Statement South Africa is prepared and ready to respond to Ebola

10 Oct 2014

The outbreak that started in Guinea during December 2013 continues to escalate and seven countries (Guinea, Sierra Leone, Liberia, Senegal, Nigeria, United States and Spain) have reported cases, while in the Democratic Republic of Congo a separate outbreak is occurring.

Although the outbreak started in December 2013, the first confirmed cases were reported in Guinea on 21 March 2014 and the World Health Organisation announced an outbreak on 23 March 2014.

In South Africa we were immediately concerned and took the following actions:

• The Multi-sectoral National Outbreak Response Team (MNORT), which co-ordinates our response to outbreaks, met monthly with Ebola virus disease (EVD) as a standing agenda item;
• Guidelines and Alerts, with case definitions were circulated to all stakeholders, public and private - Stakeholders include: Provinces, Port Health Officials, Civil Aviation Authority, Laboratories (public and private);
• Surveillance for viral hemorrhagic fevers, in particular EVD, has been strengthened at Ports of entry (ORTI and Lanseria have thermal scanners);
• Port Health services, public and private healthcare practitioners were put on alert for any ill persons that have travelled to VHF risk areas and the NICD hotline are available for consultation to them on a 24 hour basis, seven days per week;
• Screening of medical transfers into the country; and
• NHLS and the NICD also intensified lab surveillance

By 24 March 2014, EVD had spread to Liberia; on 12 May to Sierra Leone and 30 July to Nigeria. The spread of the disease alarmed SADC Health Ministers, who held an Extra-ordinary meeting on 6 August in Johannesburg to co-ordinate their response to the outbreak. The main outcome of this meeting was:

• The announcement of joint strategic actions to prevent the introduction and spread of EVD in the region;
• The formation of an Inter-ministerial committee on EVD at SADC and country level to provide overall coordination of the preparedness; and
• The NICD was designated as a centre of excellence for laboratory testing of EVD samples, training and expertise in SADC region.

South Africa's 11 designated hospitals for the treatment was announced at the SADC meeting. In addition to the Personal Protective Equipment (PPEs) that were procured for them by the provinces, 610 PPEs were distributed to them by the second week in August.

At the same time, during 6 to 7 Aug 2014, the WHO held a meeting of the International Health Regulation Emergency Committee on the outbreak and on 8 August 2014, EVD in West Africa was declared an international public health emergency, which requires:

• International support to affected countries;
• Coordinated response to control outbreak and stop further spread.

On 12 August I, the Minister of Health, personally made a presentation to the Health Portfolio Committee and on 20 August to Cabinet. Cabinet endorsed the SADC decisions and provided guidance on travel for passengers from high risk countries (Guinea, Sierra Leone and Liberia) to reduce risk of spread of EVD. In addition, Cabinet has approved a budget of R32.5 million to support EVD preparedness and response activities.

Following these meetings, the following activities ensued:

• A mobile laboratory was deployed to Sierra Leone since 17 August, became active since 25 August and more than 2000 tests have been conducted since then;
• MNORT increased their frequency of meeting from monthly to bi-weekly from 20 August and formed task teams that meet frequently on all aspects of preparedness such as border activities, surveillance, case management and training;
• A National Health Operations Centre (NATHOC) were activated to function seven days per week to consider requests to travel to and from high risk countries- from 25 August to 5 October 2014, a total of 869 travel applications were received and processed at the NATHOC of which only two were denied as they were deemed non-essential;
• The Director-General has held meetings with companies with business interests in West Africa on 22 August; she also co-ordinated meetings to discuss a on 5 September, 12 September and 19 September with the CEOs of businesses at the Johannesburg Stock Exchange;
• Through these meetings, to date 18 companies pledged services, goods and cash in the humanitarian response to West Africa, to the value of R 12 million;
• All nine Provincial Outbreak Response Teams and 51 health districts (an average of 25 health officials in each district) have been trained on Epidemic Preparedness and Response district - one outstanding district will be trained before the end of the month.
• As part of monitoring EVD preparedness activities in the provinces, bi-weekly teleconferencing was initiated on 15 September 2014;

A follow up meeting of SADC Ministers of Health were held from 4 and 5 September 2014 in Victoria Falls, where a common position on the movement of persons and goods from Ebola affected countries were adopted. Ministers approved the following restrictions on movement of people in line with the International Health Regulations IHR (2005), to contain the disease at source:

• People who have a history of coming into close contact with infected people and infected dead bodies or people and infected animals from Ebola Virus Disease (EVD) should be quarantined in country for a period of up to 21 days;
• People who are coming from Ebola affected countries should be subjected to exit screening;
• People who are entering a country from an affected country as defined and advised by WHO, are to be subjected to screening and are to be followed up for a period of 21 days. If it is absolutely essential for them to leave before completion of the 21 day period, the next country should be notified and should continue with the surveillance for the remaining period;
• Member States should discourage their citizens from travelling to affected countries / high risk areas and their trips to be postponed for as long as it is possible;
• Member States are to avoid hosting mass gatherings involving people from affected countries unless it is absolutely essential;
• An active surveillance and notification system is recommended for adoption across SADC Member States.

With regard to training, apart from that mentioned above, the following were conducted:

• From 7 August to 17 September 2014 approximately 525 health and laboratory workers at 13 hospitals (including the 11 designated facilities) were trained;
• On 22 and 23 September 2014, 80 officials from all of the fifteen SADC Member States were trained at the NICD; and
• From 19 September 2014 to the present date, around 270 officials at nine identified high risk ports of entry were trained; this training will still continue at two more border posts.

All laboratory testing for EVD are handled at the NICD. Since 24 March 2014, they have tested 14 patients in South Africa, two from Namibia and one from Zimbabwe. All of these cases were negative and almost all did not meet the case definition of EVD, which required them to be tested - tests were mainly done in order to address fears around the fact that they presented with fever and some with bleeding. The most common diagnoses on them were bacterial sepsis and malaria, which often presents with the above symptoms. It is not acceptable that a media frenzy should be created around each of these cases as fever and bleeding are very common symptoms. We will be open and transparent with the media when a case of concern presents in the country.

The latest media frenzy was around a 72-year old man who presented with fever and bleeding. He had no travel history and was isolated to exclude Congo Fever, which is endemic in the North West, Northern Cape, Free State and Eastern Cape. South Africa has around 5 - 12 Congo Fever cases (at most 20) for the last 50 years and would only declare an epidemic if more than 20 cases per year occur. This 72-year old man was not tested for EVD and his Congo Fever tests were negative. He is being treated for bacterial sepsis.

The risk of Ebola being introduced into South Africa remains low. There are a number of measures that we have introduced in South Africa and we are confident that we are prepared to respond effectively to any case imported into the country.

Statement issued by the Department of Health, October 10 2014

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