UPDATE #20 Ebola Virus Disease (EVD) Issued on 27 January 2015 at 16:00

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1 UPDATE #20 Ebola Virus Disease (EVD) Issued on 27 January 2015 at 16:00 1. NUMBER OF CASES AND FATALITIES West Africa and Incorporating the International Situation Data issued by the World Health Organization (WHO) on 23 January 2015 report 21,832 clinically compatible cases of Ebola acquired in West Africa, or related to the West African outbreak, of which 13,635 were laboratory confirmed and 8,683 had died. The cumulative case fatality rate in the three intense-transmission countries among all probable and confirmed cases for whom a definitive outcome is recorded is 71%. For those patients recorded as hospitalised, the case fatality rate is between 57% and 59% in the 3 intense-transmission countries, with no detectable improvement since the onset of the epidemic. A total of 828 health worker infections have been reported in the 3 intense-transmission countries, with 499 reported deaths. The incidence of health worker infections has fallen in Liberia and Sierra Leone, but rose in Guinea throughout December. No further cases of Ebola have been reported in Mali. The WHO declared Mali Ebola free on 18 January 2015, after completing 42 days since the last case tested negative for Ebola a second time. The British nurse who contracted Ebola while volunteering in Sierra Leone has been discharged from hospital after making a full recovery. An Australian nurse working in the Australian-managed Ebola Treatment Centre (ETC) at Hastings Airfield in Sierra Leone was airlifted to the United Kingdom (UK) on 16 January The nurse was involved in a low risk clinical incident while working in the convalescent ward in the ETC. She is undergoing observation in the UK as a precautionary measure. 2. AUSTRALIAN GOVERNMENT RESPONSE International Australia s contribution to the international Ebola response is now $45.5 million. Aspen Medical has been contracted to run a 100-bed Ebola Treatment Centre (ETC) in Sierra Leone, working in conjunction with the United Kingdom (UK) and New Zealand (NZ). The Government will contribute up to $23 million until 30 June 2015 for this treatment centre. The NZ Government is also contributing NZ$2 million (approximately $1.8 million) and up to 24 health workers across a number of rotations to the ETC. The information contained in this document uses the best currently available data. Given the rapidly changing nature of the incident, recipients should be aware of the potential for later confirmation or clarification. 1 of 7

2 The ETC is located at Hastings Airfield near Sierra Leone s capital Freetown, which continues to have a high rate of Ebola transmission, and a high demand for treatment beds. The 100 bed ETC commenced operations with five beds in mid-december and is scaling up incrementally, in accordance with best practice. This will ensure proper safety practices are in place and infection control procedures are working effectively. As at 21 January 2015, the Hastings Airfield ETC s capacity is 50 beds. Sixty-three patients have been admitted since the centre opened. Twenty-nine patients have been discharged after being given a clean bill of health. Thirty have died. Since 28 November 2014, there have been 25 Australian health care workers depart for Sierra Leone to complete in-country training and provide clinical care in the Australian-managed ETC. A further 32 have completed preliminary training in Canberra. Australia has provided $2 million to RedR Australia to fund the deployment of up to 16 technical experts to short-term non-clinical roles in the United Nations Ebola response. Nine have already deployed. Australia is also providing up to $2 million to support regional response and preparedness efforts led by the WHO. This funding is helping to train health officials in Papua New Guinea, Timor-Leste and Pacific Island Countries in Ebola preparedness measures, enabling the WHO to strengthen the health systems of partner governments in the region. Australia is also undertaking an epidemiological study on the risk and possible impacts of an Ebola outbreak in the region. Domestic Additional border screening measures at international airports were introduced from 14 November 2014 including: an updated in-flight announcement on all inbound flights and more banners and signage at airports advising of Ebola symptoms; A Travel History Card, completed by all travellers on all inbound journeys, to declare travel from or through an Ebola affected country in the last 21 days. This card is reviewed by Customs and Border Protection officers during the traveller s arrival processing. Similar questions must also be answered by travellers using SmartGate; If SmartGate identifies that a traveller has travelled to or from an Ebola-affected country in the past 21 days, SmartGate will not process the traveller and they will be directed to a Customs and Border Protection officer for further assessment; Travellers who have been in an Ebola affected country in the last 21 days are directed to biosecurity officials who will ask further questions about their travel and check their temperature; If their temperature is 37.5 degrees Celsius or greater, or they answer yes to one of the screening questions, medical personnel will check the traveller. If the person is unwell medical personnel will take action from that point, following well practiced procedures established alongside the national guidelines to which all states and territories have signed up; Data from the Travel History Card is being recorded to ensure these travellers and their families get the help they need if they are or become unwell and enable tracing of people who 2 of 7

3 may have been exposed if a sick traveller is identified. A newly revised Ebola information card is being provided to passengers identified for screening, with a single 1800 number to call in case of future illness. This number is linked to State and Territory public health services on a 24 hour basis; An information pack is provided to all screened passengers providing them with instructions for monitoring their wellbeing and contact details for the public health unit in their state or territory. Similar requirements were implemented for cruise ship passengers and crew from 1 December UPDATE ON SCREENING Targeted screening of incoming travellers to Australia commenced on 9 August 2014, and initially included people who commenced their journey from Guinea, Liberia, Sierra Leone and Nigeria, or who had been in Africa in the previous 6 days. People who reported as being unwell or who answered yes to a screening question were referred to a human quarantine officer. On 12 September 2014, the Democratic Republic of the Congo (DRC) was added to the list of countries from which travellers would be screened. On 14 November 2014, enhanced screened measures were implemented, with a 21 day travel history card to identify people who began their journey or had travelled through the affected countries (DRC, Nigeria, Sierra Leone, Guinea, and Liberia). Nigeria was removed from the list of countries screened on 15 November 2014 and DRC on 24 November Border Screening As at 22 January 2015, there were 1,527 people screened at the border, and of these, 69 were referred to a Human Quarantine Officer. Post Border Screening and Monitoring As at 21 January 2015, there were 23 people being actively monitored for signs and symptoms of Ebola, following potential exposure to the disease while overseas. As at 21 January 2015, there were 15 people tested for EVD in Australia. All have tested negative. The Minister for Immigration and Border Protection has temporarily suspended processing of permanent and some other visa applications from people in Ebola affected countries in Africa until the situation resolves. Applications that are suspended will remain valid for future consideration. Where the applicant demonstrates they present no Ebola-related risks, and subject to meeting other visa requirements, their visa will be processed as per standard practice. People who have already been granted permanent visas, but have not yet travelled to Australia will go through a managed process to provide assurance that they present no risk to the Australian community before they can travel to Australia. In some cases this will require a delay in their travel plans until this can be established. 3 of 7

4 Temporary visas held by people in Ebola affected countries in Africa are being reassessed. This provides an opportunity to assess prior to travel, the likelihood a person has recently been exposed to Ebola, and the risk they pose to Australia. In many cases once this assessment has been made, the person will be able to travel, or will be able to make arrangements to travel at a subsequent time. For existing and future temporary visa applications, these will be assessed for Ebola-related health risks. If there are Ebola-related risks, these applications will be refused. If there are no Ebola-related risks, and subject to other visa criteria being met, temporary visa applications will be processed as per standard practice. For a small number of humanitarian visa holders, yet to arrive in Australia from Ebola affected countries in Africa, the Government has also put in place rigorous arrangements for all future arrivals including a 21 day isolation period and daily health monitoring. Following this isolation period, and if the client does not present with any clinical indications of Ebola, the visa holder will be allowed to travel to Australia. Since the visa arrangements were introduced on 27 October, there have been 110 citizens from Ebolaaffected countries that have entered Australia following appropriate screening. This figure includes 42 arrivals from nationals of DRC between 27 October to 24 November (at which time the country was declared to no longer be Ebola affected). 4. PLANNED ACTIONS Australia s Chief Medical Officer (CMO) continues to meet with his counterparts in the states and territories to closely monitor the situation overseas and to share information on Australia s preparedness measures. The Australian Health Protection Principal Committee (AHPPC) is working closely with the Infection Prevention and Control Expert Advisory Group to provide the best advice on evidence based infection prevention and control measures. This advice will align with, and augment, the existing public health management guidelines. An Executive Summary of key recommendations is available on the Health website. Relevant agencies (including DFAT, Health and EMA) are implementing the appropriate preparedness measures in Papua New Guinea, Timor-Leste and Pacific Island Countries as set out in the Australian Government Ebola Regional Contingency Plan An Australian Government Interdepartmental Committee (IDC), co-chaired by Health and the Department of Foreign Affairs and Trade (DFAT) meets on a fortnightly basis to ensure consistent advice and messaging across government. Health is coordinating Ebola specific: Situation Updates Fortnightly agency planning meetings with PM&C, Attorney-General s Department/Emergency Management Australia, Defence and Department of Foreign Affairs and Trade; monitoring and reporting meetings with border agencies - Agriculture, Customs and Immigration; and updates to Whole of Government Talking Points. 4 of 7

5 5. ISSUES A special Ebola session of the WHO s Executive Board was held in Geneva on 25 January 2015 to reflect on the response to the current crisis in West Africa and discuss possible reforms to improve WHO s future outbreak and emergency response capacity. The meeting was attended by representatives from the Department of Health and Department of Foreign Affairs and Trade. Further details of the meeting outcomes will be provided in subsequent versions of the Ebola Situation Update. WHO international preparedness strengthening teams are providing technical support in 14 countries: Benin, Burkina Faso, Cameroon, Central African Republic, Cote d'ivoire, Ethiopia, Gambia, Ghana, Guinea Bissau, Mali, Mauritania, Niger, Senegal and Togo. Each country now has a tailored 90-day plan to strengthen operational readiness for response. The WHO and partners are deploying staff to the 14 countries to assist with the implementation of the 90-day plans. The WHO has published a series of 14 papers that take an in depth look at the West African Ebola epidemic, one year into the outbreak, giving special attention to the situation in Guinea, Liberia, and Sierra Leone. The success stories in Senegal, Nigeria, and likely Mali are also described. Interventions to contain the disease in the three most affected countries include isolating and treating patients, identifying their contacts and conducting burials in a safe and dignified manner. All affected districts have access to adequate laboratory capacity for diagnosis (access within 24 hours from sample collection). The WHO advises Guinea, Liberia and Sierra Leone report that between 89% and 99% of registered contacts are monitored each day, although the number of contacts traced per Ebola case remains lower in the outlying districts. A meeting of the Emergency Committee of the International Health Regulations (IHR) regarding the Ebola outbreak in West Africa was held on 20 January The Committee stated that the event continues to constitute a Public Health Emergency of International Concern and that all previous temporary recommendations currently in place for this outbreak should remain in effect. The primary emphasis must continue to be on getting to zero Ebola cases, by stopping the transmission of Ebola within the three most affected countries. This action is the most important step for preventing international spread. 6. RISKS The likelihood of an imported case in Australia remains very low given measures in place to identify and assess those most at risk at the border. Ongoing transmission from an imported case is unlikely due to infection control and public health response measures. In the unlikely event of a case of Ebola being identified in Australia, each state and territory has a designated hospital with Ebola protocols in place, including procedures for appropriate isolation and care of the patient while ensuring the safety of attending health care workers. As of 22 January 2015, there are 75 Australians registered on the Smartraveller website for the three countries most affected (11 in Guinea, 29 in Liberia and 35 in Sierra Leone). The actual number of Australians in these countries may be higher. 5 of 7

6 7. FURTHER INFORMATION Department of Health website World Health Organization - DFAT Smartraveller Health's National Incident Room is NOT currently activated. Cleared by: Rob Cameron, A/g First Assistant Secretary. Office of Health Protection (02) of 7

7 EBOLA CRISIS IN WEST AFRICA AUSTRALIA S RESPONSE SITUATION UPDATE 23 JANUARY 2015 (supplied by DFAT) Key messages: There are now 50 beds available in the Australian-managed Ebola Treatment Centre in Sierra Leone. The ETC can now cater for both confirmed and suspected cases of Ebola. Case incidence continues to fall in Sierra Leone, demonstrating the success of the Ebola response to date. The focus is now on containing smaller spot-fire outbreaks. Sustained effort is required to reach zero cases. ATTACHMENT A As at 21 January 2015, there are 21,724 confirmed, probable or suspected Ebola cases and 8,641 reported deaths, primarily in Sierra Leone, Liberia and Guinea. According to the World Health Organization, case incidence is falling quickly, including in Sierra Leone which had 117 new confirmed cases in the week to 18 January 2015 (week 3), compared to 184 in week 2 and 248 in week 1. Mali has been declared Ebola free by the World Health Organization. HASTINGS AIRFIELD EBOLA TREATMENT CENTRE, SIERRA LEONE The Hastings Airfield ETC s current capacity is 50 beds. The team is working to ensure the ETC is prioritised for referrals and actively demonstrating our capability to accept new cases. Patient numbers at 21 January 2015 Patients currently in ETC 5 Patients recovered and discharged 29 Deceased 30 Patients admitted to date (total) 64 Personnel Australians Other international* Local Total Management team Clinical team Support staff Total The next pre-deployment training will take place in March In-country training is taking place at the Hastings Airfield ETC for new clinical personnel. As at 22 January 2015, 9 Australian Aspen clinical staff have returned to Australia. As at 22 January 2015, Aspen has received 1096 international applications for clinical positions at the Hastings Airfield ETC (including 433 applications from Australians). REDR PERSONNEL Seven RedR personnel have been deployed to date. A further two have been selected and will deploy to Sierra Leone in February *including citizens of New Zealand and Kenya 7 of 7