title: Epidemiological and Surveillance Response to Ebola Virus Disease Outbreak in Lofa County, Liberia (March-September, 2014); Lessons Learned.
abstract: Ebola Virus Disease (EVD) outbreak was confirmed in Liberia on March 31st 2014. A response comprising of diverse expertise was mobilized and deployed to the country to contain transmission of Ebola and give relief to a people already impoverished from protracted civil war. This paper describes the epidemiological and surveillance response to the EVD outbreak in Lofa County in Liberia from March to September 2014. Five of the 6 districts of Lofa were affected. The most affected districts were Voinjama/Guardu Gbondi and Foya. By 26th September, 2014, a total of 619 cases, including 19.4% probable cases, 20.3% suspected cases and 44.2% confirmed cases were recorded by the Ebola Emergency Response Team (EERT) of Lofa County. Adults (20-50 years) were the most affected. Overall fatality rate was 53.3%.  Twenty two (22) cases were reported among the Health Care Workers with a fatality rate of 81.8%. Seventy eight percent (78%) of the contacts successfully completed 21 days follow-up while 134 (6.15%) that developed signs and symptoms of EVD were referred to the ETU in Foya. The contributions of the weak health systems as well as socio-cultural factors in fueling the epidemic are highlighted. Importantly, the lessons learnt including the positive impact of multi-sectorial and multidisciplinary and coordinated response led by the government and community.  Again, given that the spread of infectious disease can be considered a security threat every effort has to put in place to strengthen the health systems in developing countries including the International Health Regulation (IHR)'s core capacities. Key words:  Ebola virus disease, outbreak, epidemiology and surveillance, socio-cultural factors, health system, West Africa.
authors.affiliation: Immunization Vaccine and Emergencies Program, Regional Office for Africa, World Health Organization, Brazzaville, Congo.
authors.forename: Koffi Isidore
authors.initials: KI
authors.lastname: Kouadio
authors.affiliation: World Health Organization, Monrovia Office, Liberia.
authors.forename: Peter
authors.initials: P
authors.lastname: Clement
authors.affiliation: Lofa County Health Office, Ministry of Health and Social Welfare, Voinjama, Liberia.
authors.forename: Josephus
authors.initials: J
authors.lastname: Bolongei
authors.affiliation: Lofa County Health Office, Ministry of Health and Social Welfare, Voinjama, Liberia.
authors.forename: Alpha
authors.initials: A
authors.lastname: Tamba
authors.affiliation: World Health Organization, Monrovia Office, Liberia.
authors.forename: Alex Ntale
authors.initials: AN
authors.lastname: Gasasira
authors.affiliation: Immunization Vaccine and Emergencies Program, Regional Office for Africa, World Health Organization, Brazzaville, Congo.
authors.forename: Abdihamid
authors.initials: A
authors.lastname: Warsame
authors.affiliation: Immunization Vaccine and Emergencies Program, Regional Office for Africa, World Health Organization, Brazzaville, Congo.
authors.forename: Joseph Chukwudi
authors.initials: JC
authors.lastname: Okeibunor
authors.affiliation: Immunization Vaccine and Emergencies Program, Regional Office for Africa, World Health Organization, Brazzaville, Congo.
authors.forename: Martin Okechukwu
authors.initials: MO
authors.lastname: Ota
authors.affiliation: Community Health Services Division, Ministry of Health and Social Welfare, Monrovia, Liberia.
authors.forename: Boima
authors.initials: B
authors.lastname: Tamba
authors.affiliation: Immunization Vaccine and Emergencies Program, World Health Organization Regional Office for Africa, Brazzaville, Congo.
authors.forename: Nicksy
authors.initials: N
authors.lastname: Gumede
authors.affiliation: Immunization Vaccine and Emergencies Program, Regional Office for Africa, World Health Organization, Brazzaville, Congo.
authors.forename: Keith
authors.initials: K
authors.lastname: Shaba
authors.affiliation: Immunization Vaccine and Emergencies Program, Regional Office for Africa, World Health Organization, Brazzaville, Congo.
authors.forename: Alain
authors.initials: A
authors.lastname: Poy
authors.affiliation: Immunization Vaccine and Emergencies Program, Regional Office for Africa, World Health Organization, Brazzaville, Congo.
authors.forename: Mbaye
authors.initials: M
authors.lastname: Salla
authors.affiliation: Immunization Vaccine and Emergencies Program, Regional Office for Africa, World Health Organization, Brazzaville, Congo.
authors.forename: Richard
authors.initials: R
authors.lastname: Mihigo
authors.affiliation: Immunization Vaccine and Emergencies Program, Regional Office for Africa, World Health Organization, Brazzaville, Congo.
authors.forename: Deo
authors.initials: D
authors.lastname: Nshimirimana