Disease | Random Analytica

September 3, 2014

Random Analytics: Ebola in Sierra Leone (to 31 Aug 2014)

I noted recently that Crawford Kilian (whom I now read almost daily to give me a break from my current Workforce Planning responsibilities) stated that the Sierra Leone Ministry of Health and Sanitation had moved from an adhoc social media channel to a more developed website and it was very good.

I completely concur.

The Ministry of Health and Sanitation for the Sierra Leone Government has recently updated its Situation Report (SITREP) on the Ebola Virus Disease (EVD) to the 31st August 2014. It is recommended viewing but here is an infographic of the situation, along with a data review for the Government of Sierra Leone for consideration (the latest update comes with a data anomaly) and a couple of laymen questions.

The Ebola in Sierra Leone (by District) infographic details the cases and fatalities from EVD including probable and suspected cases. Each District which is impacted by is listed with each figure representing 10x lives and then colour coded (see notes). The provisional CFR is based on total numbers and might not represent the Ministry of Health and Sanitation figures.

It should be noted that the outbreak is ongoing so these numbers are still very provisional.

The next is a table which highlights a very minor data anomaly (in red), which I will pass on immediately to the staff at the Ministry of Health and Sanitation.

Data anomaly aside, I hope that my small intrusion into their daily (and more important work that I am currently completing) adds some value. I know that the Ministry is under huge pressure and that their work truly does matter.

Final Thoughts, Predictions or Problems:

I’ve no problem with the data-cleansing itself anymore, outside of a small anomaly. The Sierra Leone government should be congratulated on its better presentation of the data, especially given its background story, low infrastructure prior to this new medical crisis and recent history in terms of civil war etc.

Yet I find some issues with the current data presented. I’m sure there are answers to these issues but there are questions that must be answered:

The Confirmed Fatality Rate for the most impacted regional Districts seems reasonable given the economic constraints of the country. I note the Districts of Kailahun and Kenema have a current total provisional CFR in the 40-percentile range. Yet, a couple of questions:

The current CFR in Western Rural is 3.9% (yet including all cases is 57 including four deaths with a CRF of 7%; both totals seem a bit low; and:
The big unexplainable for me is the CFR in Port Loko which the latest update currently states is just 2.9%. Given that when I last looked at the data (to 13 August) the CFR was 12% with 25-cases there has been either an anomaly with the data or a health deployment that I am not yet across.

Data Sources

[1] d-maps.com. Africa: states, main cities. Accessed 28 August 2014.
[2] d-maps.com. Sierra Leone / Republic of Sierra Leone: boundaries, districts, main cities. Accessed 2 September 2014.
[3] Ministry of Health and Sanitation. Ebola Virus Disease – Situation Report (Sit-Rep) – 01 September, 2014. Sierra Leone Government. Accessed 2 September 2014.

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August 28, 2014

Random Analytics: Ebola in the DRC (to 27 Aug 2014)

Over the past 24-hours the World Health Organisation has confirmed another outbreak of Ebola Virus Disease (EVD), this time in the Democratic Republic of Congo. Although the Ebola species hasn’t yet been confirmed Ian M. Mackay (who knows a thing or two about this subject) suspects it might be Sudan Ebolavirus (read his excellent post and view his infographic here). To give you an idea where Equateur province is in relation to the DRC I’ve put together an infographic but have failed to locate where Ikanamongo Village is (where the index case ate the bush animal, possibly a bat and became ill).

According to my historical reckoning this would be the eighth outbreak of EVD in the DRC, six of Ebola Zaire, one of Ebola Bundibugyo and the most recent which remains unconfirmed. It should be noted that my count includes the retrospective confirmation of Ebola Zaire from 1972. If it does turn out to be a variant of Ebola Sudan then this would be the ninth iteration of the disease with 3 confirmations in what is now South Sudan, four in Uganda, one accidental infection in the UK and potentially the most recent DRC outbreak.

Via the World Health Organisation. Ebola virus disease – Democratic Republic of Congo Disease outbreak news 27 August 2014. Excerpt:

Epidemiology and surveillance

On 26 August 2014, the Ministry of Health, Democratic Republic of Congo (DRC) notified the World Health Organization (WHO) of an outbreak of Ebola virus disease (EVD) in Equateur Province.

The index case was a pregnant woman from Ikanamongo Village who butchered a bush animal that had been killed and given to her by her husband. She became ill with symptoms of EVD and reported to a private clinic in Isaka Village. On 11 August 2014, she died of a then-unidentified haemorrhagic fever. Local customs and rituals associated with death meant that several health-care workers were exposed and presented with similar symptoms in the following week.

Between 28 July and 18 August 2014, a total of 24 suspected cases of haemorrhagic fever, including 13 deaths, have been identified. Human-to-human transmission has been established and includes the health-care personnel who were exposed to the deceased pregnant woman during surgery (one doctor and two nurses) in addition to the hygienist and a ward boy, all of whom developed symptoms and died. Other deaths have been recorded among the relatives who attended the index case, individuals who were in contact with the clinic staff, and those who handled the bodies of the deceased during funerals. The other 11 cases are currently being treated in isolation centres.

Samples have been sent to laboratories in Kinshasa and in Gabon for confirmation of EVD and to identify the strain. The index case and the 80 contacts have no history of travel to the EVD-affected countries in West Africa (Guinea, Liberia, Nigeria, or Sierra Leone) or history of contact with individuals from the affected areas. At this time, it is believed that the outbreak in DRC is unrelated to the ongoing outbreak in west Africa.

Data Sources

[1] d-maps.com. Africa: states, main cities. Accessed 28 August 2014.
[2] d-maps.com. Democratic Republic of the Congo / République Democratique du Congo: boundaries, provinces, main cities. Accessed 26 August 2014.
[3] Wikipedia. File:Flag of the Democratic Republic of the Congo.svg. Accessed 28 August 2014.
[4] World Health Organisation. Ebola virus disease – Democratic Republic of Congo Disease outbreak news 27 August 2014. Accessed 28 August 2014.

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August 22, 2014

Random Analytics: Ebola in Liberia (to 19 Aug 2014)

It is noteworthy that over the past 24-hours we have received confirmation from the Liberian Ministry of Health and Social Welfare that the confirmed, probable and suspected cases of Ebola have now topped 1,000.

The Ebola in Liberia by County infographic details the cases and fatalities from Ebola. Each Country which is impacted by Ebola is listed with individuals listed as confirmed, probable, suspected then deceased. The provisional CFR is based on those total numbers.

Three Counties now have case counts in the hundreds including Lofa (455-cases), Monterrado (272-cases) which also includes the capital Monrovia and Bong (103-cases). Two Counties now have fatalities in the hundreds including Lofa (235) and Montserrado (212-cases).

The outbreak is ongoing so these numbers are still very provisional.

The other interesting find from doing this infographic was the Ministry of Health and Social Welfare data has some issues.

I’ve highlighted the data anomalies (where confirmed, probable and suspected cases are less than the deaths). This could be an issue of how they have structured the original document (where case lines are opposite to death lines making it easy to input the wrong data).

I suspect that the analysts in the Ministry are under a lot of pressure. I’ll pass on my findings to ReliefWeb and the Liberian Ministry of Health and Social Welfare for their review and consideration.

Data Sources

[1] d-maps.com. Liberia / Republic of Liberia. Accessed 22 August 2014.
[2] Liberian Ministry of Health and Social Welfare. Liberia Ebola Sitrep no. 96. ReliefWeb. Accessed 22 August 2014.

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August 19, 2014

Random Analytics: Ebola in Nigeria (to 16 Aug 2014)

ReliefWeb is reporting more cases in Liberia over the past 24-hours with data updated to 16 August 2014. The NIGERIA Daily Situation Report (SitRep No: 17) Date: 16th August 2014 includes a new confirmed case and three suspected cases. Crawford Kilian via his excellent H5N1 site has been following reports of a suspected case from Kaduna State, although this is not reported in the latest update (noting that said update is now almost three days old). The article coming out of Nigeria in relation to Kaduna can be found here and here while the counter-article can be found here.

As Crawford correctly points out Kaduna is an 80-minute flight away from Lagos where the imported outbreak is taking place. According to Google if you wanted to drive the 775-km it would take you about 10-hours.

The above infographic details the cases and fatalities from Ebola in Nigeria. Cases include all suspected, probable and confirmed cases and the provisional CFR is based on those total numbers (whereas ReliefWeb uses only confirmed numbers for their CFR).

The only confirmed Nigerian State to be impacted by Ebola is Lagos from an imported case back in late July where there have been 12-confirmed cases (4 deceased with some now released and some still in quarantine). The other point I wanted to make out was that the most recent articles from Nigeria have mentioned both a case from Kaduna and effectively a retraction that could be the case.

We are still in the ‘Fog of the Outbreak’ thus I have highlighted Kaduna State and await more information and evidence.

Data Sources

[1] d-maps.com. Nigeria / Federal Republic of Nigeria, boundaries, states. Accessed 19 August 2014.
[2] ReliefWeb. NIGERIA Daily Situation Report (SitRep No: 17) Date: 16th August 2014. Accessed 19 August 2014.

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August 15, 2014

Random Analytics: Ebola in Sierra Leone (to 14 Aug 2014)

Sherlock Holmes was famously quoted as saying that ‘when you have eliminated the impossible, whatever remains, however improbable, must be the truth?’

Yesterday I had a Twitter conversation with virologist Ian M Mackay and currently Sierra Leone deployed health reporter Jennifer Yang about the disconnect between the official World Health Organisation figures and the Sierra Leone Ministry of Health updates. In brief, the Sierra Leone MoH figures are always lower than those presented by WHO which made no sense to me given that the MoH should be data-prime. The numbers anomaly had recently been noted by key Flublogist Crawford Kilian on his blog H5N1.

During the conversation a number of theories were put forward by various parties including a lack of capacity on the ground, data-chain promulgation/speed issues and even a conspiracy theory where-by the Ebola outbreak is linked to central government suppression of the Kailahun/Kenema districts (which border both Guinea/Liberia) as both districts are opposition strongholds.

Although there is certainly issues around ‘boots on the ground’ capacity (see Jennifer’s excellent article from Sierra Leone) the answer to the question as to why there was a significant difference between the Sierra Leone MoH and the WHO numbers turned out to be blindingly obvious.

Most of the reports coming out directly from Sierra Leone are the Ministerial statements which only include confirmed numbers whereas if you dig a little further you can find the full updates including suspected and probable cases in the Ebola Situation Reports.

Here is the look at the situation in Sierra Leone by District based on the most updated Ebola Situation Report (Vol. 78 dated 14 August 2014).

The above infographic details the cases and fatalities from Ebola in Sierra Leone. Cases include all suspected, probably and confirmed cases and the provisional CFR is based on those total numbers.

As you can see the Kailahun and Kenema Districts are the most impacted regions with Sierra Leone accounting for 84.7% of all cases and 95.8% of all fatalities.

Data Sources

[1] Government of Sierra Leone Ministry of Health and Sanitation. EBOLA VIRUS DISEASE – SITUATION REPORT (Sit-Rep) – 14August, 2014. Government of Sierra Leone. Accessed 15 August 2014.

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August 8, 2014

Random Analytics: The West African Ebola Outbreak (to 4 Aug 2014)

Here are some updated charts and infographics of the 2014 Ebola Virus Disease outbreak using a number of primary sources including the most recent World Health Organisation Disease Outbreak News (DON) released 6 August 2014.

***** Please note that all EVD infographics in this series were updated with public source information to 4 August 2014 *****

Ebola (Top 10 Outbreaks by Case Numbers)

The first chart displays the top 10 outbreaks in order of case numbers. Each horizontal bar is filled with the flag(s) of the country where the outbreak occurred.

With clinical cases reaching 691 in Guinea, 516 in Liberia, 495 in Liberia and nine in Nigeria the West African outbreak has now become largest Ebola outbreak in history based on both case numbers (1711) and fatalities (932). The second largest outbreak was of the Ebola Sudan strain which occurred in Uganda (2000) when 425 became infected and 224 died. The recent outbreak is the first to migrate across international land borders. The only other recording of an EVD that jumped borders prior to this outbreak was the Gabon/RSA (1996) outbreak. In that instance a doctor caught the disease in Gabon and subsequently took an international flight to South Africa where he became ill and infected other Health Care Workers (HCWs).

Ebola (Cases by Classification and Year)

The second chart shows cases by classification (in order they are Ebola Zaire, Sudan, Bundibugyo, Reston and Ivory Coast) by year and then split into those recovered or those deceased (which follows in a red variant). The West African outbreak has become the most significant in terms of case numbers, eclipsing the 1976 dual outbreaks which saw 603 cases and 431 deaths (a combined Case Fatality Rate of 71.5%).

Currently the provisional Western African outbreak has seen 1711 cases and 932 deaths (a CFR of 54.5%).

Notes: Several years had just one case. They are 1972 (a retrospective fatality of Ebola Zaire in Zaire), 1977 (a single case of Ebola Zaire in Zaire), 1988 (an accidental infection of Ebola Zaire in Porton Down, UK) and 2011 (a single fatality of Ebola Sudan in Uganda).

The West African Outbreak – Cases & Fatalities by Month

The final chart shows both case numbers and fatalities by month. Each column is split into the current four impacted countries with data represented by the varying national flags.

The very interesting data point that springs out from this chart is that the DON I utilised for this only had data for the first four days of the month yet cases are already 271 and fatalities are 106. It should be noted that those figures are not exact as the DON that covered the month rollover between July and August had to be estimated (using a 50/50% split).

Acknowledgements: Data for this infographic was sourced from official reports from the World Health Organisation. I have also utilised resources from the CDC, CIDRAP, FluTrackers, and H5N1. I’m also a big fan of the analytical work of Virology Down Under (Ian Mackay) and Mens et Manus (Maia Majumder).

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July 30, 2014

Random Analytics: Ebola in Liberia (to 30 Jul 2014)

I have now been doing Random Analytics since October 2012 and analytics on Ebola itself was my sixth post (having been interested in the subject since I read The Hot Zone in the mid 1990’s. I’ve been doing complete posts on the subject recently, by impacted 2014 country, by African exposure, by top 10 outbreaks and by classification and year but this outbreak is moving faster than I can keep up with. I’ll now just concentrate on infographics that don’t get done in the mainstream narrative (or my flublogist colleagues don’t do). If you want to follow the detail more closely then follow Crawford Kilian, Ian Mackay or Maia Majumber (who does the dangdest infographics in the flublogist space).

Ebola in Liberia (to 30 July 2014)

***** Please note that this EVD infographic was updated with public source information to 2100hrs 30 July 2014 (EST) *****

As I go to print the overall Ebola situation can be found in the latest World Health Organisation advice (circa 27 July 2014). This infographic comes from the latest information from the Liberian Ministry of Health and Social Welfare via reliefweb. Situation Report No. 72 on the EBOLA Virus disease epidemic in Liberia as of 29th May to 28 July 2014. Detail:

Highlights

Lofa County

Bakedou

Citizens and CHSWT have reached a compromise to allow health workers to investigate and follow up cases. Unofficial: About 15 persons are currently ill.

Voinjama

One of the two patients in the holding room left against medical advice and relocated to Zorzor Curran Hospital. However, specimen was taken.

Bong County

There no lab technician to collect specimen

Bomi County

There is no trained personnel to manage cases – Also, there is no lab technician to collect specimen

Nimba County

Family of confirmed case continuously refuses to allow patient to be carried to treatment facility

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July 4, 2014

Random Analytics: MERS by Occupation (to >375)

Since my last Middle Eastern Respiratory Syndrome update (21 May 2014) there have been a number of key developments and even some improvements in data quality coming out of the Kingdom of Saudi Arabia.

The big announcement since my previous post was the addition of 113 legacy cases by the KSA Ministry of Health. Of the 113-cases, 42 were Health Care Workers and are included in the following charts.

Almost as importantly, the Saudi’s are now sharing their data with the World Health Organisation (WHO). The Disease Outbreak Notifications, or DON’s, are very comprehensive, light-years away from the Health Ministries updates of the past. With some irony I was pleased to see that Iran and the Kingdom featured together in the most recent DON. Perhaps we are seeing a form of MERS diplomacy occurring.

Here are the latest MERS by Occupation charts.

***** Please note that all infographics for this MERS-CoV article are using publically sourced information to 1200hrs 4 July 2014 (EST) *****

This first chart looks at those infected with MERS by Job Title or Function.

Key Notes:

Retired: The largest group. There are 150-retirees (39.5% of known job titles) represented in this chart but only 2 have been confirmed (1.3%). The bulk of the retirees represented in the chart are included if they did not have a job title or function attributed to them AND if their ages are greater than the official retirement age for their home country.
Health Care Workers (HCW): The second largest group. Includes all types of unidentified workers in the Health sector (i.e. Nurses and Doctors).
Nurse: I have been able to identify 23-Nurses and in at least two cases, their speciality (ER & ICU).
Farmer: Includes both Owners (9/75%) and Employees (3/25%). I suspect the higher weighting toward owners is due to the fact that they are all nationals (from KSA, Qatar and the UAE). The three farm employees that have been identified are all resident workers. Just a thought here. Rich owners get to see the doctor while residents might have a range of barriers which reduce their ability to receive primary care services or choose to work through what they might believe is a bad flu.
Pilgrim: Of the 11-Pilgrims I have been able to identify I believe at least 8 were Umrah linked while three were potentially due to the Haj.
Doctor: Six identified, including one surgeon and one ICU specialist.This infographic looks at those infected with MERS-CoV by Job Family. In short I think this is a key infographic for MERS as it gives you some confidence in the key narratives (i.e. that Health Care Workers are over represented in the data as an example).

Next chart, Job Families:

Key Notes:

With the inclusion of an additional 42 Health Care Workers the Non-Participatory (156/18.6%) group (Paediatrics, Students, Retiree’s and the Unemployed) move from the largest to the second largest Job Family.
Health Practitioners/Technical Operations (159/19.0%) or HCW as there more commonly known become the largest Job Family represented. This number includes the Nursing Assistant that was identified in Iran (but more on that later).
Paediatrics (18/2.1%) numbers have declined since the last update when they represented just 2.8% of the data then. Still seems low and Maia Majumder picked up on this in a recent post.
Pilgrim/Tourist (14/1.6%) has seen a slight increase due to some Umrah inclusions recently.
Healthcare Support (6/0.7%) numbers remain static so not sure if the Saudi announcement of legacy cases conflates HCW and HCSpt numbers.
Construction (2/0.2%) is a new inclusion from the previous update. Given the amount of building going on the in the Middle East, especially in Qatar this number seems on the very low side. I’d expect to see this number increase with more robust reporting.

Last chart.

The last chart looks at those overall main job families that are most impacted by MERS, specifically Farmers, Travellers, Paediatrics, Retirees, HCW & HCSpt (combined), Other and Unknown.

Key Notes:

Farmer (1.7%): With only 14 confirmed cases apart from 2013 you can barely see them across an entire year, quarter or month. Numbers seem low.
Traveller (1.7%): Like farming, numbers seem low.
Paediatrics (2.1%): As suggested previously, no new paediatric cases since my last update so the numbers have declined somewhat.
HCW & HCSpt (19.7%): Health Care Workers and I have also included Health Care Support Workers in this grouping as well. Numbers up on previous update due to the additional 42-cases.
Other (2.3%): All other occupations that have been publically released. I’ve actually reduced the number in this group by one from the last update due to improved reporting from Saudi Arabia.
Unknown (54.7%): Unknown occupations. Up slightly but with improved reporting I’m hoping that this will reduce (over time).

Final Thoughts (on the difference between a Health Care Worker and Health Care Support

Last month I tweeted that the Iranian Nursing Assistant (FT #827) should be counted as a Health Care Support worker rather than a HCW. I then got a number of return tweets from the likes of Helen Branswell, Ian M Mackay and others who disagreed with that line of thought.

When Helen and Ian ‘guide and advise’ it’s probably worth not disregarding that advice. Upon some personal review I decided that perhaps I had taken a too hard Workforce Planning line to my job functions without fully considering the clinical implications.

I have subsequently reviewed my thinking and have re-organised my data along the following lines.

Health Practitioners/Technical Operations (nee HCW) are any job title or function that is included in the Bureau of Labor Statistics SOC Occupations 29-0000 Healthcare Practitioners and Technical Occupations PLUS any clinical function that is included within the 31-0000 Healthcare Support Occupations, such as Nursing Assistants.

I am continuing to track Health Care Support personnel (there are four job titles already identified in the MERS data including Health Clinic Admin Officer, Health Domain Worker, Hospital Employee, Hospital Receptionist) as I believe the differentiation from HCW is important but I am including their data in job family charts and infographics.

In the end, I made a bad call and I thank those of you who took the time to correct my thinking.

Flublogia is certainly a community and one I truly appreciate being involved in.

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June 25, 2014

Random Analytics: Ebola 2014 (to 25 Jun 2014)

Here are some charts and infographics of the 2014 Ebola Virus Disease outbreak.

Ebola Outbreak (Guinea Prefectures 2014)

***** Please note that this EVD infographic was updated with public source information to 0900hrs 25 June 2014 (EST) *****

The above infographic looks at the breakdowns by Prefecture of EVD cases and fatalities within Guinea. Data sourced from Ebola virus disease, West Africa – update 23 June 2014.

Ebola Outbreak (Sierra Leone Districts 2014)

***** Please note that this EVD infographic was updated with public source information to 0900hrs 25 June 2014 (EST) *****

The above infographic looks at the breakdowns by District of EVD cases and fatalities within Sierra Leone. Data sourced from Ebola virus disease, West Africa – update 23 June 2014 and the latest Sierra Leone Ministry of Health update (via FluTrackers).

Ebola across Africa

***** Please note that this EVD infographic was updated with public source information to 0900hrs 25 June 2014 (EST). EVD types are EBOV = Ebola Zaire, SUDV = Ebola Sudan, BDBV = Ebola Bundibugyo and TAFV = Ebola Ivory Coast *****

The Ebola across Africa infographic details the country specific outbreaks of the EVD since it was first discovered in 1976 (with a 1972 retrospective case from Zaire included). As the map shows the bulk of the outbreaks have occurred within central Africa and the most deadly, Ebola Zaire causing the most cases in the Democratic Republic of Congo (formally Zaire). The most recent outbreak has actually occurred in West Africa, originating from Guinea and is a new isolate of Ebola Zaire (Gueckedou and Kissidougou).

As an additional point of interest I have also added the Health Expenditure per capita for each country in 2012 $USD (source: World Bank).

Notes: The 1976 – 2004 outbreaks of Ebola Sudan occurred in the bottom half of Sudan (now South Sudan). Zaire was renamed the Democratic Republic of Congo in 1997.

Ebola (Top 10 Outbreaks by Case Numbers)

***** ***** Please note that this EVD infographic was updated with public source information to 0900hrs 25 June 2014 (EST) *****

The next chart displays the top 10 outbreaks in order of case numbers and each horizontal bar is filled with the flag of the country where the outbreak occurred. With clinical cases reaching 344 in Guinea, 81 in Sierra Leone and 12 in Liberia the EBOV17 coded outbreak has now become largest (437) based on case numbers. The second largest outbreak (SUDV4) was of Ebola Sudan in Uganda (2000) when 425 became infected and 224 died. The recent outbreak is the first to migrate across international land borders. The only other recording of an EVD that jumped borders prior to this outbreak was the 10^th worst outbreak (EBOV8) when a doctor caught the disease in Gabon and subsequently took an international flight to South Africa where he became ill and infected other health workers.

Notes: EBV outbreaks in order from lowest to highest. 10^th: EBOV8 (Gabon/South Africa), 9^th: EBOV9 (Gabon), 8^th: EBOV11 (Republic of Congo), 7^th: BDBV01 (Uganda), , 6^th: EBOV15 (Democratic Republic of Congo), 5^th: SUDV1 (technically Sudan but would now be South Sudan), 4^th: EBOV6 (Zaire but now the DRC), 3^rd: EBOV2 (Zaire but now the DRC), 2^nd: SUDV4 (Uganda) and the current, now deadliest outbreak EBOV17 (Guinea/Liberia/Sierra Leone).

Ebola (Cases by Classification and Year)

***** Please note that this EVD infographic was updated with public source information to 0900hrs 25 June 2014 (EST) *****

The final chart shows cases by classification (Ebola Zaire, Sudan, Bundibugyo, Reston and Ivory Coast) by year and then split into those recovered or those deceased (following in a red variant). From 24 June this latest outbreak has become the most significant in terms of case numbers, eclipsing the 1976 dual outbreaks which saw 603 cases and 431 deaths (a combined Case Fatality Rate of 71.5%).

Currently the provisional Western African outbreak has seen 604 cases and 350 deaths (a CFR of 57.9%).

Key Facts: (source: Fact Sheet 103, WHO, last updated March 2014)

The Ebola virus causes Ebola virus disease (EVD; formerly known as Ebola haemorrhagic fever) in humans;
EVD outbreaks have a case fatality rate of up to 90%;
EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests;
The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission;
Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus;
No specific treatment or vaccine is available for use in people or animals.

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June 10, 2014

Random Analytics: Ebola 2014 (to 9 Jun 2014)

The latest outbreak of Ebola which had been on the decline in early May has now returned with a vengeance. According to the latest update from the World Health Organisation (Regional Office for Africa) there have been 437-clinical cases and 232 fatalities. Guinea has borne the brunt of the disease with 344-clinical cases (215-deaths), the second impacted country Liberia has had 12-clinical cases (11-deaths) and newly impacted country of Sierra Leone has had 81-cases (6-deaths). These numbers are still likely to change.

According to my notes, this outbreak is now the worst on record in terms of case numbers, extending beyond the 425-cases (224-deaths) experienced during the Ebola Sudan outbreak in Uganda back in 2000-2001. Another two grim milestones is that this is the first Ebola outbreak to cross a land border and the first outbreak to impact on three separate countries.

Here are four charts/infographics looking at the most recent outbreak.

Ebola Virus Disease Outbreak (Guinea Prefectures 2014)

***** Please note that this infographic of the EVD was updated with public source information to 1200hrs 9 June 2014 (EST) *****

From the World Health Organisation Regional Office for Africa. Ebola virus disease, West Africa (Situation as of 5 June 2014). Excerpt:

Guinea

Between 2 and 3 June 2014, 11 new cases (8 confirmed, 1 probable and 2 suspected) and 3 new deaths were reported from Conakry (7 new cases and 1 death), Guéckédou (2 new cases and 1 death), Telimele (1 new case and 0 death) and Boffa (1 new case and 1 death). This brings the cumulative total number of cases and deaths attributable to EVD in Guinea to 344 (laboratory confirmed 207, probable 81 and suspected 56) including 215 deaths.

The geographical distribution of these cases and deaths is as follows: Conakry (65 cases and 27 deaths; Gueckedou, 193 cases and 143 deaths; Macenta, 44 cases and 26 deaths; Dabola, 4 cases and 4 deaths; Kissidougou, 7 cases and 5 deaths; Dinguiraye, 1 case and 1 death; Telimele, 23 cases and 5 deaths; and Boffa, 7 cases and 4 deaths. In terms of isolation, 31 patients are currently hospitalized (6 in Conakry, 9 in Guéckédou, 15 in Telimele and 1 in Boffa).

Sierra Leone

Between 2 and 5 June 2014, 9 new suspected cases were reported bringing the total number of EVD clinical cases to 81 (31 confirmed, 3 probable, and 47 suspected) including 6 deaths. Kailahun district is the epicentre of the outbreak in Sierra Leone. Eleven (11) cases are currently in isolation at Kenema Hospital. The number of contacts currently being followed-up is 30. Community resistance is hindering the identification and follow-up of contacts.

Notes: The map graphic was taken from Wikipedia (then amended).

Ebola across Africa

***** Please note that this infographic of the EVD was updated with public source information to 1200hrs 9 June 2014 (EST). EBOV = Ebola Zaire, SUDV = Ebola Sudan, BDBV = Ebola Bundibugyo and TAFV = Ebola Ivory Coast *****

As an additional point of interest I have also added the Health Expenditure per capita for each country in 2012 $USD (source: World Bank).

Notes: The 1976 – 2004 outbreaks of Ebola Sudan occurred in the bottom half of Sudan (now South Sudan). Zaire was renamed the Democratic Republic of Congo in 1997.

Ebola (Top 10 Outbreaks by Case Numbers)

***** Please note that this infographic of the EVD was updated with public source information to 1200hrs 9 June 2014 (EST) *****

Ebola (Cases by Classification and Year)

***** Please note that this infographic of the EVD was updated with public source information to 1200hrs 9 June 2014 (EST) *****

The final chart shows cases by classification (Ebola Zaire, Sudan, Bundibugyo, Reston and Ivory Coast) by year and then split into those recovered or those deceased (following in a red variant). As you can see the initial outbreak in 1976 of the both Ebola Zaire and Ebola Sudan was the most significant year with 603 cases and 431 deaths (a combined Case Fatality Rate of 71.5%). With up to 437 clinical cases so far the 2014 Ebola Zaire outbreak is now the second worst in terms of case numbers.

Key Facts: (source: Fact Sheet 103, WHO, last updated March 2014)

The Ebola virus causes Ebola virus disease (EVD; formerly known as Ebola haemorrhagic fever) in humans;
EVD outbreaks have a case fatality rate of up to 90%;
EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests;
The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission;
Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus;
No specific treatment or vaccine is available for use in people or animals.

Acknowledgements: Data for this infographic was sourced from official reports from the World Health Organisation. I have also utilised resources from the CDC, CIDRAP, H5N1, Virology Down Under and National Geographic.

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Tag: Disease