Staying at Zero: Keeping Ebola Out of Liberia

Tamba Alpha, a surveillance officer, is inspecting isolation rooms at a Voinjama checkpoint with Dr. Charles Ntege, WHO county coordinator. Photo courtesy of WHO/M. Winkler

More than a month has passed since Ebola transmission ceased in Liberia. This hard-fought achievement is still being celebrated across the country, where nearly 11,000 people became infected with the virus and 4,800 died. Liberia is still urging communities not to let their guard down until Ebola is gone from the region. They are working closely with the World Health Organization (WHO) and other partners to keep Ebola from reemerging.

Ebola transmission may be over in Liberia, but in northwestern Lofa County health officials are concerned about its return. The virus first surfaced in the county in March 2014 via a traveler from Guinea and went on to devastate the country.

All six districts of northwestern Lofa County share a border with Guinea or Sierra Leone, where the Ebola transmission continues. Every day, hundreds of people pour into Lofa from the two Ebola-hit countries - traders, merchants, farmers and other economic migrants, relatives of Liberians attending weddings and funerals and patients going to Liberian health centers in border towns. On market days, the numbers double. They enter Liberia through 33 official border checkpoints and nearly 300 unofficial, mostly unmanned crossings.

"We are at high risk that Ebola will resurface in Liberia as long as transmission continues in neighbouring countries," warns Tamba Alpha, the top surveillance officer in Lofa and the man in charge of implementing the Liberian Government’s action plan to prevent re-importation of the virus. "My greatest worry is that people think Ebola is finished and are going back to their normal practices at a time when community members, health workers, local authorities, security, everyone needs to continue precautions and surveillance."

Active surveillance and infection prevention and control measures at Liberia’s borders and in border communities and health facilities is one part of a larger Liberian government surveillance strategy, designed in partnership with WHO, to prevent a reintroduction of Ebola.

The Liberian government is training hundreds of health workers, security personnel, and national, county and district officials, with the help of WHO and other key partners. They are being trained in surveillance protocols and procedures, monitoring compliance, beefing up security and health staff at checkpoints, boosting cross-border cooperation with Guinea and Sierra Leone and revising public messages - urging vigilance until Ebola is gone from the region.

The plan is both ambitious and extremely challenging.

Lofa is one of five Liberian counties that border Guinea or Sierra Leone. Alpha says 160 trained health workers have been deployed with immigration and security staff at official border crossings to screen for symptoms of Ebola and other infectious diseases. Nine isolation rooms are in place at primary checkpoints with more on the way. Critical information is exchanged at monthly coordination meetings with counterparts in Guinea, Sierra Leone, WHO and other partners.

At the border, travelers are guided to Bernice Nyumah, who screens them for symptoms of Ebola, and records their name, gender, age, destination. Photo courtesy of WHO/M. Winkler

But he still has many concerns. He ticks off a list of staffing, technical capacity and financial constraints. Mostly, he’s concerned about loosening infection prevention and control practices in border communities and at clinics, as well as the large number of people who enter unchecked Lofa County at informal border crossings.

WHO field coordinator Anthony Kergosien, who has been working closely with Alpha and the County Health Team, says community surveillance was key to containing Ebola during the emergency and will be one of the most important factors in keeping the virus from returning.

"During the outbreak in Liberia, community health workers and volunteers played a critical role in detecting something wrong in their villages and raising alarm," says Kergosien. "We need community members to stay engaged, active and alert and to keep spreading messages of caution and vigilance. They are Liberia’s best sentinels."

Source: WHO