West African Ebola virus disease (EVD) outbreak flares up in late May and in early June...[UPDATED]

Data are based on WHO DONs. Lines use the numbers on the vertical  axis on the left, bars use the right hand axis. The percentages are the proportion of fatal cases at the time point indicated.
Click on chart to enlarge.

The chart tells a pretty grim story of an outbreak that has flared up, after what looked like some weeks of things settling down. I'd said I would stop charting this outbreak back at 5-May, unless anything major happened. Well it did. In late May in Guinea and then in early June in Sierra Leone.

The causes seem to be the heartbreaking stories of family members sequestering ill loved ones or removing them from isolation wards, and in so doing, getting infected themselves, and so spreading infection.

Click on image to enlarge.

Maps purchased from maptorian and adapted by VDU

The adjacent map has been updated to help communicate an idea of the number of cases in each country.

The number of cases and deaths, not all of which are laboratory confirmed as being ebolavirus disease (EVD), are now the highest of any known outbreak of EVD (see the chart below). A grisly fact and one that doesn't change anything. But one I note nonetheless. Also worthy of note is that throughout this outbreak, the proportion of fatal cases (PFC; check the disclaimer in the legend below) has not reached the heights of the Zaire outbreak of 1976, or the Democratic Republic of Congo (DRC) outbreak of 1995, or that in the Republic of Congo (RC) during 2002-3, and others. So that's a small silver lining.

A guide to confirmed EVD cases and those who died from EVD over time.
The data for the non-West Africa-2014 outbreaks, sourced from Public Health England website [1], are defined as "confirmed". Not all of the Wet Africa-2014-related clinical cases or deaths have been laboratory confirmed so these bars are probably a little high (highlighted in the key). Note that looking at proportions alone can be confusing. For example, if 1 of 1 cases is fatal, that's a PFC of 100% but it may not reflect the situation accurately. So please interpret the grey mountains alongside the read and blue bars to get the complete picture. DRC-Democratic Republic of Congo; RC-Republic of Congo

Click on chart to enlarge.

I'll try and keep the charts up-to-date as this outbreak continues to burn. 

References...

1. http://www.who.int/csr/don/2014_06_18_ebola/en/
2. http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Ebola/GeneralInformation/

Update on Ebola virus disease (EVD) case accumulation chart with new WHO African Regional Office data for 11-Apr-2014.[AMENDED]

Lines use the axis on the left, bars use the right hand axis.
Click on image to enlarge.

Its been 4-days since the last World Heath Organisation update on the changing situation with Ebola virus disease (EVD) in Western Africa (10-April, covering numbers from 9/10-April). Yet the update we received over night (my time) only advances the case numbers by 1-2-days, covering numbers from 11-April.

Total suspected/probable/confirmed cases: 193
Total suspected/probable/confirmed deaths: 119 (61.7%)
Total lab confirmations: 77 (39.9% of 187)

There are a constant stream of social media comments about case numbers blowing out in one place/region/country or another, hashtags like #terror and #WMD, statements about unwillingness to shake hands not meaning to be an insult (but slightly more emphatic than that at times), plumpynut or onion magical remedies (they are not remedies so please ignore the magical cures (they come from ignorance and are not backed by science), implications that cases always bleed (41% in one past outbreak) and then there's the border closures and flight restrictions...

I think that the more regularly the world receives simple and reliable information on any outbreak that scares them - from the locals and volunteers who have to stare the virus down to the causal observer with the attention span of a fruit fly - the more able they are to filter out the noise and learn from the facts. I think we've all learned something about EVD form this outbreaks as we will any outbreak if we look harder enough and are willing to be educated. Its a grisly, scary but ultimately much more manageable type of virus outbreak than each year's epidemic of seasonal influenza is. Be alert but not alarmed hmm?

This announcement from WHO social media communications front man Gregory Härtl was a very welcome one in the context of that windy paragraph...

.@girlofcelje @MackayIM An update is planned for today. From now,they will b Mon,Weds,Fri. Don't follow advice that could endanger your life
— Gregory Härtl (@HaertlG) April 14, 2014

The latest graph, above, is based on these new WHO-AFRO data. It shows that cases continue to accrue slowly as do deaths and lab confirmations. Case numbers have risen by 7 since the previous report and the proportion of fatal cases, which includes suspected, probable and confirmed EVD cases, is now at 61.7%. While that proportion is a horrible number, the rise in case numbers is not exponential. Mali's samples are still being tested and so no change in suspect case numbers there. Among Guinea's 106 deaths, 42 (39.6%) have been laboratory confirmed. There is also a mention of a possible funeral-related cluster. No word on how many transmission chains are being watched now. I may have misread this, but not long ago I thought that all cases could be linked to just one source. This cluster may suggests that may have changed and a statement on this aspect of the EVD outbreak in West Africa would be helpful.

The most recent suspected EVD case onset noted in the report arose 10-April-14.

We eagerly await the next update.

Sources...

1. Ebola virus disease, West Africa – update [10-April with data from 9/10-April]
   http://www.who.int/csr/don/2014_04_10_ebola/en/
2. Ebola virus disease, West Africa (Situation as of 14 April 2014) [Data from 11-April]
   http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4095-ebola-virus-disease-west-africa-14-april-2014.html

Update on Ebola virus disease (EVD) case accumulation chart with new UNICEF data...

Click on chart to enlarge.

Thanks to a UNICEF Australia's update I've added a few cases to the produce a new chart; I expect we'll see some WHO numbers soon, and I'll update if there are any differences.

Check the version number in the bottom left hand corner - it defines whether it is the only chart of the day from VDU, or one of several.

The new version shows the proportion of fatal cases holding fairly steady at ~60% of all cases. This calculation includes those cases that also that look like EVD but have not been laboratory confirmed as EVD, as well as those that have been confirmed.

As I went into yesterday, these are very volatile numbers, so regard this chart for its trends only.

Sources...

1. UNICEF Australia's PDF of numbers from ~3-hours ago
   http://ow.ly/d/24bM

Recorded Ebola virus disease (EVD) outbreaks throughout time...

A guide of case total confirmed cases and those who died from 
Ebola virus over time.
Sourced from Public Health England website [1]:
Click on chart to enlarge.

A quick chart to highlight the larger and smaller outbreaks and importations of EVD and Ebola viruses, respectively, that have been recorded worldwide since 1976.

I've added in the current tally of 167 suspected/probable/confirmed cases for the 2014 Guinea outbreak but this number is inflated compared to the other entries on the chart because those are reportedly based on confirmed cases; only around a third (59) of Ebola cases in the current outbreak have been confirmed to date.

Thanks to @Pawixx for steering me to the PHE page.

Please note that these numbers differ a little from the World Health Organization's Table [2]. Solving that discrepancy is a problem for another day.

Source...

1. http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Ebola/GeneralInformation/
2. http://www.who.int/mediacentre/factsheets/fs103/en/

Ebola outbreak in Guinea: 13-lab confirmed cases, 73 more suspect, includes 59 deaths

Schematic of an Ebola virus virion.
Its a work in progress but feel free to use.
Just cite Ian M. Mackay, PhD and
http://virologydownunder.blogspot.com.au/
Click to enlarge.

There's an outbreak of Ebola virus (species Zaire ebolavirus) haemorrhagic fever going on in Guinea just now (see the map for where that is within Africa).

Haemorrhagic fever? That's the scary stuff that books get written about and movies based on - bleeding from tissues and person-to-person spread to infected healthcare workers and grieving family carers...horrible, scary stuff for those in the thick of it. If anything can be said to be good news to this, it is that usually (to date) cases do not pass several hundred (see Storify article of tonight's Twitter information [5]) because the virus does not transmit as easily as influenza for example (no aerosol route; spread is by bodily secretions);  scary bleeding from everywhere is not as common as the movie make out and there are survivors of infection. 

A very digestible backgrounder on Ebola that will get you up to speed on this virus and disease can be found at Mike Coston's Avian Flu Diary, here [9].

On 22-March, the World Health Organization (WHO) was made aware of an outbreak in the west African country by its Ministry of Health [1]. The outbreak of febrile disease commenced 9-Feb. When the Minister of Health released a statement, 22-Mar, he noted the disease was characterized by fever, diarrhoea, vomiting, fatigue and sometimes bleeding. 

Guinea and surrounds, Africa.
Maps purchased from maptorian.
Click on image to enlarge.

Since then, haemorrhagic fever cases in the country's capital, Conakry, have been shown to be due to something other than the Ebola virus according to testing results from the Pasteur Institute Dakar [3]. 

The Institut Pasteur in Lyon had earlier identified Ebola virus (so far in 13 cases) in Guekedou, Macenta, Nzerekore and Kissidougou districts; they also genotyped some strains using the L gene as a PCR target[10]. This led to identifying the species Zaire ebolavirus.

The Emerging and Dangerous Pathogens Laboratory Network (EDPLN) is working with the Guinean VHF Laboratory in Donka, the Institut Pasteur in Lyon, the Institut Pasteur in Dakar, and the Kenema Lassa fever laboratory in Sierra Leone to make available appropriate Filo-virus diagnostic capacity in Guinea and Sierra Leone [1]

There is no specific treatment or vaccine for Ebola disease. The first Ebola virus outbreak was identified in 1976. Ebola virus is the conversational name of the viruses that are members of the Family Filoviridae, Genus Ebolavirus and exist as 5 species [4]:

1. Species: Tai Forest ebolavirus ("Tai Forest virus")
2. Species: Reston ebolavirus ("Reston virus")
3. Species: Sudan ebolavirus ("Sudan virus")
4. Species: Zaire ebolavirus ("Ebola virus")
5. Species: Bundibugyo ebolavirus ("Bundibugyo virus")

"Multidisciplinary teams have been deployed to the field to actively search and manage cases; trace and follow-up contacts; and to sensitize communities on the outbreak prevention and control. Médecins Sans Frontières, Switzerland (MSF-CH) is working in the affected areas and is assisting with establishment of isolation facilities, and also supported transport of the biological samples from suspect cases and contacts to international reference laboratories for urgent testing." [1]

But where was the crack team of experts laden with ultra cool tech capable of diagnosing the tiny beast within minutes, containing it within hours and saving more people from becoming afflicted in days? 

Unfortunately no such crack team or timeline exists, except in the movies anyway. But as we are going to see in the coming days as diagnostic delays cause headaches for those multidisciplinary teams trying to educate the locals and begin helping contain, confirm cases and trace the disease, there is a real need for faster identification of the causes of acute and serious disease outbreaks worldwide. 

Wouldn't it be great if the world's governments and biotech industries could come together to assemble and maintain some sort of rapidly deployable multinational pathogen detection force? Several teams of scientists and healthcare workers assembled and trained by the world's best, and remaining linked to them, carrying with them all the (perhaps bespoke) tech they'd need to identify any pathogen (unbiased molecular methods). They could analyse their data on the fly or rapidly send it to others for help using satellite links. The "Force" could be funded by the contributing States, biotech and Pharma; coordinated by the WHO perhaps. I'd love to see a dedicated set-up for pathogen identification; a kind of virus/bacteria/parasite-hunting fire department that can down its regular tools and jump on a plane ASAP; someone whose number is on every country's speed dial. 

Ahh 'tis to dream. 

In the meantime, I have a lot to learn about Ebola; something that is more nightmare than dream to me.


References..

1. WHO situation report as of 22-Mar-2014 [PDF]
   http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4063-ebola-hemorrhagic-fever-in-guinea.html
2. Epidemic hemorrhagic fever in Guinea after 29 deaths, the Health Minister announces new measures
   http://www.lejourguinee.com/index.php/fr/societe/3072-epidemie-de-fievre-virale-hemorragique-en-guinee-apres-29-morts-le-ministre-de-la-sante-annonce-des-nouvelles-mesures
3. Guinea: fever cases detected in Conakry are not due to Ebola.
   http://www.france24.com/fr/20140324-guinee-conakry-ebola-virus-fievre-hemorragique-epidemie-institut-pasteur/
4. Prof Vincent Racaniello's Virology blog on Ebola virus naming
   http://www.virology.ws/2012/08/07/is-it-ebolavirus-or-ebola-virus/
5. Storify: Early timeline of the events in the Guinea Fever outrbreak
   http://storify.com/MackayIM/early-timeline-of-the-eventsin-the-guinea-fever-ou
6. WHO webpage on the Guinea Ebola outbreak
   http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4063-ebola-hemorrhagic-fever-in-guinea.html
7. WHO primer on Ebola haemorrhagic fever
   http://www.who.int/mediacentre/factsheets/fs103/en/
8. Avian Flu Diary (Mike Coston) on WHO Twitter Messaging On Ebola
   http://afludiary.blogspot.com.au/2014/03/who-twitter-messaging-on-ebola.html
9. Avian Flu Diary (Mike Coston) on A Brief History Of Ebola
   http://afludiary.blogspot.com.au/2014/03/a-brief-history-of-ebola.html
10. Guinea Ebola outbreak believed to be deadly Zaire strain
    http://www.reuters.com/article/2014/03/24/us-guinea-ebola-idUSBREA2L0MI20140324