Epidemiological and Surveillance Response to Ebola Virus Disease Outbreak in Lofa County, Liberia (March-September, 2014); Lessons Learned

Abstract

Ebola Virus Disease (EVD) outbreak was confirmed in Liberia on March 31st 2014. A response comprising of diverse expertise was mobilized and deployed to the country to contain transmission of Ebola and give relief to a people already impoverished from protracted civil war. This paper describes the epidemiological and surveillance response to the EVD outbreak in Lofa County in Liberia from March to September 2014. Five of the 6 districts of Lofa were affected. The most affected districts were Voinjama/Guardu Gbondi and Foya. By 26th September, 2014, a total of 619 cases, including 19.4% probable cases, 20.3% suspected cases and 44.2% confirmed cases were recorded by the Ebola Emergency Response Team (EERT) of Lofa County. Adults (20-50 years) were the most affected. Overall fatality rate was 53.3%. Twenty two (22) cases were reported among the Health Care Workers with a fatality rate of 81.8%. Seventy eight percent (78%) of the contacts successfully completed 21 days follow-up while 134 (6.15%) that developed signs and symptoms of EVD were referred to the ETU in Foya. The contributions of the weak health systems as well as socio-cultural factors in fueling the epidemic are highlighted. Importantly, the lessons learnt including the positive impact of multi-sectorial and multidisciplinary and coordinated response led by the government and community. Again, given that the spread of infectious disease can be considered a security threat every effort has to put in place to strengthen the health systems in developing countries including the International Health Regulation (IHR)'s core capacities.

Enhancing laboratory capacity during Ebola virus disease (EVD) heightened surveillance in Liberia: lessons learned and recommendations

“…We analyzed laboratory and epidemiologic data generated daily between May and December, 2015. The Republic of Liberia is divided into five regions; North Eastern, North Central, South Central, South Eastern-A, South Eastern-B [16]; and consists of 15 administrative counties [3]. Approximately, 50% of Liberia’s population lives in Montserrado County in which the country’s capital city, Monrovia, is located [17].…”

“…One of the pillars of effective response to an outbreak is an efficient laboratory system [1]. Between March, 2014 [2, 3] and March, 2015 [4], Liberia battled what has been reported to be the largest Ebola virus epidemic in history [5, 6]. During this period, the country had up to 11 laboratories testing for Ebola Virus Disease (EVD) with support from the government of Liberia (GoL), the World Health Organization (WHO) and international partners [1].…”

Enhancing Ebola Virus Disease Surveillance And Prevention In Counties Without Confirmed Cases In Rural Liberia: Experiences From Sinoe County During The Flare-Up In Monrovia, April To June, 2016

“…The number of health facilities investigating death alerts increased from 19 (53%, SD=34%) to 28 (84%, SD=22%) health facilities (P=0.006) in all the 10 health districts in the county (Figure 4). original outbreak in 2014, when more community deaths were reported to the health authorities to be investigated for EVD after community sensitization and acceptance (28). The reasons for reduction of live alerts were not clear from our study, and the same may have occurred owing to the increased attention focused on the death alerts during the flare-up, considering that the reporting and investigation of live alerts was already high in the county before the flare-up.…”

Participatory Monitoring and Evaluation of Ebola Response Activities in Lofa County, Liberia: Some Lessons Learned

“…Representatives of international organizations, supporting resource mobilization, met weekly to identify areas of need, harmonize interventions, avoid duplication of activities, and bridge existing service delivery gaps. 23 Data-driven decision-making helped to assure the provision of essential services within the target areas. Finally, community members played a key role in contact tracing by reporting people coming to Lofa County from Sierra Leone, Guinea, or other parts of Liberia to the town Chief.…”