Wednesday, October 15, 2014

Comparing WHO and CDC Projections of Ebola Cases in the Future



Through October  12, 2014, the World Health Organization  (WHO) has reported more than  8900 cases of Ebola since this epidemic began  (link).  The outbreak is currently out of control in three countries in West Africa, Guinea, Liberia, and Sierra Leone.  The graph below depicts the timeline of the growth of the  cumulative number of total cases reported by  each of these countries.  

 

The overall cumulative Ebola case total time series can be fitted to an exponential growth curve to project the total number of cases going into the future. The WHO data indicate that by January  2015 there will be almost 45,000 Ebola cases as shown in the graph below.

 

There is no doubt now that this outbreak will not be contained in West Africa by the end of December.  How many future cases of Ebola will there be is difficult to predict. WHO has noted on several occasions that the officially reported numbers under represent the actual number of cases and deaths in these countries.

On the other hand,  The US Center for Disease Control  (CDC) has projected cases counts ranging from 550,000 to 1.4 million cases in Sierra Leone and Liberia by mid January 2015 (link).  The CDC adjusted  existing case counts by a factor of 2.5 according to their model (as of August 28, 2014).  The graph below compares the differential growth rates based on current WHO data and the estimated case count by the CDC.  According to the CDC estimates, there are now at least 22,000 Ebola cases in West Africa compared to the 8900 reported by WHO.

The graph indicates the clear disparity in the different estimates by these two health agencies of the future case count of Ebola.  As we edge closer to the end of 2014 we will have a better idea of which projection is more accurate.

Where does the WHO estimate of 5,000 to 10,000 new Ebola cases in December come from?



The number of Ebola infections in West Africa continues to increase at an alarming rate (link).

As the official international public health agency, the World Health Organization (WHO) is tasked with tracking and reporting on infectious diseases around  the world.  As of October  14, 2014 the WHO has reported more than 8900 Ebola cases from the three West Africa nations of Guinea, Liberia, and Sierra Leone, where the Ebola outbreak has not yet been contained (link).

Below is a chart showing the continued rising number of new cases by week number in these three countries.  The data in the chart is based on official WHO data through October 12, 2014 (link).  A quote from Dr. Bruce Aylward,  a WHO spokespersonindicates that by mid December 2014 between 5,000 to 10,000 new weekly Ebola cases could reported in the three West African countries  (link).

The next graph below shows the temporal progression of the increases in new cases with a trend line projecting news cases into the coming weeks. The exponential trend line from the current  WHO data projects 5,000 to 10,000 new weekly cases of Ebola in West Africa by December 2014. This is the basis of Aylward's comments yesterday.


Tuesday, October 7, 2014

Crowd sourcing for a solution to the West African Ebola epidemic

 With the current Ebola outbreak raging in West Africa and with no immediate solution in sight,  the U.S. Agency for International Development (USAID) has proposed an online challenge to think "outside the box" regarding solutions for the current Ebola crisis.

Today, USAID launched the Fighting Ebola: A Grand Challenge for Development with a call to innovators around the world to submit ideas focused on improving the tools used by frontline healthcare workers in the fight against Ebola in West Africa. The initial focus of the Challenge, as announced by President Obama on Sept. 26, is to generate pioneering solutions to improve the personal protective equipment (PPE) and tools used by healthcare workers battling Ebola.

The Fighting Ebola Grand Challenge will help to identify innovations that improve the comfort while maintaining the safety of PPE – masks, gloves, boots, and other protective gear used by healthcare workers.

The website is an open innovation platform to crowd source and incubate innovative ideas to improve delivery of care and stem the spread of disease, including improvements in PPE;  a  challenge competition to fund and test innovations for PPE, infection treatment and control; and  partnerships for rapid testing and deployment of the best solutions.

To share your ideas or to join the conversation, visit http://ebolagrandchallenge.net.

Map: Countries with Confirmed Ebola Cases from the 2014 Outbreak



As of October 6, 2014, seven countries have reported cases of Ebola as noted below.  The Democratic Republic of Congo has reported at least 53 cases from a local Ebola outbreak (link)  not associated with the current outbreak that apparently originated in Guinea in December 2013 (link).  

Guinea (977 confirmed cases) link
Liberia (931 confirmed cases) link
Nigeria (19 confirmed cases) link
Senegal (1 imported infection) link
Sierra Leone (2179 confirmed cases) link
Spain (1 locally acquired infection) link
United State of America (1 imported infection) link


Monday, October 6, 2014

Spain: The First Locally Acquired Ebola Infection in Europe


A health care worker in Spain is the first individual outside of Africa to locally acquire an Ebola infection.  A nurse treating an Ebola case in a Madrid hospital in September has tested positive for Ebola (link). The nature of transmission from the Ebola patient to the nurse has not yet been reported.  The reports from the Ebola outbreak in Africa show that health care workers are frequently infected and die from treating Ebola patients (link). It was widely assumed that health care workers in the West Africa countries became infected because of lack of adequate PPE, proper training, and overwhelmed facilities. This new case in a European hospital raises concerns about the nature of Ebola transmission in hospital settings everywhere in the world.   

The Ebola case in Texas, USA, will provide an additional test of the nature of transmission of this virus (link). So far no secondary cases have been reported in Texas. It will be several more weeks before Texas can claim no additional secondary cases of Ebola.   

Tuesday, September 30, 2014

First Ebola Case Outside Africa in the USA

Today, the first case of Ebola outside of the continent of Africa has been confirmed from Texas in the United States of America. The Center for Disease Control  (CDC) provided an announcement and confirmation about the case today at:

First Imported Case of Ebola Diagnosed in the United States

The announcement concludes with

"CDC recognizes that even a single case of Ebola diagnosed in the United States raises concerns. Knowing the possibility exists, medical and public health professionals across the country have been preparing to respond. CDC and public health officials in Texas are taking precautions to identify people who have had close personal contact with the ill person and health care professionals have been reminded to use meticulous infection control at all times.

We know how to stop Ebola’s further spread: thorough case finding, isolation of ill people, contacting people exposed to the ill person, and further isolation of contacts if they develop symptoms. The U.S. public health and medical systems have had prior experience with sporadic cases of diseases such as Ebola. In the past decade, the United States had 5 imported cases of Viral Hemorrhagic Fever (VHF) diseases similar to Ebola (1 Marburg, 4 Lassa). None resulted in any transmission in the United States."
Only time will tell how successful the CDC and local public health officials are at identifying and containing other individuals that may have been infected by the index case here in the United States.

Ebola cases exceed 1000 new cases per week

Based on World Health Organization  (WHO) data, in early September I projected that new Ebola cases would exceed 1000 cases per week by September 21, 2014 (link).  As of the most recent WHO update on September 26, 2014 ( with data current through September 23, 2014), the number of new cases exceeded 1000 in week number 39, starting on September 21. See graph below. 

WHO has not provided a more recent update of the Ebola cases counts. But given the multitude of media reports about many additional uncounted cases and deaths in several of these West African nations, the WHO numbers are probably very low and don't reflect the nature and severity of the Ebola outbreak that is evolving in West Africa.