in the current outbreak of Ebola virus
disease (Ebola) in West Africa was 5,335, with 2,622 deaths, as at the end of 14 September 2014.
SOURCE: WHO – 18 SEP 2014
WEST AFRICA

LOCATION OF CASES THROUGHOUT THE COUNTRIES WITH MOST
INTENSE TRANSMISSION
• The map shows the location of cases throughout the
countries with widespread and intense transmission.
• The cumulative number of cases to date in each area
is shown (grey circles), together with the number of
cases that have occurred within the 21 days (red
circles) up to 14 September.
• Nine districts in which previous cases were
confirmed have reported no cases during the 21 days
prior to the end of 14 September (six districts in
Guinea, one in Sierra Leone, and two in Liberia).
• Two previously uninfected areas reported initial
cases during the seven days prior to the end of 14
September.
• In Guinea, there has been one suspected case
and one confirmed case in the newly affected
Dalaba area.
• In Liberia, four probable and two suspected
cases have now been reported in the newly
affected Maryland area, which borders Côte
d’Ivoire.
SOURCE: WHO – 18 SEP 2014

SITUATION
DISTRIBUTION OF REPORTED CASES OF EVD BY WEEK IN GUINEA, SIERRA
LEONE, LIBERIA, NIGERIA AND SENEGAL WEEK 48/2013 TO 36/2014 (AS
OF 6 SEPTEMBER 2014) SOURCE: ECDC
NOTE: This is the largest ever documented outbreak of EVD with a number of
reported cases and deaths that exceeds the case and death number of all
historical outbreaks. It is also the largest outbreak in terms of geographical
spread. THE OUTBREAK HAS NOT YET REACHED ITS PEAK AND IT IS
CURRENTLY IN A PHASE OF RAPID SPREAD. Community resistance,
inadequate treatment facilities and insufficient human resources in affected
areas are among the challenges currently faced by the countries in responding
to the EVD outbreak.
• The Ebola virus disease (EVD) outbreak continues to accelerate, with almost
40% of the total cases occurring in the past 21 days.
• The current EVD outbreak is unprecedented in scale and geographical reach:
o The present West Africa outbreak has a higher caseload than all
other previous Ebola crises combined.
o An estimated 22.34 million people are living in areas where active
EVD transmission has been reported, with 4.29 million people living
in areas where twenty or more fatalities have been reported.
o The large number of cases in high-population density settings and
simultaneously in remote, hard-to-access villages makes the
outbreak particularly difficult to contain.
• According to WHO data, more than 240 health care workers in Guinea,
Liberia, Nigeria and Sierra Leone have developed the disease with more than
120 succumbing to the epidemic.
• Because of their role as caregivers, women are experiencing the brunt of the
disease, making up 75% of all cases. Women’s economic roles also place
them at risk – they tend to work in the health care sector as nurses and
midwives or as facility cleaners or border traders.
CASES, DEATHS AND CASE-FATALITY RATIOS IN THE EVD-AFFECTED
COUNTRIES IN WEST AFRICA, AS OF 7 SEPTEMBER 2014
OCHA – 16 SEP
A woman ill with Ebola. 75% of all cases are women,

SITUATION
GROWING TENSION IN AFFECTED REGIONS. Tension and frustration
among the population have repeatedly led to difficulties in accessing
and treating affected populations.
• In Monrovia, the capital of Liberia, rioters attacked an Ebola
treatment center ‘freeing’ patients and looting Ebola infected goods
(i.e. mattress, sheets) on BBC - 17 AUG.
• A military quarantine of some 70,000people living in the West Point
slum in Monrovia was lifted on 30 August following ten days of
confinement of the population. (OCHA - 9 SEP)
• In the capital of Guinea’s Forest Region, Nzerekore demonstrators
clashed with security forces and attacked the Regional Hospital,
reportedly after the local market was sprayed with Ebola
disinfectant.
• Seven people were killed, 21 injures, during rioting in Guinea as
members of a mission seeking to educate the population about the
Ebola virus were attacked by angry crowds in the village of Wome.
The delegation was seeking to raise awareness about the deadly viral
disease, and encountered a hostile reaction of citizens who continue
to believe that Ebola does not exist, or that it was created to
eliminate them (Bloomberg - 18 SEP) ( LA Times)
• States of emergency have been declared in Guinea, Liberia, Nigeria,
and Sierra Leone, with many affected counties under quarantine,
banning any movement. (OCHA - 9 SEP)
• Sierra Leonean authorities are planning a nationwide quarantine
from 19-21 September confining people to their homes and
subjecting them to door-to-door medical screenings. (CNN -8 SEP)
• A national curfew is imposed in Liberia, where troops this month
were given the authority to shoot upon sight anyone found crossing
into their borders from Sierra Leone. OCHA - 9 SEP)
Protesters hurl rocks at retreating soldiers and policemen amid rioting in West Point.
A Liberian soldier is deployed to restrict movement of Liberians traveling from Bomi
Country to the capital Monrovia as a measure to try to curb the spread of Ebola Photo
Ahmed Jallanzo.

SITUATION
MULTI-SECTORAL IMPACT OF THE EVD OUTBREAK
• The outbreak is proving to have a wider security, economic and livelihood
impact on all affected countries and on the West African region as a whole.
• Restrictions on movement out of, into and within affected countries have
resulted in a shortage of availability of goods and services.
• Medical goods needed to respond to the outbreak and goods to meet basic
needs (i.e. food) are in shorter supply due to transport limitations.
• Agricultural activities have been abandoned due to movement restrictions,
and prices of basic foodstuffs have already markedly increased.
• Aid workers face serious challenges entering the Ebola affected countries
due to limited flight availability. Those do manage to enter are not
guaranteed a way of exit, including in the event of a medical emergency.
This situation has hampered the recruitment of much-needed personnel.
• The EVD outbreak has disrupted the availability of non-Ebola health
services, most worryingly the treatment of endemic TB and malaria, and the
provision of obstetric care for pregnant women. In addition, all schools are
closed in Liberia and Sierra Leone and Guinea has postponed the re-opening
of schools.
• The outbreak is also negatively impacting the national economies, affecting
agriculture, trade, the financial sector, small businesses and employment,
and weakening the fiscal position of impacted governments through higher
expenditures and reduction of tax revenues.
SOUCE: OCHA – 16 SEP
A number of airlines have stopped flying into affected countries
The FAO said it had been encouraging group farming, which yields more produce than
individual subsistence farming. But with the Ebola-related ban on large gatherings, farmers
have been afraid to work in groups (USAID photo)

SITUATION
IMAPCT ON CHILDREN
• There are 2.5 million children under the age of five living in areas
affected by the Ebola virus. Children face direct risks of exposure to
the virus, as well as secondary risks as a result of loss of infected
caregivers and family members, or inability to return to their
quarantined places of origin.
• As basic service delivery becomes increasingly strained as a result of
the outbreak, children’s access to health care, education and
protection may be limited, further increasing their vulnerability and
risk. Children who have lost one or both of their parents to Ebola
face the risk of growing up without proper care or having to fend for
themselves.
• In Ebola affected areas, especially Sierra Leone and Liberia where the
outbreak is nationwide, the collapse of health care systems is
challenging the provision of maternal and new-born care and the
management of acute malnutrition.
• The disruption of health services means that many children are not
receiving life-saving vaccinations, and may be left untreated for
preventable but potentially fatal common childhood illnesses, such as
malaria, pneumonia and diarrhea.
• The Ebola outbreak is likely to have negative consequences on
children’s access to education, on the availability of teachers, and on
the quality of teaching and learning as well as on the safety of school
premises.
SOUCE: OCHA – 16 SEP
A medical worker wearing a protective suit carries bags followed by Ebola infected
children in the high-risk area of the Elwa hospital run by Medecins Sans Frontieres
Photograph: Dominique Faget/AFP/Getty

QUALITY OF CORE SERVICES
SUB NATIONAL COORDINATION
http://reliefweb.int/sites/reliefweb.int/files/resources/2014-09-15_Ebola_SNC.pdf

SAFE BURIAL
http://reliefweb.int/sites/reliefweb.int/files/resources/2014-09-15_Ebola_SB.pdf

REFERRAL CENTERS
http://reliefweb.int/sites/reliefweb.int/files/resources/2014-09-15_Ebola_RC.pdf

LABORATORIES
http://reliefweb.int/sites/reliefweb.int/files/resources/2014-09-15_Ebola_Lab.pdf

http://reliefweb.int/sites/reliefweb.int/files/resources/2014-09-15_Ebola_CT.pdf
CONTACT TRACING

SITUATION
GUINEA
WHO – 18 SEP
BACKGROUND
• Affected areas include Conakry, Coyah, Dalaba, Dubreka, Forecariah,
Gueckedou, Kerouane, Macenta, Nzerekore, Pita, Yomou. (International SOS –
16 SEP)
• As of 10th September, new confirmed cases have been reported in Conakry,
Guékedou, Macenta, Siguri, Forécariah and Kérouane. (WHO – 12 SEP)
• The confirmed totals for each prefecture are: Conakry (117 cases, 47 deaths),
Guekedou (232 cases, 182 deaths), Macenta (232 cases, 134 deaths), Dubreka
(21 cases, 4 deaths), Pita (6 cases, 2 deaths), Nzerekore (14 cases, 7 deaths),
Yomou (11 cases, 5 deaths), Forecariah (7 cases, 4 deaths), Kerouane (17
cases, 1 deaths), Coyah (6 cases, 2 deaths). (International SOS – 12 SEP)
GOVERNMENT OF GUINEA
• 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)
UNOCHA – 15 SEPT
GUINEA
CONFIRMED PROBABLE SUSPECT TOTALS
Cases 750 162 30 942
Deaths 435 161 5 601
CASE FATALITY RATE: 63.8%

SITUATION
GUINEA
CASE MANAGEMENT AND INFECTION PREVENTION AND CONTROL
• The number of newly reported cases in week 37 has not increased (there
has been a slight drop compared with the previous week. This is largely
attributable to a fall in the number of cases reported from Macenta, which
borders Gueckedou, the origin of the outbreak. Transmission in the capital
• Conakry is sustained. There is no indication of a sustained reduction in
case incidence in Guinea. (WHO – 18 SEP)
• WHO reports that approximately 33 percent of the 936 suspected,
probable, and confirmed EVD cases in Guinea were identified in the past
21 days. Of the 595 suspected EVD-related deaths in Guinea, WHO reports
that 429 have been confirmed as EVD cases as of September 13 )(USAID –
17 SEP).
• Guinea-Bissau launched a nationwide hygiene drive, cleaning and
disinfection of public places the last Saturday of every month, according
to the office of Prime Minister Domingos Simoes Pereira (30 AUG-Agence
France-Presse)
FOOD: Guinea: WFP began food distributions because of Ebola four months
ago and has reached around 40,000 people (in Biffa, Fria, Télémélé,
N’Zerekore, Macenta and Guekedo). Preparations are being made to gradually
increase distributions to 464,000 people over a period of three months. (WFP
3 SEP)
RIOTS/ DEMONSTRATIONS
• In Nzérékoré, Guinea’s second largest city, on 28 AUG, riots occurred
The cause was a rumor that officers reportedly went into the local
market to spray against Ebola.
• People panicked, looted, and attacked the Regional Hospital of
Nzérékoré. Groups of youths armed with stones, sticks and other
sharp objects chanted “Ebola, it's wrong, there is no Ebola.”
• Regional and prefectural authorities, elders, religious leaders and
local representatives of the UN system, including UNICEF, are
conducting advocacy to find lasting solutions to this situation. (29
AUG UNICEF BBC
RUMORS AND CHALLENGES
• In reluctant villages in Guékédou it was notable to see the fear
caused by the bottles of chlorine among villagers who consider the
chlorine to be poison used to introduce the virus or disease. (29 AUG
UNICEF)
• The reluctance of people makes it very difficult to undertake
interpersonal communication and sensitize community leaders.
Community sensitizers often face danger and their activities in the
field are routinely suspended. Local media is an essential compliment
in these cases, but their lack of coverage limits their actions (29 AUG
UNICEF)
RISK COMMUNICATIONS
• Community sensitization activities continue in Conakry, Nzérékoré
Macenta Yomou, Siguiri and Kouroussa continue.
• 220 new religious leaders were trained and gave sermons in 220
places of worship in Conakry and Nzérékoré; 11,050 households
we re sensitized through door to door visits and public events. This
included the distribution of 28.066 pieces of soap, chlorine 15.084
bottles, and thousands of flyers. (UNICEF 29 AUG)

SITUATION
LIBERIA
LIBERIA
CONFIRMED PROBABLE SUSPECT TOTALS
Cases 812 1233 675 2710
Deaths 631 518 310 1459
WHO – 18 SEP
CASE FATALITY RATE: 53.8%
GOVERNMENT OF LIBERIA
• Vice President Mr. Joseph Boakai officially launched the “Wash Away Ebola”
strategy, which was developed by the Ministry of Public Works together with
UNICEF, and which will guide nationwide Water, Sanitation and Hygiene
(WASH) efforts geared at stopping the spread of Ebola. (UNICEF – 10 SEP)
• The GoL recently approved an additional ETU at the Samuel K. Doe (SKD)
Stadium in Monrovia, which humanitarian actors report may be able to
accommodate up to 600 beds. The GoL approved the use of a large structure
behind SKD Stadium as a humanitarian warehouse. (USAID – 17 SEP)
• Additionally, the GoL approved the construction of up to eight additional
ETUs outside of Montserrado County by the Armed Forces of Liberia (AFL).
AFL personnel are working with CDC, USAID, DoD, Médecins Sans Frontières
(MSF), and WHO to determine ETU locations and provide design
specifications. (USAID – 17 SEP)
MINISTRY OF HEALTH AND SOCIAL WELFARE
• The Ministry of Health and Social Welfare has established hotlines that the
public can call to get basic Ebola information: 1333, 4455, 0886229641,
0886397381, and 0776547437. (International SOS – 16 SEPT)
• 15 SEP: In its latest situation report the Ministry of Health and Social Welfare
reports new suspected and probable cases in Bomi, Bong, Lofa, Margibi,
Montserrado and Nimba counties. On 11 September, there were 59 new
admissions and 230 patients receiving treatment. (International SOS – 16
SEP)
• 12 SEPT The Ministry of Health and Social Welfare in its latest Situation
Report as of 10 September confirms additional cases, deaths and contacts.
At least 539 suspected, 1080 probable and 796 confirmed cases were
reported. Most cases were detected in Lofa and Monstserrado counties. In
Bong county, the new Ebola Treatment Unit has been handed over to
health authorities. (International SOS – 16 SEP)
• The Ministry of Health and Social Welfare has set up epidemiological
surveillance for the outbreak and plans to strengthen this further with
support from Centre for Disease Control-World Health Organization. One
of the major gaps in the current response is contact tracing within all
locations.
• The Ministry of Health and Social Welfare has also reported a lack of
personal protective equipment at primary health care levels and referral
pathways as well as ambulances for the transportation of suspected cases
to isolation centers. (IFRC SEP)
Residents look on as the body of a man suspected of dying from Ebola lies in a busy street, after
it was reportedly dragged there to draw attention of burial teams following days of failed
attempts by his family to have his body picked up, in Monrovia, Liberia, Sept. 15, 2014. (TIME)

SITUATION
LIBERIA
SOURCE: UNOCHA - 15 SEPT
• 12 SEPT: Media sources report that fake death certificates mentioning non-
Ebola causes of death in Ebola victims are being issued in Liberia. Such
certificates allow family members to carry out traditional burials of the dead
bodies. Health authorities have started inspecting medical facilities to
investigate this as traditional burial practices will further spread the disease.
(International SOS – 16 SEP)
• Liberia accounts for more than half of all the ebola cases in the region
• Based on the data, the epicenter of the outbreak has shifted from Foya,
Lofa County, where the rate of reported cases appears to be lessening, to
Monrovia, Montserrado County, where the rate of reported cases is
rapidly rising. (UNICEF – 10 SEP)
• Training for the County Health Teams in infection control has commenced.
This is the first step toward reopening health facilities nationwide. (UNICEF
– 10 SEP)
• Together with the Ministry of Health and Social Welfare (MoHSW), WHO
and other key partners, UNICEF conducted a refresher Training of Trainers
(ToT) for 42 Master Trainers. These trainers will support UNICEF-funded
trainings, including trainings of over 2,000 general Community Health
Volunteers (gCHVs) in all 15 counties for their door to door messaging.
(UNICEF – 10 SEP)

SITUATION
LIBERIA
HOSPITAL RESPONSE AND ISOLATION/TREATMENT CENTERS
• As at 5 September, the country has 314 treatment beds, and WHO
estimates many more are required (additional 760 beds required in
Monrovia).
• Foya, Lofa county: Borma Hospital Ebola Treatment Unit (ETU) is being
run by Medecins Sans Frontieres (MSF) as at 15 August. It has a capacity
of 40 beds, with expansion to 80 beds underway. No date for completion
has been announced. A "mid-level isolation unit" has been established in
Telewowan Hospital, Voinjama, managed by MSF. The centre will expand
to 40 beds although no estimated date for completion has been set.
• Monrovia: ELWA hospital ETU is being run by MSF. The new 120-bed
facility opened on 17 August. There are plans to expand to 300 beds by
2nd September. The facility in JFK Hospital is functioning as a full ETU.
WHO advised on 5 September an additional 40 beds had been opened in
Monrovia. There is a Holding Unit at Redemption Hospital.
• Montserrado:West Point holding unit has been established.
• Nimba: Renovation of the holding facilties at G. W. Harley and Ganta
Hospitals is underway as at 20 August.
• Bong: The new 50 bed facility has been handed over to the County
Authority and is awaiting admissions, as at 10 September.
• Bomi: Bomi County Health Team (CHT) opened three, two-room
quarantine units with a 12-bed capacity for Ebola patients. There is a
holding centre in Tubmanburg.
SOURCE: INTERNATIONAL SOS – 16 SEP
Health workers in protective suits carried the body of an Ebola
victim in Liberia on 12 SEP

SIERRA LEONE
CONFIRMED PROBABLE SUSPECTED TOTALS
Cases 1,513 37 123 1,673
Deaths 517 34 11 562
EBOLA VIRUS DISEASE-SITUATION REPORT--UPDATE 18 SEPTEMBER 2014 CASE FATALITY RATE: 33.5%
BACKGROUND:
• 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 13 August, 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.
GOVERNMENT OF SIERRA LEONE
• On 29 August, Government of Sierra Leone (GoSL) President Ernest Bai
Koroma dismissed GoSL’s Minister of Health Miatta Kargbo, citing her
ineffective management of the ongoing EVD outbreak, according to
international media.
• Parliament in Sierra Leone has passed a law that imposes jail time (up to
two years) for concealing Ebola-infected patients. Legislation also passed
that imposes up to 6-month jail sentence to individuals entering or leaving
Ebola affected areas who are not authorized (30 AUG-ACAPS)
• From September 19 to 21, the government has a "House to House Ebola
Talk" planned, to identify cases of Ebola in the community and educate the
general public. During this time, everyone is asked to remain in their
residence, and some businesses are expected to be closed.
• Recent actions include new protocols for arrivals and departures at the
Lungi International Airport, restrictions on public and other mass gatherings,
quarantine measures for Ebola affected communities until cleared by a
medical team, authorized police and military personnel to enforce these
measures, and required local governments to establish laws to support
Ebola prevention .
SOURCE: OCHA 15 SEPT 2014
SITUATION
SIERRA LEONE
SOURCE: CDC- 13 AUG 14 International SOS 16 SEPT 2014 CDC 11 SEPT 2014

ISOLATION / TREATMENT CENTERS
• Kenema: The Red Cross isolation facility in Kenema Government
Hospital was relocated outside of the Kenema township, a few miles
from Hanga. The facility has 60 beds and was operational as of
September 12. Admissions initially staggered to keep healthcare
workers safe.
• Kailahun: There is an 80-bed facility, operated by MSF. The villages of
Koindu and Buedu have "referral units", where patients who have
symptoms of Ebola are isolated and evaluated. If they are determined
to have Ebola they are then transferred to the isolation facility.
• Freetown: An isolation unit has been established at Connaught
Hospital, with assistance from a medical team from King's Health
Partners, UK.
• Bo: MSF is constructing a 35-bed isolation centre which is expected to
be functional by 28 August. A transit centre in Gondama is run by MSF.
Construction has begun on an isolation ward at Bo government hospital.
• Port Loko: On September 12, officials announced a holding center
would be established at the St John of God Hospital and should be
“operational anytime”. The hospital reopened September 13 after a 21-
day closure.
• Western Area: A holding facility is being established in Lakka, and a
facility is being constructed in Kerry Town. Maculy Street Hospital will
be renovated to serve as an isolation unit due to the high demand for
additional beds
• Bomball: ADDAX is assisting in the construction of a holding center.
Expected completion by the first week of October.
• Ministry of Energy committed to providing electricity to EVD lab in
Lakka and Solar Street lights to Kerry Town treatment center
SITUATION
SIERRA LEONE
• Difficult to transport commodities in and out of the country due to airline
suspensions and poor road conditions worsened by the rainy season.
• Diminished food availiability and income earning opportunities is another
concern USAID 10 SEPT 2014.
LABORATORY CAPACITY
• Additional laboratory support is needed in addition to the Kenema laboratory
(supported by Metabiota and the US Department of Defense Critical Reagent
Team) to cope with the increasing disease burden. (WHO 29 AUG)
• A mobile laboratory from South Africa has been deployed to Freetown,
where Ebola treatment centers are being constructed to care for patients
locally and in better conditions, rather than referring them to Kenema. (WHO
29 AUG)
• The incidence of cases in Sierra Leone has been relatively flat, although with
increases in the past week. Problems in scaling up response measures
persist, notably in two districts, Kenema and Kailahun. Numbers of cases
increased in the capital, Freetown (WHO 29 AUG) . On September 11,
Kenemaand Kallahun centers reached maximum capacity. International SOS
16 SEPT 2014
MOST URGENT HUMANITARIAN NEEDS
In order to be more effective in the Ebola response there is a
continued urgent need for the following:
• Additional Health Workers (doctors & nurses),
• Additional Transport – Ambulances (4x4), Pick-ups (4x4),
motorcycles
• Medical supplies (including personal protective equipment),
• Continued Nation-wide community outreach/social mobilization
programs,
• Scaling-up of quality Contact Tracing
• Support to survivors & affected communities (including Family
Tracing & Reunification and PsychoSocial Support).
INTERNATIONAL RESPONSE UPDATES
• Sept 12: Cuba announces team of 165 healthcare workers to arrive in
October and stay 6 months.
• Sept 9: Britain announces new treatment center new Freetown
• Sept 16: China to dispatch mobile lab team of 59 to Chines Sierra
Leone friendship hospital
Source: International SOS 16 SEPT 2014 WHO 16 SEPT 2014 GoSL 12 SEPT 2014

RESPONSE ACTIVITIES
“ In the hardest hit countries, an exponentially rising caseload
threatens to push governments to the brink of state failure. WHO has
successfully managed many big outbreaks in recent years. But this
Ebola event is different. Very different This is likely the greatest
peacetime challenge that the United Nations and its agencies have
ever faced.
None of us experienced in containing outbreaks has ever seen, in our
lifetimes, an emergency on this scale, with this degree of suffering,
and with this magnitude of cascading consequences.
This is not just an outbreak. This is not just a public health crisis. This
is a social crisis, a humanitarian crisis, crisis, an economic crisis, and a
threat to national security well beyond the outbreak zones.
In some areas, hunger, hunger has become an even greater concern
than the virus.
For example, the fertile fields of Lofa County, once Liberia’s
breadbasket, are now fallow. In that county alone, nearly 170 farmers
and their family members have died from Ebola.
Dr Margaret Chan
Director-General of the World Health Organization
Address to emergency session of the UN Security Council
Peace and security in Africa (Ebola)
New York, USA
18 September 2014
CURRENT RESPONSE STATUS
BEDS
• There are still critical shortages of Ebola treatment center beds in Guinea, Liberia,
and Sierra Leone, the three countries that have intense and widespread
transmission.
• In the past week, an additional 40 beds have been established by Médecins Sans
Frontières (MSF) in Monrovia; a further 40 beds will soon be available in Bong,
Liberia.
• Another 170 beds are expected to be available soon in Sierra Leone.
• Based on current capacity and needs, an additional 980 Ebola treatment center
beds are required, with 760 of these in Monrovia alone. Although plans are in place
to build such facilities, there is a critical shortage of clinical teams available to
manage them.
LABORATORY CAPACITY
• Laboratory capacity is gradually expanding; however, there are still critical needs in a
number of locations.
• Increased laboratory capacity is essential for proper screening and triage of patients.
CONTACT TRACING AND SAFE BURIALS
• Contact tracing and safe burials continue to be of concern in light of increasing cases
and deaths. Of particular concern is the safety of community burials and mass
cremation. MSF is putting in place increased capacity for cremation services in
Monrovia.
SOCIAL MOBILIZATION
• Responsible agencies are rapidly improving the coordination and scale of social
mobilization efforts in affected countries.
• National Social Mobilization Task Forces have been established, additional human
resources are being identified and deployed.
• Additional work is needed to ensure the quality of social mobilization national and
sub-national plans and efforts at district level are coordinated with the overall
response.
MOBILIZATION
• The US, UK, China, Cuba and other countries are using a variety of assets, including
military assets
SOURCE : WHO – 18 SEP

RESPONSE ACTIVITIES
UNITED NATIONS
18 September 2014 – The Security Council, in its first emergency meeting on a
public health crisis, declared the Ebola outbreak in West Africa a threat to peace
and security.
Secretary-General Ban Ki-moon announced that the United Nations will deploy a
new emergency health mission to combat one of most horrific diseases on the
planet that has shattered the lives of millions.
The international mission, to be known as the United Nations Mission
for Ebola Emergency Response, or UNMEER, will have five priorities: stopping the
outbreak, treating the infected, ensuring essential services, preserving stability
and preventing further outbreaks.
Under the leadership of a Special Representative of the Secretary-General, the
Mission will bring together the full range of UN actors and expertise in support of
national effort.
The mission’s effectiveness will depend crucially on support from the international
community. (UN NEWS CENTER – 18 SEP)
History was made on Thursday as the Security Council
unanimously adopted a resolution, sponsored by 131
countries – reportedly more than any other sponsors of a
resolution to date – the resolution calls countries to
provide health personnel and supplies, and declared that
the outbreak was a threat to international peace and
security.
U.N. Secretary-General Ban Ki-moon speaks during a U.N. Security Council
meeting about the Ebola epidemic in West Africa at U.N. headquarters in New
York City on Sept. 18, 2014 (TIME)

RESPONSE ACTIVITIES
WORLD HEALTH ORGANIZATION
WHO is initiating the disbursement of the African Development
Bank grant provided for the EVD outbreak response. The first
tranche, totaling US$ 37.5 million, will mainly support laboratories,
procurement of personal protective equipment, medical waste
management, IT software for emergency alert and response, health
information management systems, training and deployment of
health personnel, rehabilitation and isolation units.
WHO has disbursed a total of US$ 756 130 from the accounts of the
African Public Health Emergency Fund (APHEF) to support
Democratic Republic of the Congo, Guinea, Liberia and Sierra Leone
in their fight against Ebola.. (WHO – 12 SEP)
Increases in demand for Ebola Treatment Centre (ETC) beds and
referral unit places are continuing to outstrip capacity in Guinea,
Liberia, and Sierra Leone. WHO continues to mobilize partners in
response to these needs. (WHO - 12 SEP)
• 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
o 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.
o 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.
Image Source: WHO – 17 SEP

RESPONSE ACTIVITIES
WORLD FOOD PROGRAM
WFP’s response is targeting up to 1.3 million people in Guinea, Liberia and Sierra
Leone. WFP is deploying 50 additional staff across the three affected countries,
while the United Nations Humanitarian Air Service, managed by WFP, has
deployed a 19-seat airplane and a helicopter to allow vital access for humanitarian
personnel and the cargo delivery to the three affected countries. (WHO - 12 SEP)
The U.N. World Food Program (WFP) reports that food prices have risen along the
borders of Guinea and Senegal since the start of the EVD outbreak. In particular,
palm oil prices have increased by 40 percent and coffee prices have
increased by 50 percent since mid-August. WFP also notes that traders have
reported a 50 percent drop in market activities (USAID - 17 SEP)
To date, in the three most affected countries of Liberia, Guinea and Sierra Leone:
3,000 mt of food delivered for 147,500 people since April 2014;
290 responders transported by UNHAS, with 2 planes and 1 helicopter in
operation; and 400 m3 of medical cargo transported.
• Guinea: WFP in Guinea aims to deliver food and nutrition packages to 464,000
people over a period of three months . In cooperation with FAO, the Ministry
of Agriculture, and the Ministry of Livestock, WFP is preparing a rapid
assessment on the impact of the outbreak on food security.
• Liberia: WFP in Liberia is scaling up operations in response to the Ebola
outbreak. WFP will provide food to 449,000 people in areas of widespread and
intense transmission. All the 15 counties are targeted, with seven initially
prioritized (Lofa, Monteserrado, Nimba, Margibi, Bomi, Bong, and Grant Bassa
Counties).
• Sierra Leone: WFP’s immediate priorities are the provision of food to: ebola
treatment centers; the most vulnerable areas of Freetown; and the priority
epicentre areas of Kenema and Kailaian. WFP is currently targeting 400,000
people in Sierra Leone. WFP is preparing to distribute 5,000 food parcels as
take-home rations for people suspected of having ebola who have to stay at
home for 21 days. (WFP – 15 SEP)
Food distribution in Monrovia, Liberia (WFP)
The U.N. World Food Program (WFP) reports that food prices have risen
along the borders of Guinea and Senegal since the start of the EVD
outbreak. In particular, palm oil prices have increased by 40 percent and
coffee prices have increased by 50 percent since mid-August. WFP also
notes that traders have reported a 50 percent drop in market
activities.
The Famine Early Warning Systems Network (FEWS NET) predicts that
between September 2014 and March 2015, Stressed—IPC 2—food
insecurity or higher is expected for at least 20 percent of the
population in EVD-affected areas of Sierra Leone and Liberia.
A smaller proportion of the population is expected to face illness and
market disruptions in Guinea, where Minimal—IPC 1—acute food
insecurity is expected.
FEWS NET predicts that food insecurity will likely particularly affect
households with ill family members and the urban poor.

RESPONSE ACTIVITIES
UNITED NATIONS CHILDREN'S FUND
UNICEF:
• UNICEF is appealing for US$200 million to respond to the Ebola outbreak
in West Africa. Of the $200 million, nearly $65 million will go to UNICEF’s
programs in Liberia, around $61 million to Sierra Leone and more than
$55 million to Guinea. An additional $10 million will help neighboring
countries be prepared for a potential spread of the disease within their
borders. The remaining $9 million are required for regional coordination
efforts. (UNICEF – 16 SEP)
• UNICEF has delivered 402 metric tons of essential medicine and protective
equipment to the three major Ebola-affected countries in 32 shipments
since early August. Of the total, 70.6 MT were flown in to Guinea, 213.8
MT to Liberia and 117.7 MT to Sierra Leone. (UNICEF – 5 SEP)
• In Liberia, Vice President Mr. Joseph Boakai officially launched the “Wash
Away Ebola” strategy, which was developed by the Ministry of Public
Works together with UNICEF, and which will guide nationwide Water,
Sanitation and Hygiene (WASH) efforts geared at stopping the spread of
Ebola.
• In Liberia, together with the Ministry of Health and Social Welfare
(MoHSW), WHO and other key partners, UNICEF conducted a refresher
Training of Trainers (ToT). These trainers will support UNICEF-funded
trainings, including trainings of over 2,000 general Community Health
Volunteers in all 15 counties for their door to door messaging. (UNICEF –
10 SEP)
• On September 17, USAID/OFDA contributed $2.2 million to UNICEF
to procure and distribute 50,000 household protection kits in Liberia.
In response to the current shortage of EVD treatment facilities in
Liberia,
• UNICEF plans to distribute household protection kits to people who
exhibit EVD symptoms but do not have access to ETU care.
• UNICEF is training ETU staff, contact tracers, and case investigation
teams to distribute the kits and train recipients to properly use them
to minimize the risks of EVD transmission for home-based patients.
Each household protection kits contains a bucket, a sprayer, garbage
bags, gloves, protective gowns, surgical makes, soap, and chlorine.

RESPONSE ACTIVITIES
US GOVERNMENT
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.
• On August 15. U.S. Chargé d’Affaires Ervin Massinga declared a disaster due to
the magnitude of the EVD outbreak in Guinea
• The U.S. Government (USG) has launched a whole-of-government response to the EVD
outbreak in West Africa, including increased involvement from the U.S. military.
• On September 16, President Obama announced that an estimated 3,000 U.S. troops
plan to deploy to provide logistics support, construct EVD treatment units (ETUs), and
train health care workers. Additionally, the U.S. Public Health Service Commissioned
Corps plans to deploy health care workers to West Africa. (USAID -17 SEP)
• The Ebola epidemic in West Africa and the humanitarian crisis there is a top national
security priority for the United States. In order to contain and combat it, the US is
partnering with the United Nations and other international partners to help the
Governments of Guinea, Liberia, Sierra Leone, Nigeria, and Senegal respond just as the
US fortify its defenses at home. (WHITE HOUSE - 16 SEP)
• The US Strategy is predicated on four goals:
o Controlling the epidemic at its source in West Africa;
o Mitigating second-order impacts, including blunting the economic, social, and
political tolls in the region;
o Engaging and coordinating with a broader global audience; and,
o Fortifying global health security infrastructure in the region and beyond.
Liberian Red Cross distributes food provided by USAID to
Monrovia's West Point neighborhood. (Liberian Red Ross)
• The President also announced the launch of our Community Care
Campaign, which will ensure that every family and every
community gets the support they need to protect themselves
from this deadly virus.
• Partnering with the affected countries, the U.N. Children’s Fund
(UNICEF), the Paul G. Allen Family Foundation, and organizations
on the ground, USAID will initially target 400,000 of the highest
risk households in Liberia with vital training and important
tools—soap, chlorine, and protective equipment.
• Working alongside the Paul G. Allen Foundation, the US will
airlift 50,000 USAID-funded home healthcare kits this week to be
delivered to some of the most isolated and vulnerable
communities in Liberia.
TESTIMONY OF ASSISTANT ADMINISTRATOR FOR DEMOCRACY, CONFLICT AND HUMANITARIAN ASSISTANCE NANCY
LINDBORG BEFORE THE HOUSE SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH, GLOBAL HUMAN RIGHTS AND
INTERNATIONAL ORGANIZATIONS

USG PROGRAMS FOR EBOLA OUTBREAK IN WEST AFRICA
USAID 17 SEPT 2014

RESPONSE ACTIVITIES
US AGENCY FOR INTERNATIONAL DEVELOPMENT
USAID DART
• The USAID-led Disaster Assistance Response Team (DART)—comprising
disaster response and public health experts from USAID/OFDA, CDC, the US
Forest Service, 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.
• The DART team’s medical component, led by CDC, is supporting Ebola
treatment units that help isolate and treat those affected by the disease,
helping minimize the further spread of Ebola. CDC specialists across the
region are assisting with contact tracing, database management, and health
education. These experts are also providing technical guidance to the
national public health agencies in the region to help prevent, detect, and
stop the spread of the virus.
• The Department of Defense is working to upgrade laboratory testing facilities
to help quickly detect the disease.
• Days after the DART deployed to the region in early August, the US began
airlifting urgent medical supplies and emergency equipment to West Africa.
This includes 10,000 sets of personal protective equipment to safeguard
health workers—with an additional 130,000 being delivered in the coming
weeks. Two portable water storage tanks and two water treatment systems;
40 tons of chlorine; 250 rolls of plastic sheeting to help bolster infrastructure
at the Ebola treatment units; 5,000 body bags to increase support for the
safe and dignified removal and transport of the bodies of Ebola victims; and
500 infrared thermometers to boost Ebola screening efforts.
• To ensure these critical supplies are reaching the affected countries, USAID is
supporting the UN Humanitarian Air Service, which is operating flights in and
out of Guinea, Liberia, and Sierra Leone, ensuring that personnel and medical
equipment are getting to areas of need despite commercial flight limitations.
TESTIMONY OF ASSISTANT ADMINISTRATOR FOR DEMOCRACY, CONFLICT AND HUMANITARIAN
ASSISTANCE NANCY LINDBORG BEFORE THE HOUSE SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH,
GLOBAL HUMAN RIGHTS AND INTERNATIONAL ORGANIZATIONS
A team of U.S. experts from CDC, the U.S. Army Medical
Research Institutes for Infectious Diseases (AMRIID), and the
U.S. National Institutes of Health has almost doubled LIBR’s
Ebola specimen testing capacity by training local staff and
bringing in more equipment. Photo credit: Carol Han,
USAID/OFDA

RESPONSE ACTIVITIES
US CENTER FOR DISEASE CONRTOL
CDC’s response to Ebola is the largest international outbreak response in
CDC’s history. As of 16 SEP 2014, CDC has more than 100 disease
detectives on the ground in West Africa, supported by hundreds of public
health emergency response experts stateside. CDC teams are deployed
from the CDC 24/7 Emergency Operations Center (EOC), activated at Level
1, its highest level, because of the significance of this outbreak. Each team is
flexibly composed to match talents and expertise with critical needs in
country:
• CDC’s disease detectives find emerging cases to identify contacts and
stop further transmission with isolation and improved infection control
practices
• CDC’s lab scientists diagnose Ebola cases and crack Ebola virus DNA
codes to map outbreak connections
• Outbreak control specialists find patterns of spread and population
vulnerabilities so scarce resources can be deployed more efficiently
• CDC’s Ebola outbreak veterans lead with expert guidance to national and
international counterparts and new recruits in the Ebola fight
• Health risk communication specialists fight rumors, stigmatization and
unsafe practices in real time
• Emergency operations teams bring incident management expertise to
organize complex efforts.
ESTABLISHING EMERGENCY OPERATIONS CENTERS (EOCS). CDC supports
countries establish national and sub-national EOCs. All 3 West African
countries at the center of the epidemic now have an Incident Manager,
reporting to the President of the country, to lead efforts.
STRENGTHENING SURVEILLANCE AND EPIDEMIOLOGY. CDC helps
countries track the epidemic, including using real-time data to improve real-time
response (e.g., identifying the epicenter and tracking the response).
IMPROVING CASE FINDING AND CONTACT TRACING. CDC strengthens
efforts in West Africa to investigate cases and track their contacts. CDC
helps interview people who may have been in contact with Ebola patients
to see if they have symptoms and monitor them for 21 days. A single missed
contact can start another chain of transmission.
SUPPORTING LABORATORY NETWORKS. CDC is operating and supporting labs in the
region to improve diagnosis. CDC is also testing samples from people with suspected
Ebola from around the world, and, with Department of Defense support, helped 12
labs around the US gain the capacity to test for Ebola within hours.
STRENGTHENING HEALTH CARE SYSTEMS. CDC leads infection control training for
health care workers and safe patient triage throughout the health care system,
communities, and households.
IMPROVING HEALTH COMMUNICATION. CDC health communicators and public
health advisors in Sierra Leone, Guinea, and Liberia are working with country
embassies, UNICEF, WHO, MSF, other NGOs and Ministries of Health to improve
health information.
COORDINATING WITH PARTNERS AND FACILITATING INVOLVEMENT BY PUBLIC
HEALTH ORGANIZATIONS AROUND THE WORLD. CDC is working closely with
USAID’s Office of Foreign Disaster Assistance, to support the deployment of a
Disaster Assistance Response Team. CDC is also facilitating assistance by critical
organizations such as the African Union, which will mobilize at least 150 staff
(including doctors, nurses, epidemiologists and health educators) to support the
response. CDC also works closely with non-governmental organizations on many
aspects of the response.
ADVISING TRAVELERS ON HOW TO PROTECT THEIR HEALTH AND PREVENTING SICK
TRAVELERS FROM GETTING ON PLANES. CDC works with airlines, airports, and
Ministries of Health to provide technical assistance for exit screening and travel
restrictions in affected areas to prevent sick travelers from getting on planes. CDC
also works with airlines to address crew and airline staff concerns while ensuring
that humanitarian and public health organizations can still travel to affected
countries.
SOURCE: CDC EBOLA SURGE – 16 SEP

RESPONSE ACTIVITIES
FOOD AND DRUG ADMINSTRATION
FDA has a critical role in helping to facilitate the development, manufacturing, and
availability of investigational products for use against Ebola virus disease.
FDA is actively working to facilitate development of treatments and vaccines with
the potential to help mitigate this epidemic. They are providing scientific and
regulatory advice to U.S. government agencies that support medical product
development, including the National Institute of Allergy and Infectious
Diseases (NIAID) at the National Institutes of Health (NIH), the Biomedical
Advanced Research and Development Authority (BARDA), and the U.S. Department
of Defense (DoD), to help speed development and production programs.
September 4, 2014 – The largest, most severe and most complex outbreak of Ebola
virus disease in history is highlighting the absence of authorized medicines to treat or
prevent this terrible disease affecting people in a number of countries in West Africa.
In the face of this outbreak, medicines regulators worldwide have committed to
enhanced cooperation with the World Health Organization (WHO) and between
regulatory agencies to encourage submission of regulatory dossiers and evaluation
of the submitted information on potential new medicines. The aim is to accelerate
access to investigational treatments for patients most in need during the current
outbreak. The enhanced cooperation also aims to ensure that in the future, public
health authorities in countries affected by Ebola have safe and efficacious medicines
at their disposal, and so strengthen their ability to respond effectively to outbreaks
and to save lives. This pledge was made by members of an interim International
Coalition of Medicines Regulatory Authorities (ICMRA). Read the full statement
August 25, 2014 – FDA and the World Health Organization Department of Essential
Medicines and Health Products (WHO EMP) have signed an agreement (PDF, 550
KB) to help facilitate communications between FDA and WHO EMP regarding an
actual or potential public health crisis or public health emergency of international
concern, such as the Ebola outbreak in West Africa. The agreement allows sharing of
information that is non-public but important to address public health emergencies
between the organizations. More information about FDA’s international
arrangements
August 22, 2014 – FDA Voice blog post: FDA works to mitigate the West
Africa Ebola outbreak - The world is witnessing the devastating effects of the
Ebola virus outbreak in West Africa, the worst Ebola outbreak in recorded
history. We at FDA are dedicated to helping end this outbreak as quickly as
possible, and to help prevent future outbreaks like this. Read more
August 20, 2014 – Responding to Ebola: The View From the FDA - As part of
FDA's expert commentary and interview series, Medscape spoke with FDA
Acting Deputy Chief Scientist and Assistant Commissioner for
Counterterrorism Policy Luciana Borio, MD, about the issue of compassionate
use and FDA efforts to respond to the Ebola outbreak.
August 14, 2014 – FDA statement: FDA is advising consumers to be aware of
products sold online claiming to prevent or treat the Ebola virus. Since the
outbreak of the Ebola virus in West Africa, the FDA has seen and received
consumer complaints about a variety of products claiming to either prevent
the Ebola virus or treat the infection.
Español - La FDA advierte a los consumidores contra productos para el
tratamiento del ébola fraudulentos
Français - La FDA met en garde les consommateurs contre les produits
frauduleux de traitement contre l’Ebola
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 and September 17, 2014 Federal Register
notice: Authorization of Emergency Use of an In Vitro Diagnostic Device for
Detection of Ebola Zaire Virus)

RESPONSE ACTIVITIES
US DEPARTMENT OF DEFENSE – OPERATION UNITED ASSITANCE
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)
• DoD has provided more than 10,000 Ebola test kits to the
Liberian Institute of Biological Research and the Kenema
Government Hospital in Sierra Leone. They have also provided
personal protective equipment, have trained local professionals,
and plan to send a field-deployable hospital to Liberia.
• Requested $500 million in FY 2014 Overseas Contingency
Operations funds, a portion of which will be used for military air
transport of DoD and non-DoD isolation units, personnel,
supplies PPE, logistics and engineering support, and experts in
sanitation and mortuary affairs. (WHITE HOUSE - 16 SEP)
U.S. AFRICA COMMAND – OPERATION UNITED ASSITANCE
• U.S. Africa Command will set up a Joint Force Command headquartered in Monrovia, Liberia, to provide regional command and control support to U.S. military
activities and facilitate coordination with U.S. government and international relief efforts. Major General Darryl A. Williams , Commander, U.S. Army Africa, will
lead this effort, which will involve an estimated 3,000 U.S. forces.
• U.S. Africa Command will establish a regional intermediate staging base (ISB) to facilitate and expedite the transportation of equipment, supplies and personnel.
Of the U.S. forces taking part in this response, many will be stationed at the ISB
• Command engineers will build additional Ebola Treatment Units in affected areas, and the U.S. Government will help recruit and organize medical personnel to
staff them.
• Additionally, the Command will establish a site to train up to 500 health care providers per week, enabling healthcare workers to safely provide direct medical
care to patients.
• The United States Public Health Service Commissioned Corps is preparing to deploy 65 Commissioned Corps officers to Liberia to manage and staff a previously
announced DoD hospital to care for healthcare workers who become ill. The deployment roster will consist of administrators, clinicians, and support staff.
SOURCE: WHITE HOUSE - 16 SEP
Major General Darryl A. Williams and members of his staffed arrived in Liberia on Tuesday, 16
SEP to begin the process of building a Combined Joint Task Force (CJTF) to combat Ebola and
coordinating efforts in the region

RESPONSE ACTIVITIES
EUROPEAN UNION
EUROPEAN COMMISSION HUMANITARIAN AID (ECHO):
• In a statement on 17 September, the EU Commissioner for International
Cooperation, Humanitarian Aid and Crisis Response emphasized that,
beyond funding, “what is needed now is personnel, equipment, and
transport.” To that end, the EU has deployed three mobile laboratories to
help with testing and identifying the virus, and ECHO has put a health
expert in each of the three most-affected countries, as well as the United
Nations Disaster Assessment and Coordination (UNDAC), and the
European Response Coordination Center (ERCC) in Brussels is coordinating
intra-EU meetings in response to the crisis.
• The EU Commissioner also emphasized the importance of being able to
transport supplies, equipment and humanitarian personnel into and out of
the region, and is working to develop a European coordination system for
medical evacuation of humanitarian workers. (ECHO – 17 SEP)
• The European Mobile Laboratory (EMlab) project has deployed a third
mobile laboratory to Liberia. The laboratory is being set up and should be
providing diagnostic services soon. Supply chain is being set up to ensure
replenishment for supplies at laboratories in Guinea, Nigeria and Liberia.
(EMLab – 10 SEP) EMLab deployed its ninth medical team to Guéckédou,
Guinea, made up of colleagues from Public Health England, the Robert
Koch Institute in Germany and the Heinrich Pette Institute in Germany.
(EMLab – 10 SEP)
FRANCE:
• France is mobilizing approximately 20 reserve personnel from its Health
Emergency Preparedness and Response Agency who will work on a
rotating basis over the next three months in Guinea. (France – 4 SEP)
• France will set up a military hospital in Guinea to fight the Ebola outbreak.
(ReliefWeb – 18 SEP)
ITALY:
• The National Institute for Infectious Disease “Lazzaro Spollanzani” and the
Italian Ministry of Foreign Affairs and Cooperation are dispatching a mobile
laboratory team of four to the MSF Ebola Treatment Center in Foya, Lofa
County, Liberia. (Liberia MOFA – 8 SEP)
UNITED KINGDOM:
• The UK’S Foreign Secretary announced a commitment to provide an
additional 700 treatment beds in Sierra Leone, more than 200 of
which are already in the pipeline, with 500 to be delivered in the
coming months. UK Armed Forces will provide logistical support in
planning, delivering and constructing sites for the additional sites. The
UK will work with partners to provide trained staff to operate the
treatment centers. (UK – 17 SEP)
• The UK’s Department for International Development (DFID) and
Ministry of Defense, in partnership with Save the Children, will be
establishing a medical treatment center for Ebola victims in Sierra
Leone. The facility will have a 50-bed medical unit to treat victims of
Ebola, as well as an additional 12-bed treatment center for local and
international medical workers, and should be operational within the
next eight weeks. (UK – 11 SEP)
• The UK government has called on medical, logistics and WASH
practitioners to sign up for the UK International Emergency Medical
Register. (UK – 8 SEP)
• In addition to its call for global research on improved management of
Ebola outbreaks, the UK, working with Wellcome Trust and Medical
Research Council, has co-funded clinical trials of vaccines and has
approved GlaxoSmithKline to manufacture additional doses of the
vaccine so that, if the trials are successful, the the stocks can be made
available for emergency vaccination of at risk communities. (UK – 11
SEP)
GERMANY:
• Germany’s Bernard Nocht Institute for Tropical Medicine (BNI) has
been working on Ebola diagnosis in Guinea since the start of the crisis,
with support from the German Federal Foreign Office. (Germany – 17
SEP)
• German medical and pharmaceutical company, B. Braun Melsungen
AG, donated 50,000 pieces of gloves to the Liberian government.
(Liberia MOFA – 11 SEP)

RESPONSE ACTIVITIES
OTHER COUNTRIES
CUBA
Cuba confirmed the sending of 165 health workers to Sierra Leone to help fight
the Ebola outbreak during a United Nations Security Council emergency meeting
on Thursday. The Cuban health workers going to Sierra Leone are part of the
International Henry Reeve Contingent, a special medical force created in Cuba in
2005 in order to fight health and humanitarian emergencies all over the world.
JAPAN:
• Japan sent $288,000 worth of equipment to Liberia, including 100 tents, 500
sleeping pads, 500 blankets, 25 generators, 30 water storage tanks and 500
water containers. The supplies will support medical facilities in Montserrado,
Bong and Lofa counties. (Liberia MOFA – 2 SEP)
CHINA:
• China chartered two planes to deliver a China Center for Disease Control and
Prevention laboratory team and a mobile laboratory to Sierra Leone. The
team includes 29 medical experts from the China CDC and 30 doctors and
nurses from the Military Hospital of China. The team will run a holding center
at the Sierra Leone – China Friendship Hospital for six months. This is China’s
third delivery of emergency medical materials, and its third team of medical
experts to Sierra Leone. (China – 18 SEP)
GHANA:
• Ghana has begun airlifting approximately 100 tons of humanitarian food
supplies to Guinea, Liberia and Sierra Leone, including rice, oil and milk to
help feed people in Ebola treatment centers. (Ghana – 15 SEP) The Ghanaian
government has also agreed to Accra being used as a logistical hub in the
region for the UN and other international organizations. (Ghana – 29 AUG)
MALAYSIA:
• The government of Malaysia has coordinated with private sector companies
to contribute 20.9 million medical rubber gloves in eleven containers to West
African Countries. Guinea, Liberia and Sierra Leone will each receive three
containers, and DRC and Nigeria will each receive one container. (Malaysia –
15 SEP)
AFRICAN UNION:
• The African Union Support to Ebola in West Africa (ASEOWA) is sending a team
of 30 volunteer health workers and specialists to work in Liberia after
undergoing pre-deployment briefings in Addis Ababa. The epidemiologists,
clinicians, public health specialists and communications personnel come from
Uganda, Rwanda, DRC, Nigeria and Ethiopia. A second group of volunteers is
expected to be deployed to Sierra Leone soon. (AU – 15 SEP)
ECONOMIC COMMUNITY OF WEST AFRICAN STATES (ECOWAS):
• The ECOWAS Committee of Chiefs of Defense Staff (CCDS) has pledged the
support of the militaries of various member states in response to the Ebola
outbreak in the region. (ECOWAS – 14 SEP)
SWITZERLAND:
• Swiss Humanitarian Aid sent 14 tons of medical supplies to Monrovia, Liberia
at the beginning of September, including 31,000 bottles of hand disinfectant,
300,000 protective gloves, 100,000 masks, 200 body bags, 6,840 intravenous
drips and 3,000 rehydration solutions. (Switzerland – 12 SEP)
• The Swiss Agency for Development and Cooperation (SDC) and the University
Hospitals of Geneva sent a joint needs assessment team to West Africa, and
the results of the mission are currently being analyzed. (Switzerland – 12 SEP)
• Clinical trials of two experimental Ebola vaccines are expected to begin in
Switzerland, according to the Tropical and Public Health Institute. 100 people
are set to take part in the tests. (ReliefWeb – 19 SEP)
CANADA:
• Canada has committed to donating $2.5million worth of personal protective
equipment to WHO from its National Emergency Strategic Stockpile (NESS) and
Health Canada’s First Nation and Inuit Health Branch (FNIHB). Canada is also
operating a mobile laboratory unit in Sierra Leone. (Canada – 15 SEP)

HEALTHCARE WORKERS
• Infections among healthcare workers continue to be a concern. As of 12 September 2014, 301
healthcare workers have developed the disease, almost half of whom have died. (OCHA - 16 SEPT)
• There remains a big concern regarding the lack of specialized staff, including doctors and nurses
throughout the affected areas.
HOW CAN HEALTHCARE WORKERS DECREASE THE CHANCE OF INFECTION?
• Wear the right personal protective equipment, including but not limited to masks, gloves, gowns,
and eye protection, when entering patient care areas.
• Use proper infection prevention and control measures including:
• Follow cleaning and disinfection recommendations of reusable medical equipment, proper
disposal of needles and other disposable equipment, and proper disposal of patient
excretions.
• Wash your hands often, using soap and water (or alcohol-based hand sanitizers when soap
and water are not available) to remove potentially infectious materials from your skin and
help prevent disease transmission.
• Do not reuse gloves; instead dispose of them according to recommended infection control
precautions. After disposing of the gloves, wash your hands.
• Learn the signs and symptoms of Ebola and develop a triage system so Ebola patients can be
identified and properly handled.
• Avoid direct, unprotected contact with the bodies of people who have died from Ebola
• Several infectious diseases endemic in the region, like malaria, typhoid fever, and Lassa fever, mimic
the initial symptoms of Ebola virus disease. It is important to be aware of the similarities and
differences they present.
• As part of a comprehensive and coordinated response, the CDC is developing an introductory
training course for licensed clinicians intending to work in an Ebola Treatment Unit (ETU) in Africa.
This will be a 3-day course held weekly beginning in October in the United States. (CDC - 11 SEPT)
• The high proportion of medical staff that
has become infected can be attributed
to factors such as shortages of personal
protective equipment and/or improper
use of protective equipment, insufficient
numbers of medical staff to handle
patients, and exhaustion of current
medical staff.
• An estimated 2% of the entire Liberian
healthcare workforce has been infected.
This is primarily due to the lack of access
to Ebola Treatment Units (ETUs). (OCHA -
16 SEPT)
• Due to the lack of ETUs, infected
individuals are seeking care from under-resourced
private health care facilities,
creating increased risk of infection for
health care workers in those facilities.
• The CDC is educating U.S. health care
providers to consider Ebola if symptoms
are present within 3 weeks of a traveler
returning from West Africa. The CDC is
also issuing infection control guidance
for hospitals to prevent further spread to
health care workers and communities
• Instances of civil unrest and violence
against aid workers have been reported
in West Africa as a result of the
outbreak. The public health systems in
the affected countries are being severely
strained as the outbreak grows.

HEALTHCARE WORKERS
UPDATES ON HCW CONDITIONS
Both foreign and local health care workers have been affected as this continues to
be a global fight. MSF has 1,800 HCWs working on Ebola in Guinea, Sierra Leone,
Liberia and Nigeria. Of those, 184 are foreign volunteers. WHO has both foreign
and local people on the ground and the U.S. CDC has more than 100 disease
detectives on the ground.
GUINEA
• The bodies of eight officials and journalists who went to a remote village in
Guinea to dispel rumors about the deadly Ebola outbreak gripping the
region were discovered after a rock-hurling mob attacked the delegation,
claiming that it had come to spread the illness. (NYT- 18 SEP)
• Nurses told the press they lacked basic medical equipment to treat
patients. Cases are being reported in new districts towards Guinea Bissau
that are exacerbating already stressed resources. (ReliefWeb - 17 SEP)
LIBERIA
• The ELWA3 Ebola treatment centre in Monrovia will not be accepting any
new patients until investigations are complete into how a French nurse
volunteering with MSF became infected. (INTERNATIONALSOS - 17 SEP)
• As the Ebola death toll mounts, burial teams are having to contend with
physical risk and trauma as they take charge of safely burying the dead.
Due to increasing violence and risk of physical harm, police now escort
burial teams. (ReliefWeb - 12 SEPT)
SIERRA LEONE--The International Federation of Red Cross and Red Crescent
Societies (IFRC) has opened a treatment center in Kenema.
(INTERNATIONALSOS - 16 SEPT)
A health worker brings a woman suspected of having
contracted the Ebola virus to an ambulance in
Monrovia, Liberia, on September 15, 2014. Photo
Credit: James Giahyue Reuters
A team of specialized officers from the U.S. Public
Health Service Commissioned Corps is being
prepared to deploy to manage and staff a previously
announced U.S. Department of Defense hospital in
Liberia to care for health care workers who become
ill from Ebola. This includes 65 Commissioned Corps
officers, with diverse clinical and public health
backgrounds. (HHS - 16 SEPT)

HEALTHCARE WORKERS
The above table indicates the total number of probable, confirmed, and suspected cases in
healthcare workers in Guinea, Liberia, and Sierra Leone as of 14 September 2014
(WHO Ebola Roadmap Report 6 – 18 SEP)
DEATHS and NEW INFECTIONS
AMONG HCWs
• A French MSF staff member in
Liberia has tested positive for
Ebola. The MSF staff member
was on assignment in Monrovia
and was placed in isolation on
16 September. It is unclear at
this time how she contracted
the disease. According to MSF
protocol, she will be transferred
to a treatment center in France.
(ReliefWeb - 17 SEPT)
• The CDC returned a staff
member from West Africa by
charter flight after the employee
had low-risk contact with an
international health worker who
recently tested positive for
Ebola. The CDC staff member is
not sick and does not currently
show symptoms of Ebola. (CDC -
17 SEPT)
• A medical team from
International SOS evacuated two
Dutch doctors with possible
exposure to the Ebola virus from
Sierra Leone on 14 September.
They were not exhibiting any
symptoms at the time of
removal. (INTERNATIONALSOS -
15 SEPT)

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 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.

VACCINE DEVELOPMENTS
There are currently no FDA approved vaccines for Ebola. The NIH's National Institute of Allergy and
Infectious Diseases is working on developing an Ebola vaccine. NIH recently announced they are
expediting their work, and has launched PHASE 1 clinical trials . The early-stage trial will begin initial
human testing of a vaccine co-developed by NIAID and GlaxoSmithKline (GSK) and will evaluate the
experimental vaccine’s safety and ability to generate an immune system response in healthy adults. The
study is the first of several Phase 1 clinical trials that will examine the investigational NIAID/GSK Ebola
vaccine and an experimental Ebola vaccine developed by the Public Health Agency of Canada and
licensed to NewLink Genetics Corp. The study is the first of several Phase 1 clinical trials that will
examine the investigational NIAID/GSK Ebola vaccine and an experimental Ebola vaccine developed by
the Public Health Agency of Canada and licensed to NewLink Genetics Corp. (CDC)
Testing in humans for a vaccine against Ebola has begun in the UK. In an
unprecedented move, the untested vaccine has already gone into mass
production. Some 10,000 doses are being manufactured by the British drug
company GlaxoSmithKline, funded by the Wellcome Trust and the UK
government, which are also supporting the Oxford trial. (17 SEP)
The candidate vaccine is against the Zaire species of Ebola - the one
circulating in West Africa - and uses a single Ebola virus protein to generate
an immune response. As it does not contain infectious virus material, it
cannot cause a person who is vaccinated to become infected with Ebola.
Pre-clinical research by the NIH and Okairos, a biotechnology company
acquired last year by GSK, has indicated that it provides promising
protection in non-human primates exposed to Ebola, without significant
adverse effects.
PHASE I:
• Phase I of the clinical trial will take place in the U.S. at the NIH Clinical Center in
Bethesda, Maryland, and will involve 20 healthy human adults. Researchers
will be assessing the safety of the vaccine and watching participants' immune
responses for side effects. No one will be infected with Ebola. The vaccine
reportedly uses a single Ebola virus protein to generate an immune response.
• The vaccine also will be tested in the United Kingdom, Gambia and Mali, and
officials in Nigeria are discussing conducting another trial with the Centers for
Disease Control and Prevention. Professor Adrian Hill, director of the Jenner
Institute at the University of Oxford is leading the parallel tests .
PHASE 2: The second phase of the clinical trial for the vaccine likely will involve a
larger group and serve to confirm formulations and doses, as well as identify the
need for boosters and the best intervals between each dose.
PHASE 3: A third phase could evaluate the protection given to several thousand
volunteers who are at risk from the disease.
A $4.6 million grant from the Wellcome Trust, the Medical Research Council and
the UK Department for International Development is funding the trial overseas
SOURCE: WELLCOME TRUST
WASHINGTON POST
USA NEWS AND WORLD REPORT
The first British volunteer is Ruth
Atkins, 48, a communications and
engagement manager in the NHS
from Marcham in Oxfordshire and a
former nurse. She heard on the
radio as she was driving home from
work that volunteers were needed
for a vaccine trial run by Oxford
University researchers. She is the
first of 60 healthy volunteers
receive the vaccine.

KEY RESOURCE MATERIAL FROM CDC
• Advice for Humanitarian Aid Organizations (On Traveler's Health website)
- September 16, 2014
• Health Care Facility Preparedness Checklist for Ebola Virus Disease
(EVD)[PDF - 2 pages] - September 12, 2014
• Health Care Provider Preparedness Checklist for Ebola Virus Disease[PDF -
2 pages] - September 12, 2014
• CDC Safety Training Course for Healthcare Workers Going to West Africa
in Response to the 2014 Ebola Outbreak - September 11, 2014
• How U.S. Clinical Laboratories Can Safely Manage Specimens from
Persons Under Investigation for Ebola Virus Disease - September 11, 2014
• Guidance on Air Medical Transport for Patients with Ebola Virus Disease -
Updated September 11, 2014
• Ebola Outbreak: Airport, Border, and Port of Entry Resources for Use by
International Partners (on Traveler's Health Website) - Updated
September 11, 2014
• Interim Guidance Regarding Compliance with Select Agent Regulations for
Laboratories Handling Patient Specimens that are Known or Suspected to
Contain Ebola Virus - September 8, 2014
• Updated: Interim Guidance about Ebola Virus Infection for Airline Flight
Crews, Cleaning Personnel, and Cargo Personnel - September 5, 2014
• Ebola Outbreak: Communication Resources for Use by International
Partners - Updated September 5, 2014
• Interim Guidance for Specimen Collection, Transport, Testing, and
Submission for Persons Under Investigation for Ebola Virus Disease in
the United States - Updated August 26, 2014
• Interim Guidance for Emergency Medical Services (EMS) Systems and
9-1-1 Public Safety Answering Points (PSAPs) for Management of
Patients with Known or Suspected Ebola Virus Disease in the United
States - August 26, 2014
• Guidance for Safe Handling of Human Remains of Ebola Patients in U.
S. Hospitals and Mortuaries - August 25, 2014
• Advice for Humanitarian Aid Workers Traveling to Guinea, Liberia,
Nigeria, or Sierra Leone during the Ebola Outbreak (on Traveler's
Health website) -August 23, 2014
• Interim Guidance for Monitoring and Movement of Persons with
Ebola Virus Disease Exposure - Updated August 22, 2014

West Africa Ebola - 19 September 2014 Yale-Tulane Special Report

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