Author: Janet Howe

This is an interesting interview which answers some common questions!

As efforts to find a cure for the Ebola virus gather momentum, Yemisi Akinbola for Africa Renewal caught up with Dr Bernadette Murgue (in photo), the Deputy Director of the French Institut de Microbiologie et des Maladies Infectieuses IMMI (Institute of Microbiology and Infectious Diseases), to talk about issues surrounding Ebola treatment. The following are excerpts from the interview:

 Africa Renewal: Prior to the 2014 Ebola virus outbreak, what research had been done into finding a vaccine for the disease?

Dr Murgue: There is a vaccine by GlaxoSmithKline (GSK) in collaboration with the National Institutes of Health (NIH) that is currently in phase one trials. It has been under evaluation in pre-clinical trials for safety and tolerability. It is being tried on a small number of healthy people.

Why the limited doses then?

There are two vaccines. The one by GSK and they have at least 10,000-20,000 doses. The other one is a collaboration between Canada and America. The most advanced is the GSK one and they have quite a lot of doses at the moment. The vaccine is to prevent, not to treat the disease and was to be given to the people that are the most exposed.

How about those that are infected?

Those infected need to be cared for. We require infrastructure, personnel and hospital equipment. If the infected can get care when they arrive at the Ebola centres as early as possible, the chances of survival increase.

Is ZMapp currently being used widely on the ground?

First of all, ZMapp is not a vaccine, it is a therapeutic. Many times it has been called a vaccine, but it’s not, it is a treatment. It has been given to patients, mostly patients from Northern countries and also to health care workers in Liberia.

Are there any organisations in Africa working on vaccines for Ebola?

It would be good if it were possible to do that. It’s very expensive to develop a vaccine. But in the future, once a candidate has been identified, then why not advocate for a company in Africa to produce a vaccine?

Is there anything else you would like to add?

There’s one main point here, treatment of Ebola at the onset and standard care is key for the patient. That is why we need infrastructure, logistics, human resources, health care workers and all of us to fight this disease.

Do you think the world in general and Africa in particular have responded appropriately and on time?

We know the countries that are affected by Ebola are already in a difficult situation, especially their healthcare systems. Nobody expected Ebola to be such a catastrophic epidemic. It started in a remote area which is not very densely populated and it took a bit of time for experts to realise that it was something different and very frightening.

By: Yemisi Akinbobola, Courtesy of Africa Renewal

– See more at: http://www.sierraexpressmedia.com/?p=72742#sthash.GYG74Wb7.dpuf

On a bright, hot day, hundreds of Ebola Response Volunteers walk through Freetown’s congested Grafton community, armed with a megaphone, posters and flyers and thermometers for temperature checks, they uncovered four Ebola suspects lying down in house.
The four people were visibly sick after a temperature check was done by the Ebola volunteers they were referred to the National Ebola Response Center at Grafton for further medical checks.
The Ebola hotspot busters are deploy rapidly to communities that are considered hotspots of the Ebola epidemic, as part of an immediate response to the Ebola outbreak.
Members of the community themselves, are trained to intensify social mobilization activities and increase engagement of communities to stop the spread of Ebola. They conduct one-on-one sensitization sessions, house-to-house visits and public awareness-raising.
To ensure that the hotspot is covered, the social mobilizers activate youth, women and volunteer networks in each community and reach approximately 9,000 households every week. The Ebola volunteers are involved in active community surveillance and are approached by community members to call, 117, Ebola hotline, so as to refer sick ones to the nearest hospital.
Since the initiative began, the Ebola Response Volunteers have carried out social mobilization in more than 30 hotspot communities with some 2,500; households been reached on their house-to-house visits.
In partnership with Rectour, Volunteers are supported by welthungerhilfe a German NGO is pioneering the project in the hope that greater social participation will lead to heightened awareness and accountability for one’s own community.
The efforts are bearing fruit, in Tombo, Devil Hole and Grafton within the Western Area, community spirit is paving the way for better coordination, reporting and trust of social mobilizers, contact tracers and other Ebola workers in the community.
Manfilla Kellie Marrah the Western Area Ebola Response Coordinator for Welthungerhilfe said over 200 volunteer’s help their neighbours understand why Ebola workers such as the Hotspot Busters are coming into their community.
“We try and make them understand the essence of driving Ebola out from their communities and also making people accept that Ebola is real,” Manfilla Marah stated.
Community leaders also consider the social mobilizers integral to their overall Ebola response. Councillor Ibrahim Conteh from the Grafton community said more than a hundred per cent the social mobilizers have been helpful to us,” he says.
They work around the clock as a member of the community, always with us and always involved. They investigate the issues, go to the homes to educate people and report if there are sick persons to make sure they are taken to the hospital, Councillor Conteh said.
The Sierra Leone Police and the military joined the Ebola Volunteers to carry out the house to house check for the sick at Grafton.
By Saidu Bah
Monday February 02, 2015

Restrictions on travel within Sierra Leone have been lifted.

It only needs ONE carrier to move to another community to start a hot-spot!

From Awareness Times Newspaper in Freetown

By Augustine Samba Jan 23, 2015

The President of the Republic of Sierra Leone Dr. Ernest Bai Koroma on Thursday 22 January 2015 removed ban on traveling and movement across Sierra Leone. Addressing the nation last evening on the Sierra Leone Broadcasting Cooperation (SLBC), President Koroma disclosed that the country has taken a downward trend in the fight against Ebola and it was timely for  restrictions on movement be eased to support economic activity.

“As such, there will no longer be any district or chiefdom level restrictions on movement. No quarantines or restrictions on movement above the household level will be imposed either by Government or local authorities” he stated adding “But we should not become complacent”.

However, President Koroma supported the initiative of the District Ebola Response Centers and local authorities to enhance community surveillance and community watch efforts.

“These efforts must continue as we move into a phase of hunting down the disease” he posited.

Further President Koroma said they will still embark on the second phase of the Western Area Surge, as they have decided to ease the restrictions on trading hours in the Western Area.

“Trading hours on Saturday will now end at 6pm. However, restrictions of trading on Sundays remain in force” he opined.

He said as they move towards their target of zero cases, by 31st March, hazard pay for Ebola Response Workers and health workers will be removed at the end of March. He informed that they will be reviewing the needs of the sector as a whole, to ensure transition towards a stronger and more resilient healthcare system.

President Koroma said starting from 1st of February this year; they will implement a more rigorous system of payment for hazard pay, ensuring fair compensation for exposure to risk, whilst ensuring that they will not allow people do not take unfair advantage of the system.

“Any persons found to have falsified lists or taken advantage of the system will be investigated” he warned.

He said they will not let the heroic and tireless and zealous works of the burial teams, swappers, doctors, nurses, lab technicians, surveillance officers and others be tainted by those wishing to take advantage of the situation for their own personal gain will be held accountable.

He assured that NERC and the Ministry of Health and Sanitation are working intensely to ensure the urgent payment of all back pay owed to Ebola Response Workers.

President Koroma went on to say they are putting modalities in place for the safe re-opening of schools and the target date is the third and fourth week in March.

“Towards this, we have designed a Schools Re-opening Programme that will ensure the following actions” he maintained.

He said prior to the re-opening of schools they will disinfect all institutions which have been used as Holding and/or Treatment Centers as well as those institutions identified as having accommodated Ebola victims.

“Satisfactory water and sanitation facilities at schools; providing educational institutions with thermal sensors; training of teachers on Ebola; safety protocols and incentives to get pupils to schools” he disclosed and further that “school feeding programme, education provisions in place for girls who became pregnant during Ebola period and are unable to return to school; and supplementing teaching and learning at all levels through broadcast programmes will be included”.

The government has designed a promising package for students which include: education provisions in place for girls who became pregnant during Ebola period and are unable to return to school; and supplementing teaching and learning at all levels through broadcast programmes until we have had zero cases for 42 days. He reiterated that until our neighbours in Liberia and Guinea have had zero cases for 42 days, unless the surveillance capacity firmly remain in place so that no new cases can go beneath the radar and until the government built the capacity and resilience in our healthcare system to break the chain of transmission and prevent future outbreaks, the fight against the scourge is not over.

He concluded that although victory is imminent, we must not relent, we must continue to push on, we must continue to refrain from touching the sick and corpses, we must continue to mount and support surveillance and contact tracing activities. “These are the actions we must collectively continue to take ensure victory in the shortest possible time, and intensify the recovery of our beloved Sierra Leone” he concluded.

Freetown, Jan. 12, 015 (MOHS) – The National Malaria Control Programme, Ministry of Health and Sanitation will be conducting its second cycle of the Mass Drug Administration Campaign from January 16 – 19, 2015 in selected chiefdoms in the Bombali , Kambia, Koinadugu, Moyamba, Port Loko, Tonkolili and in all Wards in the Western Urban, Rural Area.

Addressing a press conference at the National Malaria Control Programme at New England Ville in Freetown, the Programme Manager, Dr. Samuel Smith noted the Ebola emergency situation, and the effect of the outbreak that has created numerous challenges for the continuation of routine health delivery services at all levels. The Ebola outbreak he added is having some adverse effects on the malaria programme intervention if appropriate measures are not put in place to support the malaria activities.

The goal of the campaign is to contribute to the containment of the Ebola outbreak in the country thereby reducing morbidity and mortality, with specific objectives to rapidly reduce malaria related incidence and mortality rates by providing intervalled Mass Distribution Administration using Artesunate/Amodaquine (AS/AQ) targeting all ages including children under five and pregnant women. The campaign also aimed at the rapid reduction of number of febrile Ebola suspected cases that would otherwise have required screening and isolation in the Ebola suspected holding centres to exclude Ebola as the cause of illness; and reduce the risk of Ebola transmission among malaria patients.

Dilating on the criteria for exclusion, Dr. Smith said a total population of 2,386, 968 are targeted to cover all ages above 6 months. Children below 6 months, malnourish children, pregnant women who are in their first three months, and all persons with fever and or looking sick are exempted. “Anyone who has received the AS/AQ drug within the last month, patients taking Zidovudine, Efavirenz or co-trimoxazole, are also exclusion to the drug administration”, said Dr. Smith.

Programme Manager, Dr. Samuel Juana Smith briefing the Journalists

Quarantine houses, the Programme Manager re-emphasized must not be visited for the distribution by the MDA teams, adding that alternative arrangements have been made through Surveillance Officers and Contact Tracers at district level.

Answering questions on the findings for the 1st cycle Mass Drug Administration and the utilization of health facilities, Dr. Smith opined that there has been a significant decline in the utilization of health facilities across the country, with malaria prevention and diarrhea continue to be the primary killers of children under five in Sierra Leone, and will remain the main killers during the outbreak,  that the detection and management of Ebola and malaria has been challenging for health workers as the initial clinical presentation of the two diseases is similar. All the targeted 24 chiefdoms in six districts and 30 zones in the Western Ares (10 zones in rural and 20 in urban were covered with satisfactory implementation coverage.

Other highlights in his presentation include lessons learnt in relation to strength, weakness, challenges, mistrust and misconception.

In his contribution, the Registrar of Pharmacy Board, Wiltshire Johnson dilated on Drug Safety and Monitoring.

He spoke on the side effects of the drug as in any other drugs, pointing out that it has been proven safe in line with WHO standard and protocols. Mr. Johnson noted the misconception, rumours and mistrust, disclosing that no established evidence of death was registered during the 1st cycle MDA campaign as a result of the drug, and encouraged compliance in line with the prescribed dosage and criteria of exclusion.

The Public Relations Officer and Chairman for the occasion, Jonathan AbassKamara said social mobilization and community engagement, use of the media and other approaches heightened awareness about the MDA distribution campaign.

He expressed gratitude and appreciation to both the electronic and print media for the pivotal role played in the sensitization and education on the 1st cycle MDA campaign, encouraged journalists to give the same prominence to the forth coming campaign in January 16, 2015.

Mr. Kamara reiterated that the drugs will be administered FREE OF COST.

KK/MOHS

MASS DRUG ADMINISTRATION FOR MALARIA – 16TH -19TH JANUARY 2015

QUESTIONS AND ANSWERS ON MASS DRUG ADMINISTRATION (MDA)

National Malaria Control Programme and Partners, UNICEF, WHO, Global Fund, MSF, Roll Back Malaria

WHAT IS THE CAMPAIGN ABOUT?

Mass Drug Administration (MDA) is the treatment of a well defined population in a geographic area with a curative dose of an Antimalarial drug without first testing for infection and regardless of the presence of symptoms.

MDA is being considered and tested as a strategy to reduce the burden of malaria with the goal of elimination. It may result in a short-term reduction in malaria parasitaemia among the population.

WHY ARE WE DOING THE CAMPAIGN?

–       To rapidly and significantly reduce clinical malaria and the resultant mortality among highest risk target population children and pregnant women;

–       To rapidly reduce the number of febrile episodes(suspected Ebola cases) that would otherwise have required screening and isolation to exclude Ebola as the cause of illnesses;

–       To improve diagnostic accuracy in diagnosis of suspected EVD cases by reducing the disease most likely to be mistaken for EVD, while reducing the burden on overloaded Ebola Treatment Units and Health Facilities;

WHO ARE THE BENEFICIARIES OF THIS CAMPAIGN?

Target will be populations older than 6 months old including adults

WHO ARE EXEMPTED FROM THIS CAMPAIGN?

• Children below 6 months
• Malnourished children
• Pregnant women who are in their first three months
• All persons who are ill (looking sick) according to the Ebola Alert Criteria – (cared for someone with Ebola, attended a funeral of someone with Ebola)
• Anyone who has received AS+AQ within the last month.
• Patient taking Zidovudine, Efavirenz or co-trimoxazole and
• Quarantine houses (alternative arrangements are made for them through surveillance officers and contact tracers)

WHEN IS THE CAMPAIGN?

The 2nd Cycle of the campaign will be from the 16th to 19th January 2015

WHERE IS THE CAMPAIGN?

The campaign will be conducted in selected chiefdoms in Bombali, Kambia, Koinadugu, Moyamba, Port Loko, Tonkolili and all wards in Western Area (Urban and Rural)

HOW ARE WE GOING TO DO THE CAMPAIGN?

– The MDA distribution will be held during the high malaria transmission period (November 2014 to January 2015) in two cycles with an interval of 30 to 45 days to ensure therapeutic blood levels of AS/AQ over the targeted period;

– Administration of this regimen would be door-to-door, with Directly Observed Treatment (DOT) for first dose. The client will be educated and encouraged to comply with the treatment regimen by taking the two subsequent doses on the two days following the administration of the first dose.

– Distribution will be accompanied with strict adherence to the “no touch” policy.

WHY AS+AQ FOR THE CAMPAIGN?:

–       AS/AQ has been chosen for the MDA because it is the first line drug for the treatment of uncomplicated malaria in Sierra Leone. It is efficacious, safe, and well tolerated.

–       There is no reported local resistance to AS/AQ;

–       The drug AS/AQ is well known and acceptable to the Sierra Leonean population;

–       Health Workers and Community Health Workers are already trained to administer AS/AQ;

–       Fixed Does AS/AQ is known to be highly effective and acceptable in the targeted areas and is available.

–       Drug will be delivered in age appropriate blister-packs of 3 fixed does.

POTENTIAL BENEFITS OF MDA

–       Reduction in malaria morbidity/mortality;

–       Decreased presentation of febrile patients in the targeted communities and holding centres, resulting in potential decrease risk of transmission of Ebola to malaria patients;

–       Reduction of “Non Ebola” pressure on the health system;

–       Improved community engagement with disaffected population;

–       Improved linkage with other services (integration)

ROLES AND RESPONSIBILITIES OF PARENTS/GUARDIANS

Parents/Guardians and Individuals should Ensure:

• All members of the household 6 months and above receive AS+AQ tablets
• To adhere to the prescribed AS+AQ dose according to the age.
• To complete the three days treatment regimen.
• To report immediately any side effects observed during the course of taking the AS+AQ tablets.
• Native herbs must not be taken with the Antimalarial tablets during the three days regime.
• Never to share the prescribed dose for an individual with someone else.

Let us all acknowledge the selfless efforts of the doctors and nurses, and the ancillary staff, involved in the on-going battle against Ebola. Nurse Pauline Cafferkey in the Royal Free Hospital is one amongst many volunteers and is not deserving of the mindless criticism levied by some uncaring and selfish individuals. We must all pray for her and all other victims at this time.