A. Situation analysis
On 14 February 2021, the Government of Guinea declared a new outbreak of the Ebola virus (EVD) in the Gouécké sub-prefecture which is part of the N’Zérékoré prefecture in the Guinée Forrestière region. This is the first known resurgence of Ebola in West Africa since the 2013-2016 epidemic that began in Guinea and killed more than 11,300 people across the region. Following a warning from the director of the N’Zérékoré Regional Hospital for cases of vomiting, bloody diarrhea and total hematuria, bleeding at the injection sites of five (05) patients from the same family hospitalized in the intensive care unit and then transfer to Conakry (CHU Donka). The supervisory team of the regional health authorities (DRS) and the prefectural health authorities (DPS) went to the hospital, ie to the Gouécké sub-prefecture, for an investigation.
Based on known information, seven (07) people have been infected to date, including three deaths, three patients hospitalized in N’Zérékoré and one hospitalized in Conakry. Although the first case was confirmed in February, it is unclear when the outbreak began, meaning the virus could have spread beyond previously known cases and there have been at least two precarious burials in the community. The origin of the epidemic is currently unknown and all cases known so far are in the same family (Gouécké and N’Zérékoré) and in people over 25 years of age.
As of February 16, a joint mission of the Ministry of Health has already been set up to support Gouecké’s field assessment team. Several actions have been launched to prevent transmission and identify new infections: case isolation, investigation and data collection to search for potential new cases, mobilization of vaccines and diagnostic kits, opening of a treatment center and safe and dignified burials to prevent post-mortem transmission. A national-level coordination mechanism has also been launched to mobilize partners, while neighboring countries, including Ivory Coast, Liberia and Sierra Leone, are on high alert.
While investigations and seeking contacts are underway to determine the extent of the outbreak and the geography of the risk, all humanitarian partners are due to meet on 19 February to adopt an intervention strategy. Areas of probable impact are the prefectures of N’Zérékoré, Guékédou, Macenta, Lola, Yomou and Beyla. The number of at-risk people in these areas is estimated at 1,042,251 inhabitants. The expected effect is a significant increase in cases and the spread of disease due to the displacement of the infected.
To note, the N’zérékoré region is the third most populous region in Guinea, covering 18% of the national territory. It is also the furthest from Conakry (870 km away), most have no access to the sea and the least urbanized. Socio-cultural conflicts (ethnic, religious or socio-economic) have led to unprecedented violence in the Guinea Forest region since 2010. The region’s rugged terrain makes access difficult, highlighting the isolation of several villages in the region.
The response to the Covid-19 epidemic has set positive dynamics in terms of epidemic control and increased hygiene measures among the population to stop the spread of the disease. However, this should not be considered sufficient to prevent the 2014 scenario with an outbreak of EVD spreading in the region. In this remote area, population and behavioral isolation driven by fear of stigma and the social impacts of the recent Ebola outbreak remains a problem, and community burials are both common practice and a high risk for rapid virus transmission. In this context, the next few weeks will be crucial and must be spent on building robust protection and control measures to avoid the spread of the epidemic.