Ebola virus epidemic in West Africa

Ebola virus epidemic in West Africa

Situation map of the outbreak in West Africa
Date December 2013 – present
Casualties
  • Note: the CDC currently estimates that actual cases in Liberia, Sierra Leone, and Guinea are two to three times higher than officially reported numbers.[1][2][3]
Country Cases Deaths Last update
1 May 2015
Liberia Liberia 10,322 4,608 23 April 2015[4]
Sierra Leone Sierra Leone 12,398 3,901 29 April 2015[4]
Guinea Guinea 3,578 2,383 29 April 2015[4]
Nigeria Nigeria 20 8 outbreak ended 19 October 2014[5][6]
Mali Mali 8 6 outbreak ended 18 January 2015[7]
United States United States 4 1 outbreak ended 21 December 2014[8]
United Kingdom United Kingdom 1 0 outbreak ended 10 March 2015[9]
Senegal Senegal 1 0 outbreak ended 17 October 2014[5]
Spain Spain 1 0 outbreak ended 2 December 2014[10]
Total 26,333 10,907 as of 29 April 2015

The most widespread epidemic of Ebola virus disease (commonly known as "Ebola") in history is currently ongoing in several West African countries.[11][12] It has caused significant mortality, with reported case fatality rates of up to 70%[13][14][15][note 1] and specifically 57–59% among hospitalized patients.[16] Ebola virus disease was first described in 1976 in two simultaneous outbreaks in sub-Saharan Africa; this is the 26th outbreak and the first to occur in West Africa. It began in Guinea in December 2013 and then spread to Liberia and Sierra Leone.[13] A small outbreak of twenty cases occurred in Nigeria and one case occurred in Senegal; both Nigeria and Senegal are now declared disease-free.[17] Several cases were reported in Mali,[18] but this outbreak has also been declared over,[7] and an isolated case has been reported in the United Kingdom.[15] Imported cases in the United States and Spain led to secondary infections of medical workers but did not spread further.[19][20] As of 29 April 2015, the World Health Organization (WHO) and respective governments have reported a total of 26,333 suspected cases and 10,907 deaths,[21] though the WHO believes that this substantially understates the magnitude of the outbreak.[1][22]

This is the first Ebola outbreak to reach epidemic proportions; past outbreaks were brought under control within a few weeks. Extreme poverty, a dysfunctional healthcare system, a mistrust of government officials after years of armed conflict, and the delay in responding to the outbreak for several months have all contributed to the failure to control the epidemic. Other factors include local burial customs that include washing of the body after death and the spread to densely populated cities.[23][24][25][26][27]

As the disease progressed, many hospitals, short on both staff and supplies, became overwhelmed and closed, leading some health experts to state that the inability to treat other medical needs may be causing "an additional death toll [that is] likely to exceed that of the outbreak itself".[28][29] Hospital workers, who work closely with the highly contagious body fluids of the diseased, have been especially vulnerable to catching the disease. In August 2014, the WHO reported that ten percent of the dead have been healthcare workers.[30] In September 2014, it was estimated that the countries' capacity for treating Ebola patients was insufficient by the equivalent of 2,122 beds; by December there were a sufficient number of beds to treat and isolate all reported Ebola cases, although the uneven distribution of cases was resulting in serious shortfalls in some areas.[31] On 28 January 2015, the WHO reported that for the first time since the week ending 29 June 2014, there had been fewer than 100 new confirmed cases reported in a week in the three most-affected countries. The response to the epidemic then moved to a second phase, as the focus shifted from slowing transmission to ending the epidemic.[32] On 8 April 2015, the WHO reported a total of only 30 confirmed cases, the lowest weekly total since the third week of May 2014.[33]

The World Health Organization has been criticised for its delay in taking action to address the epidemic.[34] By September 2014, Médecins Sans Frontières/Doctors Without Borders (MSF), the non-governmental organization (NGO) with the largest working presence in the affected countries, had grown increasingly critical of the international response. Speaking on 3 September, the president of MSF spoke out concerning the lack of assistance from the United Nations member countries saying, "Six months into the worst Ebola epidemic in history, the world is losing the battle to contain it."[35] In a 26 September statement, the WHO said, "The Ebola epidemic ravaging parts of West Africa is the most severe acute public health emergency seen in modern times" and the Director-General, Margaret Chan, called the outbreak "the largest, most complex and most severe we've ever seen".[36] In March 2015, the United Nations Development Group reported that due to a decrease in trade, closing of borders, flight cancellations, and foreign investment and tourism activity fuelled by stigma, the epidemic has resulted in vast economic consequences in both the affected areas and even throughout African nations that experienced low or no cases of Ebola.[37] In April 2015, the Pulitzer Prize for feature photography was awarded to Daniel Berehulak for his photojournalism of the Ebola outbreak.[38]

Epidemiology

Outbreak

  Widespread outbreak: Guinea
  Limited outbreak: Sierra Leone
  Isolated cases: Liberia
  Medically evacuated cases
  Ebola-free after prior cases

Researchers generally believe that a one-year-old boy,[39] later identified as Emile Ouamouno, who died in December 2013 in the village of Meliandou, Guéckédou Prefecture, Guinea, was the index case of the current Ebola virus disease epidemic.[40][41] His mother, sister, and grandmother then became ill with similar symptoms and also died. People infected by those initial cases spread the disease to other villages.[42][43] Although Ebola represents a major public health issue in sub-Saharan Africa, no cases had ever been reported in West Africa and the early cases were diagnosed as other diseases more common to the area. Thus, the disease had several months to spread before it was recognized as Ebola.[41][42]

On 25 March 2014, the World Health Organization (WHO) reported that Guinea's Ministry of Health had reported an outbreak of Ebola virus disease in four southeastern districts, with suspected cases in the neighbouring countries of Liberia and Sierra Leone being investigated. In Guinea, a total of 86 suspected cases, including 59 deaths had been reported as of 24 March.[44] By late May, the outbreak had spread to Conakry, Guinea's capital, a city of about two million inhabitants.[44] On 28 May, the total number of cases reported had reached 281 with 186 deaths.[44]

In Liberia, the disease was reported in four counties by mid-April 2014 and cases in Liberia's capital Monrovia were reported in mid-June.[45][46] The outbreak then spread to Sierra Leone and progressed rapidly. By 17 July, the total number of suspected cases in the country stood at 442, overtaking the number in Guinea and Liberia.[47] By 20 July, additional cases of the disease had been reported in the Bo District and the first case in Freetown, Sierra Leone's capital, was reported in late July.[48][49]

The first death in Nigeria was reported on 25 July 2014:[50] a Liberian-American with Ebola flew from Liberia to Nigeria and died in Lagos soon after arrival.[51][52] As part of the effort to contain the disease, possible contacts were monitored – 353 in Lagos and 451 in Port Harcourt.[53] On 22 September, the WHO reported a total of 20 cases, including eight deaths. The WHO's representative in Nigeria officially declared Nigeria Ebola-free on 20 October after no new active cases were reported in the follow up contacts.[54]

On 29 August 2014, Senegalese Minister of Health announced the first case in Senegal. The victim was subsequently identified as a Guinean national who had been exposed to the virus and had been under surveillance, but had travelled to Dakar by road and fallen ill after arriving.[55] This person subsequently recovered, and on 17 October 2014, the WHO officially declared that the outbreak in Senegal had ended.[56]

In August and September 2014, two Spanish health care workers contracted Ebola in Liberia and were transferred to Spain for treatment where they both died. In October, a nursing assistant who had been part of their health care team was diagnosed with Ebola, making this the first Ebola case contracted outside of Africa. The nursing assistant recovered and was declared disease-free on 19 October.[57] There have been Ebola cases in the United States of America as well. A Liberian man who had traveled from Liberia to be with his family in Texas was declared to have Ebola and subsequently died on 8 October. Two nurses who had cared for the patient contracted the disease;[58] they both recovered and tested Ebola-free on 27 October 2014. On 23 October, the first case of Ebola in Mali was confirmed, a two-year-old girl who had returned from Guinea.[6][59][60] In a separate outbreak in November, Mali reported seven cases with five deaths in Bamako.[18]

In mid-November, the WHO reported that while all cases and deaths continued to be under-reported, "there is some evidence that case incidence is no longer increasing nationally in Guinea and Liberia, but steep increases persist in Sierra Leone".[61][62][63] One year into the outbreak, the total number of cases exceeded 20,000 on 29 December 2014.

On 28 January 2015, the WHO reported that for the first time since the week ending 29 June 2014, there had been fewer than 100 new confirmed cases reported in a week in the three most-affected countries. A combined total of 99 confirmed cases were reported from the three countries in the week to 25 January: 30 in Guinea, 4 in Liberia, and 65 in Sierra Leone. The response to the epidemic then moved to a second phase as the focus shifted from slowing transmission to ending the epidemic. Efforts have now moved from rapidly building infrastructure to ensuring that capacity for case finding, case management, safe burials, and community engagement is used as effectively as possible.[32]

On 31 March 2015, one year since the outbreak was first reported, the total number of cases exceeded 25,000 with over 10,000 deaths according to the latest WHO report.[64] The 8 April 2015 WHO Ebola Situation Report stated that a total of 30 confirmed cases were reported in the week to 5 April; this is the lowest weekly total since the third week of May 2014.[33]

Countries with widespread transmission

Ebola outbreak in West Africa – outbreak distribution map as of 15 April 2015

Guinea

On 25 March 2014, the WHO reported an outbreak of Ebola virus disease in four southeastern districts with a total of 86 suspected cases, including 59 deaths. Médecins Sans Frontières (MSF) assisted the Ministry of Health of Guinea by establishing Ebola treatment centers in the epicenter of the outbreak.[44] On 31 March, the U.S. Centers for Disease Control and Prevention (CDC) sent a five-person team to assist Guinea's Ministry of Health and the WHO as they led an international response to the Ebola outbreak.[44]

Thinking that the virus was contained, MSF closed its treatment centers in May leaving only a small skeleton staff to handle the Macenta region. However, high numbers of new cases reappeared in the region in late August.[65]

On 19 October 2014, the WHO reported that although disease transmission remained intense, of the three districts affected, transmission remained the lowest in Guinea.[5] In mid-November it was reported that, while all cases and deaths continued to be under-reported, there was some evidence that case incidence was no longer increasing.[61] However, on 7 December, the WHO reported that the trend in Guinea since early October had been slightly increasing, with between 75 and 148 confirmed cases reported in each of the previous seven weeks.

According to the WHO, 60% of the Ebola cases in Guinea are related to the practice of traditional burial rituals. Speaking on 27 January, Guinea's Grand Imam El Hadj Mamadou Saliou Camara, the country's highest cleric, said, "There is nothing in the Koran that says you must wash, kiss or hold your dead loved ones," and he called on citizens to do more to stop the virus by practicing safer burying rituals that do not compromise tradition.[66]

On 11 February, Guinea recorded a rise in cases for the second week in a row.[67] Health authorities said that the rise in cases was related to the fact that they "were only now gaining access to faraway villages" where violence had previously prevented them from entering.[68] On 14 February, violence broke out and an Ebola treatment center near the center of the country was destroyed. According to Guinea Red Cross teams, they have been attacked an average of 10 times a month over the last year.[69] On 24 February, MSF reported that acceptance of Ebola education in Guinea remained low and that an increase in violent attacks against their workers may force them to leave. On 28 March, a 45-day "health emergency" was declared in 5 regions of the country in response to the virus.[70] On 20 April, it was reported that the court system in Guinea sentenced 11 individuals to life in prison after having murdered a team of Ebola educators.[71]

Liberia

An Ebola treatment unit in Liberia

In Liberia, the disease was reported in Lofa and Nimba counties in late March 2014.[72] On 27 July, Ellen Johnson Sirleaf, the Liberian president, announced that Liberia would close its borders, with the exception of a few crossing points such as the airport, where screening centres would be established.[73] Schools and universities were closed,[74][75] and the worst-affected areas in the country were placed under quarantine.[76]

With only 50 physicians in the entire country—one for every 70,000 Liberians—Liberia already faced a health crisis even before the outbreak.[77] In September the US CDC reported that some hospitals had been abandoned while those which were still functioning lacked basic facilities and supplies.[78] In October, the Liberian ambassador in Washington was reported as saying that he feared that his country may be "close to collapse".[77] By 24 October, all of the 15 Liberian districts had reported Ebola cases.[5][79]

In November the rate of new infections in Liberia appeared to be declining and the state of emergency was lifted. The drop in cases was believed to be related to an integrated strategy combining isolation and treatment with community behaviour change including safe burial practices, case finding and contact tracing.[80][81]

In January 2015, the MSF field coordinator reported that Liberia was down to only five confirmed cases.[82] In March, after two weeks of not reporting any new cases, three new cases were confirmed.[83] On 8 April, a new health minister was named in an effort to end Ebola in Liberia. The last known case of Ebola died on 27 March, and the country is conducting the 42-day countdown to be officially declared free of the disease.[84] On 26 April, Doctors Without Borders handed ELWA - 3, an Ebola treatment facility, back to the government of Liberia.[85] On 30 April, the U.S. shut down a special Ebola treatment unit in Liberia.[86]

Sierra Leone

Kenema Hospital, Sierra Leone

The first person reported infected in the spread to Sierra Leone was a tribal healer who had been treating Ebola patients from across the nearby border with Guinea and died on 26 May 2014. According to tribal tradition, her body was washed for burial and this appears to have led to infections in women from neighbouring towns.[87] On 11 June, Sierra Leone shut its borders for trade with Guinea and Liberia and closed some schools in an attempt to slow the spread of the virus.[88] On 30 July, the government began to deploy troops to enforce quarantines.[89] By 15 October, the last district in Sierra Leone untouched by the disease had declared Ebola cases.[90]

During the first week of November, it was reported that the situation was "getting worse" due to intense transmission in Freetown as a contributing factor. According to the Disaster Emergency Committee, food shortages resulting from aggressive quarantines were making the situation worse.[91] On 4 November, it was reported that thousands violated quarantine in search for food in the town of Kenema.[92] With the number of cases continuing to increase, a MSF coordinator reported the situation in Sierra Leone as "catastrophic", saying: "There are several villages and communities that have been basically wiped out... Whole communities have disappeared but many of them are not in the statistics."[93] In mid-November the WHO reported that, while there was some evidence that cases were no longer increasing in Guinea and Liberia, steep increases persisted in Sierra Leone.[61] Although the international community had responded to the emergency by building and equipping treatment centres, they were not able to function effectively because of lack of staff, poor coordination, government mismanagement and inefficiency.[94]

Ebola crisis- More UK aid arrives in Sierra Leone

On 9 December, news reports described the discovery of "a grim scene": piles of bodies, overwhelmed medical personnel and exhausted burial teams in the remote Eastern Kono District.[95] On 15 December, the CDC indicated that their main concern was Sierra Leone where the epidemic had given no evidence of halting and cases continued to rise exponentially; during the second week of December Sierra Leone reported nearly 400 cases, more than three times the number of cases reported by Guinea and Liberia combined. According to the CDC, "the risk we face now [is] that Ebola will simmer along, become endemic and be a problem for Africa and the world, for years to come."[96] On 17 December, President Koroma launched "Operation Western Area Surge" and workers went door-to-door in the capital city looking for possible cases.[97][98] The operation led to a surge in the number of cases, with 403 new cases reported between 14 to 17 December.[97][99]

According to the 21 January 2015 WHO Situation Report, case incidence was rapidly decreasing in Sierra Leone,[100][101] but on 5 February, it was reported that there was a rise in weekly cases for the first time this year.[102][103] The U.N. indicated that the sharp drop in cases had "flattened out" raising concern about the spread of the virus,[104] and on 5 March, a report indicated cases in Sierra Leone continued to rise.[105]

A 5 April WHO report again disclosed a downward trend in cases with confidence that it will continue. Sierra Leone had reported zero cases on 3 days during the week to 5 April with no reports of unsafe burials over the same period.[106]

Countries with successfully contained spread

Senegal

In March 2014, the Senegal Ministry of Interior closed the southern border with Guinea,[107] but on 29 August the Senegal health minister announced Senegal's first case, a university student from Guinea who was being treated in a Dakar hospital.[55] The case was a native of Guinea who had traveled to Dakar, arriving on 20 August. On 23 August, he sought medical care for symptoms including fever, diarrhoea, and vomiting. He received treatment for malaria, but did not improve and left the facility. Still experiencing the same symptoms, on 26 August he was referred to a specialized facility for infectious diseases, and was subsequently hospitalized.[55]

On 28 August 2014, authorities in Guinea issued an alert informing medical services in Guinea and neighbouring countries that a person who had been in close contact with an Ebola infected patient had escaped their surveillance system. The alert prompted testing for Ebola at the Dakar laboratory, and the positive result launched an investigation and triggered urgent contact tracing.[55] On 10 September, it was reported that the student had recovered but health officials would continue to monitor his contacts for 21 days.[108] No further cases were reported.[109] and on 17 October, the WHO officially declared that the outbreak in Senegal had ended.[5]

The WHO have officially commended the Senegalese government, and in particular the President Macky Sall and the Minister of Health Dr Awa Coll-Seck, for their response in quickly isolating the patient and tracing and following up 74 contacts, as well as for their public awareness campaign. This acknowledgement was also extended to MSF and the CDC for their assistance.[110] On 27 January, Senegal opened its land border with Guinea.[111]

Nigeria

Nigerian states with Ebola cases (Lagos, Port Harcourt)
Nigerian health care workers at a training event, August 2014

The first case in Nigeria was a Liberian-American, Patrick Sawyer, who flew from Liberia to Nigeria's commercial capital Lagos on 20 July 2014. Sawyer became violently ill upon arriving at the airport and died five days later. In response, the Nigerian government observed all of Sawyer's contacts for signs of infection and increased surveillance at all entry points to the country.[112] On 6 August 2014, the Nigerian health minister told reporters, "Yesterday the first known Nigerian to die of Ebola was recorded. This was one of the nurses that attended to the Liberian. The other five [newly confirmed] cases are being treated at an isolation ward."[113] On 19 August, it was reported that the doctor who treated Sawyer, Ameyo Adadevoh, had also died of Ebola disease.[114]

On 22 September 2014, the Nigeria health ministry announced, "As of today, there is no case of Ebola in Nigeria. All listed contacts who were under surveillance have been followed up for 21 days." According to the WHO, 19 cases and 7 deaths had been confirmed, along with the imported case, who also died. Four of the dead were health care workers who had cared for Sawyer. In all, 529 contacts had been followed and of that date they had all completed a 21-day mandatory period of surveillance.[115] The WHO's representative in Nigeria officially declared Nigeria to be Ebola free on 20 October after no new active cases were reported in the follow up contacts, stating it was a "spectacular success story".[54]

On 9 October 2014, the European Centre for Disease Prevention and Control (ECDC) acknowledged Nigeria's positive role in controlling the effort to contain the Ebola outbreak. "We wish to thank the Federal Ministry of Health, Abuja, Nigeria, and the staff of the Ebola Emergency Centre who coordinated the management of cases, containment of outbreaks and treatment protocols in Nigeria." Nigeria's quick responses, including intense and rapid contact tracing, surveillance of potential contacts, and isolation of all contacts were of particular importance in controlling and limiting the outbreak, according to the ECDC.[116] Complimenting Nigeria's successful efforts to control the outbreak, "the usually measured WHO declared the feat 'a piece of world-class epidemiological detective work'."[117]

Spain

On 5 August 2014, the Brothers Hospitallers of St. John of God confirmed that Brother Miguel Pajares, who had been volunteering in Liberia, had become infected. He was evacuated to Spain and died on 12 August.[118] On 21 September it was announced that Brother Manuel García Viejo, another Spanish citizen who was medical director at the San Juan de Dios Hospital in Lunsar, had been evacuated to Spain from Sierra Leone after being infected with the virus. His death was announced on 25 September.[119]

In October 2014, a nursing assistant, Teresa Romero, who had cared for these patients became unwell and on 6 October tested positive for Ebola,[120][121] making this the first confirmed case of Ebola transmission outside Africa. On 19 October, it was reported that Romero had recovered,[57] and on 2 December the WHO declared Spain Ebola-free following the passage of 42 days since Teresa Romero was found to be cured.[122]

United States

On 30 September 2014, the United States Centers for Disease Control and Prevention (CDC) declared its first case of Ebola virus disease. The CDC disclosed that Thomas Eric Duncan became infected in Liberia and traveled to Texas on 20 September. On 26 September he fell ill and sought medical treatment but was sent home with antibiotics. He returned to the hospital by ambulance on 28 September and was placed in isolation and tested for Ebola.[123][124] Thomas Duncan died on 8 October.[125] Two additional cases stemmed from Thomas Eric Duncan, when Nina Pham and Amber Vinson tested positive for Ebola on October 10 and 14[126][127] and ended when they were declared Ebola free on October 24 and 22, respectively.[128][129]

A fourth case of Ebola was identified on 23 October 2014 when Dr. Craig Spencer, a physician who had treated Ebola patients in West Africa, himself tested positive for Ebola.[130] This case had no relation to the cases originating from Thomas Eric Duncan. He recovered and was released from hospital on 11 November.[131]

Mali

Malian regions with Ebola cases (Kayes, Bamako)

On 23 October 2014, the first case of Ebola disease in Mali was confirmed in the city of Kayes; a two-year-old girl who had arrived with a family group from Guinea. Her father had worked for the Red Cross in Guinea and had also worked in a private health clinic; he died earlier in the month, likely from an Ebola infection which he had contracted in the private clinic. It was later established that a number of family members had also died of Ebola. A family group returned to Mali after the father's funeral via public bus and taxi, a journey of more than 1,200 kilometres (750 mi). On 23 October, the girl tested positive for Ebola but died the next day.[132][133] All contacts were followed for 21 days, with no further spread of the disease reported.[134]

On 12 November 2014, Mali reported deaths from Ebola in an outbreak which is not connected with the first case in Kayes. The first probable case was an imam who had fallen ill on 17 October in Guinea and was transferred to the Pasteur Clinic in Mali's capital city Bamako for treatment. He was treated for kidney failure but was not tested for Ebola; he died on 27 October and his body was returned to Guinea for burial.[135] A nurse and a doctor who had treated the imam subsequently fell ill with Ebola and died.[136][137] The next three cases were related to the imam as well: a man who had visited the imam while he was in hospital, his wife, and his son. On 22 November, the final case related to the imam was reported: a friend of the Pasteur Clinic nurse who had died from the Ebola virus.[138] On 12 December, the last case in treatment recovered and was discharged, "so there are no more people sick with Ebola in Mali”, according to a Ministry of Health source.[139] On 16 December, Mali released the final 13 individuals who were being quarantined[6][140] and 24 days later (18 January 2015) without new cases the country was declared Ebola-free.[7]

Countries with limited local cases

United Kingdom

On 29 December 2014, a British aid worker who had just returned to Glasgow from Sierra Leone via Casablanca Airport and London Heathrow Airport was diagnosed with Ebola in Glasgow.[141][142] She was transferred to the specialist high-level isolation unit at the Royal Free Hospital in London[141][143] where she was treated with blood plasma from Ebola survivors.[144] She was declared to be free of infection and released from hospital on 24 January 2015.[145] On 10 March, the U.K. was declared Ebola-free by WHO.[9]

Countries with medically evacuated cases

A number of people who had become infected with Ebola virus disease have been medically evacuated to treatment in isolation wards in Europe or the US. These are mostly health workers with one of the NGOs in the area. With the exception of a single isolated case in Spain, no secondary infections have occurred as a result of these medical evacuations.

France

A French volunteer health worker working for MSF in Liberia contracted Ebola and was flown to France on 18 September 2014. After successful treatment at Bégin Military Teaching Hospital, she was discharged on 4 October.[146]

On 1 November, a United Nations employee who had contracted Ebola was evacuated from Sierra Leone to France for treatment. On 23 November, it was announced that the person, whose identity was not disclosed, had recovered.[147]

Germany

On 27 August 2014, a Senegalese epidemiologist working for the WHO in Sierra Leone became the first German patient. On 4 October he was discharged after being declared noninfectious.[148]

On 4 October 2014, a Ugandan pediatrician, Michael Mawanda working in Sierra Leone, was flown to Germany for treatment at the University Hospital in Frankfurt.[149][150] He was released on 19 November after seven weeks of intensive treatment.[151]

On 9 October 2014, a Sudanese doctor working with the United Nations UNMIL peacekeeping force in Liberia[152] was transported to the St Georg Hospital in Leipzig for treatment.[153] He died on 14 October, becoming the first person on German soil to die of Ebola.[154]

Italy

On 24 November 2014 the Italian Health Ministry announced that an Italian doctor later identified as Fabrizio Pulvirenti, working for Emergency in Lakka, Sierra Leone, contracted Ebola.[155] On 25 November a military plane carrying Pulvirenti landed at Pratica di Mare military airport, from which he was transferred to the Lazzaro Spallanzani National Institute for Infectious Diseases in Rome. On 10 December, the infectious disease unit of the hospital reported that the patient's conditions improved[156] and he was discharged on 2 January 2015.[157][158]

Netherlands

A United Nations UNMIL Peacekeeper who contracted the disease in Liberia arrived in the Netherlands on 6 December 2014 according to the Health Ministry.[159] The Nigerian soldier was treated at the University Medical Centre in Utrecht. This is the third peacekeeper who contracted the disease. The first two cases were fatal.[160] On 19 December, it was reported that the Nigerian UN peacekeeper was cured of Ebola; on 23 December, the peacekeeper was released and returned to Liberia.[161]

Norway

On 6 October 2014, MSF announced that one of their workers, a Norwegian national, had become infected in Sierra Leone. On 7 October the woman, Silje Lehne Michalsen, was admitted to a special isolation unit at Oslo University Hospital.[162][163] On 20 October, it was announced that she had been successfully treated and had been discharged.[164]

Switzerland

On 18 November 2014 a Cuban doctor, Felix Baez, tested positive for Ebola in Sierra Leone. He arrived in Geneva on Friday 21 Nov for treatment at the Geneva University Hospital. Baez was able to step off the plane unaided.[165] On December 6 it was announced that he had recovered and left the country.[166]

United Kingdom

An isolation unit at the Royal Free Hospital, London, received its first case on 24 August 2014. William Pooley, a British nurse, was evacuated from Sierra Leone by the Royal Air Force on a specially-equipped C-17 aircraft. He was released from hospital on 3 September.[167][168]

On 11 March 2015, a U.K. military worker tested positive for Ebola and was flown home for treatment at Royal Free Hospital in London.[169] On 17 March, it was reported that another U.K. worker had been sent back to the United Kingdom from Sierra Leone due to fear of having contracted the virus.[170] Cpl Anna Cross, the U.K. military worker tested positive for Ebola, was the first person in the world to be treated with the experimental Ebola drug MIL 77 and was released from hospital after making a full recovery. The doctors treating her confirmed it is too soon to speculate if the drug helped in her recovery.[171]

United States

A number of people who contracted Ebola virus disease while working in the affected areas have been medically evacuated to the United States for treatment; most recovered, but one has died.[172] On 17 November 2014 Dr. Martin Salia, evacuated from Sierra Leone to the US, died of the Ebola virus, aged 44 years.[173] On 12 March, a U.S. health worker was diagnosed positive in Sierra Leone, and was therefore medically evacuated to Bethesda, Maryland. The individual was said to be in serious condition,[174][175] which was changed to critical,[176] and 10 or more Americans were evacuated from Sierra Leone to the U.S. due to exposure.[177] On 26 March 2015 the NIH have upgraded the medically evacuated health worker who is currently being treated in Bethesda, Maryland from critical to serious. A further 16 volunteers are being monitored for possible exposure.[178]

Separate outbreak in the Democratic Republic of the Congo

In August 2014, the WHO reported an outbreak of Ebola virus in the Boende District, part of the northern Équateur province of the Democratic Republic of the Congo (DRC), where 13 people were reported to have died of Ebola-like symptoms.[179] Genetic sequencing revealed that this outbreak was the Zaire Ebola species, which is indigenous to the DRC; there have been seven previous Ebola outbreaks in the country since 1976. The virology results and epidemiological findings indicate no connection to the epidemic in West Africa.[179][180]

The index case was initially reported to have been a woman from Ikanamongo Village who became ill with symptoms of Ebola after she had butchered a bush animal.[179] However more recent findings suggested that there may have been several previous cases, and it was reported that the pigs in the village may have been infected with Ebola some time before the first human case occurred.[181] The WHO declared the outbreak over on 21 November 2014, with a total of 66 cases with 49 deaths.[182][183]

Virology

Ebola virus particles
See also: Ebola_virus

Ebola virus disease is caused by four of five viruses classified in the genus Ebolavirus. Of the four disease-causing viruses, Ebola virus (formerly and often still called the Zaire virus), is the most dangerous and is the species responsible for the ongoing epidemic in West Africa.[184][185] Since the discovery of the viruses in 1976 when outbreaks occurred in Sudan and the Democratic Republic of Congo (then called Zaire), Ebola virus disease has been confined to areas in Central Africa, where it is endemic. With the current outbreak, it was initially thought that a new species endemic to Guinea might be the cause, rather than being imported from central to West Africa.[41] However, further studies have shown that the current outbreak is likely caused by an Ebola virus lineage that has spread from Central Africa via an animal host within the last decade, with the first viral transfer to humans in Guinea.[184][186]

In a study done by Tulane University, the Broad Institute and Harvard University, in partnership with the Sierra Leone Ministry of Health and Sanitation, researchers may have provided information about the origin and transmission of the Ebola virus that sets this outbreak apart from previous outbreaks. For this study, 99 Ebola virus genomes were collected and sequenced from 78 patients diagnosed with the Ebola virus during the first 24 days of the outbreak in Sierra Leone. From the resulting sequences, and three previously published sequences from Guinea, the team found 341 genetic changes that make the outbreak distinct from previous outbreaks. It is still unclear whether these differences are related to the severity of the current situation.[184] Five members of the research team became ill and died from Ebola before the study was published in August 2014.[184]

The ongoing genome sequencing in Sierra Leone has provided valuable information in the study of the Ebola virus. Researchers have tracked the spread of Ebola in Sierra Leone from the group first infected, the 13 women who had attended the funeral of a traditional healer where they contracted the disease, giving a unique opportunity to track how the virus has changed. This tracking has provided "the first time that the real evolution of the Ebola virus can be observed in humans.” The research showed that the outbreak in Sierra Leone was sparked by at least two distinct viruses which had been introduced from Guinea at about the same time. It is not clear whether the traditional healer was infected with both variants, or if perhaps one of the women attending the funeral was independently infected. As the Sierra Leone epidemic progressed, one virus lineage disappeared from patient samples, while a third lineage appeared. The discovery that the genome is changing fairly rapidly has raised concerns related to diagnostic testing, vaccines, and the effectivness of medications such as the drug ZMapp.[187][188] In January 2015, researchers in Guinea also reported that the virus is going through considerable change in the samples that they were looking at. They reported: "We've now seen several cases that don't have any symptoms at all, asymptomatic cases. These people may be the people who can spread the virus better, but we still don't know that yet. A virus can change itself to less deadly, but more contagious and that's something we are afraid of." Also, while extremely unlikely, researchers remain concerned that the virus could morph into an airborne disease given the time.[189]

Transmission

The life cycles of the Ebolavirus

It is not entirely clear how an Ebola outbreak starts.[190] The initial infection is believed to occur after an Ebola virus is transmitted to a human by contact with an infected animal's body fluids. Evidence strongly implicates bats as the reservoir hosts for ebolaviruses. Bats drop partially eaten fruits and pulp, then land mammals such as gorillas and duikers feed on these fallen fruits. This chain of events forms a possible indirect means of transmission from the natural host to animal populations.[191] As primates in the area were not found to be infected and fruit bats do not live near the location of the initial zoonotic transmission event in Meliandou, Guinea it is suspected that the index case occurred after a child played with an insectivorous bat from a colony of Angolan free-tailed bats near the village.[192]

Human-to-human transmission occurs only via direct contact with blood or bodily fluids from an infected person who is showing signs of infection or by contact with objects recently contaminated by an actively ill infected person.[193] Airborne transmission has not been documented during Ebola outbreaks, however in February 2015 a group of researchers published a paper suggesting, "it is very likely that at least some degree of Ebola virus transmission currently occurs via infectious aerosols". Commenting on the study, an infectious disease specialist, William Schaffner, said that while the study raised issues "it would be rare; as the study points out, it has never been demonstrated in humans."[194]

The time interval from infection with the virus to onset of symptoms is two to twenty-one days. Because dead bodies are still infectious, the handling of the bodies of Ebola victims can only be done while observing proper barrier/ separation procedures.[195] One study suggested that the virus can live up to 7 days in a deceased individual.[196] Semen and possibly other body fluids (e.g., breast milk) may be infectious in survivors for months.[197][198]

One of the primary reasons for spread is the poorly-functioning health systems in the part of Africa where the disease occurs.[199] The risk of transmission is increased among those caring for people infected. Recommended measures when caring for those who are infected include medical isolation via the proper use of boots, gowns, gloves, masks and goggles, and sterilizing equipment and surfaces.[190]

One of the biggest dangers of infection faced by medical staff requires their learning how to properly suit up and remove personal protective equipment. Full training for wearing protective body clothing can take 10 to 14 days.[200] Even with proper isolation equipment available, working conditions such as lack of running water, climate control, and flooring have made direct care difficult. Two American health workers who contracted the disease and later recovered said that to the best of their knowledge their team of workers had been following "to the letter all of the protocols for safety that were developed by the CDC and WHO", including a full body coverall, several layers of gloves, and face protection including goggles. One of the two, a physician, had worked with patients, but the other was assisting workers to get in and out of their protective gear, while wearing protective gear herself.[201] Difficulties in attempting to halt transmission have also included the multiple disease outbreaks across country borders.[202] Dr Peter Piot, the scientist who co-discovered the Ebola virus, has stated that the present outbreak is not following its usual linear patterns as mapped out in previous outbreaks. This time the virus is "hopping" all over the West African epidemic region.[65] Furthermore, past epidemics have occurred in remote regions, but this outbreak has spread to large urban areas, which has increased the number of contacts an infected person may have and has made transmission harder to track and break.[33] On 15 April, a WHO statement indicated, "for greater security and prevention of other sexually transmitted infections, Ebola survivors should consider correct and consistent use of condoms for all sexual acts beyond three months until more information is available."[203] On the same day it was reported that the virus has been detected in semen, 6 months after recovery.[204] On 28 April, it was reported that WHO will try to isolate all patients with the virus in West Africa towards the end of May.[205]

Containment and control

Nigerian doctors receive training in how to use protective clothing by the World Health Organization.

In August 2014, the WHO published a road map of the steps required to bring the epidemic under control and to prevent further transmission of the disease within West Africa; the coordinated international response is working to realise this plan.[206] Key elements required to prevent transmission are contact tracing and follow-up as well as social mobilisation and public awareness.

Surveillance and contact tracing

Contact tracing is an essential method of preventing the spread of the disease. This requires effective community surveillance so that a possible case of Ebola can be registered and accurately diagnosed as soon as possible, and subsequently finding everyone who has had close contact with the case and tracking them for 21 days. However, this requires careful record-keeping by properly trained and equipped staff.[207] WHO Assistant Director-General for Global Health Security, Keiji Fukuda, said on 3 September, "We don't have enough health workers, doctors, nurses, drivers, and contact tracers to handle the increasing number of cases."[208] There is a massive ongoing effort to train volunteers and health workers, sponsored by USAID.[209] According to WHO reports, 25,926 contacts from Guinea, 35,183 from Liberia and 104,454 from Sierra Leone were listed and being traced as of 23 November 2014.[62]

Community awareness

In order to reduce the spread, the World Health Organization recommends raising community awareness of the risk factors for Ebola infection and the protective measures individuals can take.[210] These include avoiding contact with infected people and regular hand washing using soap and water.[211] A condition of extreme poverty exists in many of the areas that have experienced a high incidence of infections. According to the director of the NGO Plan International in Guinea, "The poor living conditions and lack of water and sanitation in most districts of Conakry pose a serious risk that the epidemic escalates into a crisis. People do not think to wash their hands when they do not have enough water to drink."[212]

A number of organisations have enrolled local people to conduct public awareness campaigns among the communities in West Africa.[213] "...what we mean by social mobilization is to try to convey the right messages, in terms of prevention measures, adapted to the local context – adapted to the cultural practices in a specific area,” said Vincent Martin, FAO’s representative in Senegal.[214]

Denial in some affected countries has also made containment efforts difficult.[215] Language barriers and the appearance of medical teams in protective suits has sometimes increased fears of the virus.[216] In Liberia, a mob attacked an Ebola isolation centre, stealing equipment and "freeing" patients while shouting "There's no Ebola."[217] Red Cross staff were forced to suspend operations in southeast Guinea after they were threatened by a group of men armed with knives.[218] In September 2014 in the town of Womey in Guinea, suspicious inhabitants wielding machetes murdered at least eight aid workers and dumped their bodies in a latrine.[219]

An August 2014 study found that nearly two thirds of Ebola cases in Guinea were believed to be due to burial practices including washing of the body of one who has died.[25][26][27][39][48][220] In November, WHO released a protocol for safe and dignified burial of people who die from Ebola virus disease which encourages inclusion of family and clergy, giving specific instructions for Muslim and Christian burials.[221] In the 21 January 2015 WHO road map update it was reported that 100% of districts in Sierra Leone and 71% of districts in Guinea have a list of key religious leaders who promote safe and dignified burials.[222] Speaking on 27 January 2015, Guinea's Grand Imam, the country's highest cleric, gave a very strong message saying, "There is nothing in the Koran that says you must wash, kiss or hold your dead loved ones," and he called on citizens to do more to stop the virus by practicing safer burying rituals that do not compromise tradition.[223]

Travel restrictions and quarantines

A quarantine travel pass for people providing help to people who are infected with Ebola

There is serious concern that the disease may spread further within West Africa or elsewhere in the world.

West Africa

On 8 August 2014, a cordon sanitaire, a disease-fighting practice that forcibly isolates affected regions, was established in the triangular area where Guinea, Liberia, and Sierra Leone are separated only by porous borders and where 70 percent of the known cases had been found.[224] This has subsequently been replaced by a series of simple checkpoints for hand-washing and measuring body temperature on major roads throughout the region, manned either by local volunteers or by military.[225][226]

International

Many countries have considered imposing restrictions on travel to or from the region. On 2 September 2014, WHO Director-General Margaret Chan advised against this, saying that they are not justified and that they are preventing medical experts from entering the affected areas and are "marginalizing the affected population and potentially worsening the crisis". UN officials working on the ground have also criticized the travel restrictions, saying the solution is "not in travel restrictions but in ensuring that effective preventive and curative health measures are put in place".[30] MSF, also speaking out against the closure of international borders, called it "another layer of collective irresponsibility" and added, "The international community must ensure that those who try to contain the outbreak can enter and leave the affected countries if need be."[35]

As of February 2015, countries still maintaining entry restrictions for Ebola affected countries are Antigua and Barbuda, Australia, Bahrain, Belize, Botswana, Brazil, Cameroon, Cape Verde, Cayman Islands, Central African Republic, Chad, Ivory Coast, Dominican Republic, Equatorial Guinea, Gabon, Gambia, Guyana, Haiti, India, Iraq, Jamaica, Kenya, Maldives, Mauritius, Mongolia, Oman, Panama, Rwanda, Sao Tome and Principe, Saudi Arabia, Senegal, Seychelles, Singapore, South Africa, Sri Lanka, Saint Kitts and Nevis, Suriname, Trinidad and Tobago and the United States.[227]

Returning health workers

There is concern that people returning from affected countries, such as health workers and reporters, may be incubating the disease and become infectious after arriving. A number of agencies have issued guidelines for returning workers; examples are CDC,[228] MSF,[229] Public Health England,[230] and Public Health Ontario.[231] Generally these recommend a risk assessment based on the likelihood of exposure. People in the low risk category are recommended to self-monitor for 21 days for symptoms which may indicate Ebola; there are more stringent requirements for those judged to be at higher risk.

Treatment

Practising taking blood in Ebola safety suits

No proven Ebola virus-specific treatment presently exists,[232] however there are measures that can be taken that will improve a patient's chances of survival.[233] Ebola symptoms may begin as early as two days or as long as 21 days after one is exposed to the virus. They usually begin with a sudden influenza-like stage characterized by feeling tired, fever, and pain in the muscles and joints. Later symptoms may include headache, nausea, and abdominal pain. This is often followed by severe vomiting and diarrhoea.[234] In past outbreaks it has been noted that some patients may experience the loss of blood through bleeding internally and/or externally, however early data suggests that bleeding has been a rare symptom in this particular outbreak.[235]

Without fluid replacement, such extreme loss of fluids leads to dehydration which may lead to hypovolaemic shock, a condition which occurs when there isn't enough blood for the heart to pump through the body. If a patient is alert and is not vomiting, oral rehydration fluids may be given, but patients who are vomiting or are delirious should be hydrated with intravenous therapy (IV); however, administration of intravenous fluids is difficult in the African environment. Inserting an IV needle while wearing three pairs of gloves and goggles which may be fogged is difficult and once in place, the site and line must be constantly monitored. Without sufficient staff to care for patients, needles may become dislodged or pulled out by a delirious patient. A patient's electrolytes must be closely monitored to determine correct fluid administration, and many areas do not have access to laboratory services.[236]

Although there is currently no cure or treatment for the disease medical experts are divided over whether aggressive treatment with IV fluids must be given to Ebola patients. Some believe that aggressive treatment with IV fluids is medically possible and even "a moral obligation". According to the WHO, the main reason that most patients in American and European hospitals have survived is the use of IV fluids along with constant measuring of blood chemistry. Dr. Robert A. Fowler, a specialist leading the WHO Ebola team, states that the “early, liberal use of intravenous fluid and electrolyte replacement,” should be standard care in all Ebola treatment centers. Paul Farmer of Partners in Health, an NGO that has only recently begun to treat Ebola patients, strongly supports IV therapy for all Ebola patients stating, “What if the fatality rate isn’t the virulence of disease but the mediocrity of the medical delivery?" Farmer has suggested that every treatment facility should have a team that specializes in inserting IVs, or better yet, peripherally inserted central catheter (PICC) lines. Based on many years of experience in Africa and several months of experience working with the present epidemic, MSF takes a more conservative approach. While using IV treatment for as many patients as they can manage, they argue that improperly managed IV treatment is not helpful and may even kill a patient. They also state that they are concerned about the further risk for staff.[236] While experts have studied the mortality rates of different treatment settings, given the wide differences in variables that affect outcome adequate information has not yet been gathered to make a definitive statement about what may constitute the optimal care in the West African setting.[237]

Some Ebola survivors have reported lingering health effects. A WHO consultant states “Many of the survivors are discharged with the so-called Post-Ebola Syndrome. We want to ascertain whether these medical conditions are due to the disease itself, the treatment given or chlorine used during disinfection of the patients. This is a new area for research; little is known about the post Ebola symptoms.”[238][239]

Prognosis

Ebola virus disease has a high case fatality rate (CFR-risk of death in those infected) which varies between 25 percent and 90 percent of those who have contracted the disease. The average case fatality rate is about 50%, however it is known that the Zaire species, which is responsible for the current outbreak, carries a higher death rate.[240] Care settings that have access to medical expertise may increase survival by providing maintenance of hydration, circulatory volume, and blood pressure.[235]

The disease affects males and females equally and the majority of those that contract Ebola disease are between 15 and 45 years of age.[13] For those over 45 years of age, a fatal outcome has been more likely in the current epidemic, as has also been noted in past outbreaks.[235] Only rarely do pregnant women survive. A midwife who works with MSF in a Sierra Leone treatment center states that she knew of "no reported cases of pregnant mothers and unborn babies surviving Ebola in Sierra Leone."[241]

It has been suggested that the loss of human life is not limited to Ebola victims alone. Many hospitals have shut down leaving people with other medical needs without care. A spokesperson for the UK-based health foundation the Wellcome Trust said in October that "the additional death toll from malaria and other diseases [is] likely to exceed that of the outbreak itself".[28] Doctor Paul Farmer states "Most of Ebola's victims may well be dying from other causes: women in childbirth, children from diarrhoea, people in road accidents or from trauma of other sorts."[29] On 9 April, WHO indicated that virus survivors were having eye and joint problems.[242]

Level of care

WHO workers gear up to go into Ebola isolation ward in Lagos, Nigeria - 2014.

In June 2014 it was reported that local authorities did not have resources to contain the disease, with health centres closing and hospitals overwhelmed.[243] There were also reports that adequate personal protection equipment was not being provided for medical personnel.[244] The Director-General of MSF said, "Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the international community to provide this support on the most urgent basis possible."[202]

In late August, MSF called the situation "chaotic" and the medical response "inadequate". They reported that they had expanded their operations but were unable to keep up with the rapidly increasing need for assistance which had forced them to reduce the level of care they were able to offer: "It is not currently possible, for example, to administer intravenous treatments." Calling the situation "an emergency within the emergency", MSF reported that many hospitals had shut down due to lack of staff or fears of the virus among patients and staff, which has left people with other health problems without any care at all. Speaking from a remote region, a MSF worker said that a shortage of protective equipment was making the medical management of the disease difficult and that they had limited capacity to safely bury bodies.[245]

By September, treatment for Ebola patients had become unavailable in some areas. Speaking on 12 September, WHO Director-General Margaret Chan said, "In the three hardest hit countries, Guinea, Liberia and Sierra Leone, the number of new cases is moving far faster than the capacity to manage them in the Ebola-specific treatment centers. Today, there is not one single bed available for the treatment of an Ebola patient in the entire country of Liberia."[246] According to a WHO report released on 19 September, Sierra Leone was currently meeting only 35% of its need for patient beds, and Liberia was meeting only 20% of its need.[247] The WHO set a goal to isolate and treat 100% of Ebola cases and provide safe burials by 1 January 2015.

In early December, the WHO reported that at a national level there were a sufficient number of beds in treatment facilities to treat and isolate all reported Ebola cases, although the uneven distribution of cases was resulting in serious shortfalls in some areas. Similarly, all affected countries had sufficient and widespread capacity to bury all reported deaths; however, because not all deaths are reported, it was possible that some areas still had insufficient burial capacity. They reported that every district now had access to a laboratory to confirm cases of Ebola within 24 hours from sample collection, and that all three countries had reported that more than 80% of registered contacts associated with known cases of EVD were being traced, although contact tracing was still a challenge in areas of intense transmission and in areas of community resistance.[31]

Current bed capacity in countries with active cases as of 21 Dec 2014.[248]
Countries Existing beds Planned beds Percentage of
existing/planned beds
Guinea 250 655 38%
Liberia 510 1,989 26%
Sierra Leone 1,207 1,783 59%
Total 1,967 4,427 44%

Healthcare settings

Ebola treatment centre built by the UK in Kerry Town, Sierra Leone, in 2014

A number of Ebola Treatment Centres have been set up in the area, supported by international aid organisations and staffed by a combination of local and international staff. Each treatment centre is divided into a number of distinct and rigorously separate areas. For patients, there is a triage area, and low- and high-risk care wards. For staff, there are areas for preparation and decontamination. An important part of each centre is an arrangement for safe burial or cremation of bodies, required to prevent further infection.[249][250] In January 2015, a new treatment and research center was built by Rusal and Russia in the city of Kindia in Guinea. It is one of the most modern medical centers in Guinea.[251][252] Also in January, MSF admitted its first patients to a new treatment centre in Kissy, an Ebola hotspot on the outskirts of Freetown, Sierra Leone. The center has a maternity unit for pregnant women with the virus.[253][254]

Although the WHO does not advise caring for Ebola patients at home, in some cases it became a necessity when no hospital treatment beds were available. For those being treated at home, the WHO advised informing the local public health authority and acquiring appropriate training and equipment.[255][256] UNICEF, USAID and the NGO Samaritan's Purse began to take measures to provide support for families that were forced to care for patients at home by supplying caregiver kits intended for interim home-based interventions. The kits included protective clothing, hydration items, medicines, and disinfectant, among other items.[257][258] Even where hospital beds are available, it has been debated whether conventional hospitals are the best place to care for Ebola patients, as the risk of spreading the infection is high.[259] In October the WHO and non-profit partners launched a program in Liberia to move infected people out of their homes into ad hoc centres that could provide rudimentary care.[260]

Protective clothing

The Ebola epidemic has caused an increasing demand in protective clothing. A full set of protective clothing includes a suit, goggles, mask, socks and boots, and an apron. Boots and aprons can be disinfected and reused, but everything else must be destroyed. Health workers change garments frequently, discarding gear that has barely been used. This not only uses a great deal of time but also exposes them to the virus because for health care workers wearing protective clothing, one of the most dangerous times for catching Ebola is while suits are being removed.[261]

The protective clothing set that MSF uses cost about $75 apiece. Staff who have returned from deployments to West Africa say the clothing is so heavy that it can be worn for only about 40 minutes at a stretch. A physician working in Sierra Leone has said, "After about 30 or 40 minutes, your goggles have fogged up; your socks are completely drenched in sweat. You're just walking in water in your boots. And at that point, you have to exit for your own safety...Here it takes 20-25 minutes to take off a protective suit and must be done with two trained supervisors who watch every step in a military manner to ensure no mistakes are made, because a slip up can easily occur and of course can be fatal."[262][263] By October there were reports that protective outfits were beginning to be in short supply and manufacturers began to increase their production,[264] but the need to find better types of suits has also been raised.[265]

USAID published an open competitive bidding for proposals that address the challenge of developing "... new practical and cost-effective solutions to improve infection treatment and control that can be rapidly deployed; 1) to help health care workers provide better care and 2) transform our ability to combat Ebola".[266][267][268] On 12 December 2014, USAID announced the result of the first selection in a press release.[269]

On 17 December 2014, a team at Johns Hopkins developed a prototype breakaway hazmat suit. The project has been awarded a grant from the U.S. Agency for International Development (USAID) to develop. The prototype has a small, battery-powered cooling pack on the worker's belt; "you'll have air blowing out that is room temperature but it's 0% humidity ... the Ebola worker is going to feel cold and will be able to function inside the suit without having to change the suit so frequently," indicated one source.[270] On 19 March, Google developed a tablet that can be cleaned with chlorine; it was created to help medics treating patients with the virus.[271] The device will be used in Sierra Leone. It is charged wirelessly and can transmit information to servers outside of the area.[272]

Médecins Sans Frontières and American CDC staff preparing to enter an Ebola treatment unit in Liberia

Healthcare workers

In the hardest hit areas there have historically been only one or two doctors available to treat 100,000 people, and these doctors are heavily concentrated in urban areas.[33] In August 2014, it was reported that healthcare workers represented nearly 10 percent of the cases and fatalities, significantly impairing the ability to respond to the outbreak in an area which already faces a severe shortage.[273] By 22 February 2015, the WHO reported a total of 854 health workers had been infected and 496 had died. One infected case in Spain has been reported, as well as three in the United States, two in Mali with one death, and 11 in Nigeria, including five deaths.[274] Of the three most heavily affected areas Liberia has been especially hard hit with 372 and 180 deaths reported. Guinea reported 170 infected cases with 89 deaths. Sierra Leone registered 295 cases with 221 fatalities on 17 February 2015.[275]

Healthcare providers caring for people with Ebola and family and friends in close contact with people with Ebola are at the highest risk of getting infected, because they may come in direct contact with the blood or body fluids of the sick person. In some places affected by the outbreak care may be provided in clinics with limited resources, and workers can be in these areas for several hours with a number of Ebola infected patients.[276] According to the WHO, the high proportion of infected medical staff can be explained by a lack of the number of medical staff needed to manage such a large outbreak, shortages of protective equipment or improperly using what is available, and "the compassion that causes medical staff to work in isolation wards far beyond the number of hours recommended as safe".[33]

Among the fatalities is Samuel Brisbane, a former advisor to the Liberian Ministry of Health and Social Welfare, described as "one of Liberia's most high-profile doctors".[277] In July 2014, leading Ebola doctor Sheik Umar Khan from Sierra Leone died in the outbreak.[87] His death was followed by two more deaths in Sierra Leone: Modupe Cole, a senior physician at the country's main referral facility,[278] and Sahr Rogers, who worked in Kenema.[279] In August, a well-known Nigerian physician, Ameyo Adadevoh, died.[280] Mbalu Fonnie, a licensed nurse midwife and nursing supervisor with over 30 years of experience at the Kenema hospital in Sierra Leone, died after contracting Ebola while caring for a fellow nurse who was pregnant and had Ebola. Fonnie was a co-author of a study that analyzed the genetics of the Ebola virus; five others contracted Ebola and died while working on the study as well.[187]

Basing their choice on "the person or persons who most affected the news and our lives, for good or ill, and embodied what was important about the year", in December 2014 the editors of Time magazine named the Ebola health workers as Person of the Year. Editor Nancy Gibbs said, "The rest of the world can sleep at night because a group of men and women are willing to stand and fight. For tireless acts of courage and mercy, for buying the world time to boost its defenses, for risking, for persisting, for sacrificing and saving, the Ebola fighters are Time's 2014 Person of the Year."[281]

Experimental treatments, vaccines and testing

Experimental treatments

There is as yet no known effective medication, vaccine, or treatment. However, should an effective vaccine be developed only moderate levels of coverage are needed to control epidemics (e.g. 20% coverage of a highly effective vaccine would likely be adequate [282]) . The director of the US National Institute of Allergy and Infectious Diseases has stated that the scientific community is still in the early stages of understanding how infection with the Ebola virus can be treated and prevented.[283][284][285]

As of February 2015 a number of experimental treatments are undergoing clinical trials.[286][287][288] One of these, Favipiravir (Avigan), was successful in initial trials and authorities in Guinea have approved its wider use.[289] On 1 February 2015, a clinical drug trial in Liberia was halted due to lack of patients. Health authorities have also reported that the falling number of patients may affect the plans for the testing of the experimental drug ZMapp and two vaccines as well.[290] On 22 April, it was reported that TKM-Ebola-Makona had worked by protecting three highly infected monkeys from the virus.[291]

Experimental preventative vaccines

Main article: Ebola vaccine

Several Ebola vaccine candidates had been developed in the decade prior to 2014, and had been shown to protect nonhuman primates (usually macaques) against lethal infection, but none has yet been approved for clinical use in humans.[292][293] In response to this epidemic, the clinical trial process has been accelerated; two of the potential vaccines cAd3-EBOZ and VSV-ZEBOV progressed to mass trials early in 2015.[294] Part of the trial will incorporate a ring vaccination strategy designed to test if vaccines might be useful for stamping out hot spots in outbreak settings.[295] As of 7 March, large scale vaccine trials have started in Guinea and Liberia.[296] On 25 March, it was reported that the vaccine raised no safety concerns; the rVSV-ZEBOV vaccine candidate invoked an anti-viral response in all the subjects.[297] On 8 April, two new vaccines by Merck, that in initial form caused joint pain, have been reintroduced and have passed initial tests.[298]

Potential diagnostic tests

One issue which hinders control of Ebola is that diagnostic tests which are currently available require specialised equipment and highly trained personnel. Since there are few suitable testing centres in West Africa, this leads to delay in diagnosis. In December, a conference in Geneva will aim to work out which diagnostic tools could be to identify Ebola reliably and more quickly. The meeting, convened by the WHO and the non-profit Foundation for Innovative New Diagnostics, seeks to identify tests that can be used by untrained staff, do not require electricity or can run on batteries or solar power and use reagents that can withstand temperatures of 40 °C.[299]

As of February 2015 a number of diagnostic tests are under trial:

Outlook

Since the beginning of the outbreak, there has been considerable difficulty in getting reliable estimates both of the number of people affected, and of the geographical extent of the outbreak.[305] The three countries which are most affected, Sierra Leone, Guinea and Liberia, are among the poorest in the world, with extremely low levels of literacy, few hospitals or doctors, poor physical infrastructure, and poorly functioning government institutions.[306]

Statistical measures

Calculating an accurate case fatality rate (CFR) is difficult for an ongoing epidemic due to differences in testing policies, the inclusion of probable and suspected cases, and the inclusion of new cases that have not run their course. In August 2014, the WHO made an initial CFR estimate of 53% though this included suspected cases.[307][308] In September and December 2014, WHO released revised and more accurate CFR figures, using data from patients with definitive clinical outcomes, of 70.8% and 71% respectively.[13][14][15] The CFR among hospitalized patients, based on three intense-transmission countries, is between 57% and 59%.[16]

The basic reproduction number R0 is a statistical measure of the average number of people who are expected to be infected by one person who has the disease in question. If the rate is less than 1, the infection will die out; if the rate is greater than 1, the infection will continue to spread in a population with exponential growth of cases.[309] During the first 9 months of the current outbreak, the reproduction number was estimated to be between 1.5 and 2.5.[13][310] If the reproduction number had continued to be approximately 1.5, as it was estimated to be in September 2014, the total number of infected individuals would have been 100,000 by the end of January 2015.[311]

Projections of future cases

On 28 August 2014, the WHO released its first estimate of the possible total cases (20,000) from the outbreak as part of its roadmap for stopping the transmission of the virus.[206] The WHO roadmap states "this Roadmap assumes that in many areas of intense transmission the actual number of cases may be two- to fourfold higher than that currently reported. It acknowledges that the aggregate case load of Ebola could exceed 20,000 over the course of this emergency. The Roadmap assumes that a rapid escalation of the complementary strategies in intense transmission, resource-constrained areas will allow the comprehensive application of more standard containment strategies within three months."[206] It includes an assumption that some country or countries will pay the required cost of their plan, estimated at half a billion dollars.[206]

When the WHO released its first estimated projected number of cases, a number of epidemiologists presented data to show that the WHO's projection of a total of 20,000 cases was likely an underestimate.[312][313] On 9 September, Jonas Schmidt-Chanasit of the Bernhard Nocht Institute for Tropical Medicine in Germany, controversially announced that the containment fight in Sierra Leone and Liberia has already been "lost" and that the disease would "burn itself out".[314]

On 23 September, the WHO revised their previous projection, stating that they expect the number of Ebola cases in West Africa to be in excess of 20,000 by 2 November.[13] They further stated, that if the disease is not adequately contained it could become endemic in Guinea, Sierra Leone and Liberia, "spreading as routinely as malaria or the flu",[315] and according to an editorial in the New England Journal of Medicine, eventually to other parts of Africa and beyond.[316]

A report on 23 September by CDC analyses the impact of under-reporting – which requires correction of case numbers by a factor of up to 2.5. With this correction factor, approximately 21,000 total cases were estimated for the end of September 2014 in Liberia and Sierra Leone alone. The same report predicted that total cases, including unreported cases, could reach 1.4 million in Liberia and Sierra Leone by the end of January 2015 if no improvement in intervention or community behaviour occurred.[1] However at a congressional hearing on 19 November the director of CDC said that the number of Ebola cases is no longer expected to exceed 1 million, moving away from the worst scenario that had been previously predicted.[317]

A study published in December 2014 found that transmission of the Ebola virus occurs principally within families, in hospitals and at funerals. The data, gathered during three weeks of contact tracing in August, showed that the third person in any transmission chain often knew both the first and second person. The authors estimated that between 17 percent and 70 percent of cases in West Africa are unreported – far fewer than had been estimated in prior projections. The study concludes that the epidemic is not as difficult to control as feared, if rapid, vigorous contact tracing and quarantines are employed.[318]

The Laboratory for the Modeling of Biological and Socio-Technical Systems (MoBS) at Northeastern University has published an online model which assesses the progression of the epidemic in West Africa and its international spread based on simulations of epidemic spread worldwide. The analysis is considered as a live paper that is constantly updated with new data, projections and analysis; it has been updated periodically through 2014.[319][320]

Economic effects

In addition to the loss of life, the outbreak is having a number of significant economic impacts.

Responses

Flag of WHO

Following the first known case in December 2013 in the village of Meliandou, Guinea, the disease spread to neighboring villages causing about 70 deaths. The deaths were attributed to other diseases endemic to the area; it was not properly identified as Ebola until March 2014.[370] The initial response by MSF, WHO and CDC seemed effective in April and May, but, in fact, failed.[371] By 21 June, according to MSF, the epidemic was “out of control.”[39]

In July, WHO convened an emergency meeting with health ministers from eleven countries and announced collaboration on a strategy to co-ordinate technical support to combat the epidemic. In August they published a roadmap to guide and coordinate the international response to the outbreak, aiming to stop ongoing Ebola transmission worldwide within 6–9 months, and formally designated the outbreak as a Public Health Emergency of International Concern.[372] This is a legal designation used only twice before (for the 2009 H1N1 (swine flu) pandemic and the 2014 resurgence of polio) which invokes legal measures on disease prevention, surveillance, control, and response, by 194 signatory countries.[373][374]

In September, the United Nations Security Council declared the Ebola virus outbreak in West Africa "a threat to international peace and security" and unanimously adopted a resolution urging UN member states to provide more resources to fight the outbreak; the WHO stated that the cost for combating the epidemic would be a minimum of $1 billion.[375][376]

During October, WHO and UNMEER announced a comprehensive 90-day plan to control and reverse the Ebola epidemic. The immediate objective was to isolate at least 70% of Ebola cases and safely bury at least 70% of patients who died from Ebola by 1 December 2014 (the 60-day target). The ultimate goal was to have capacity in place for the isolation of 100% of Ebola cases and the safe burial of 100% of casualties by 1 January 2015 (the 90-day target).[377] Many nations and charitable organizations cooperated to realise the plan.[378] A WHO situation report in mid-December indicated that the international community was on track to meet the 90-day target.[379] On 26 April, the U.N. appointed a new head for the emergency mission to West Africa in charge of the Ebola crisis.[380]

Criticism

There has been heavy criticism of the WHO from some aid agencies because its response has been perceived as slow and insufficient, especially during the early stage of the outbreak.[34][371] In October, the Associated Press reported that in an internal draft document the WHO admitted that "nearly everyone" involved in the Ebola response failed to notice factors that turned the outbreak into the biggest on record, and they had missed chances to stop the spread of Ebola due to "incompetent staff, bureaucracy and a lack of reliable information".[381] Peter Piot, co-discoverer of the Ebola virus, has called the WHO regional office in Africa "really not competent."[382] On 19 April, WHO admitted very serious failings in handling the crisis and indicated reforms for any future crisis; "we did not work effectively in coordination with other partners, there were shortcomings in risk communications and there was confusion of roles and responsibilities" further indicated a statement released by the organization.[383] Furthermore, WHO said it was a "reminder that the world, including WHO, is ill prepared for a large sustained disease outbreak".[384]

Timeline of reported cases and deaths

Data sources

Data comes from reports by the World Health Organization Global Alert and Response Unit[Resource 1] and the WHO's Regional Office for Africa.[Resource 2] All numbers are correlated with United Nations Office for the Coordination of Humanitarian Affairs (OCHA), if available.[Resource 3] The reports are sourced from official information from the affected countries' health ministries. The WHO has stated the reported numbers "vastly underestimate the magnitude of the outbreak", estimating there may be 3 times as many cases as officially reported.[1][385][386] As an example, Sierra Leone has had cases grow at a much faster rate, while simultaneously at an insoluble lower reported death rate versus those in Guinea and Liberia.[387] Liberia was singled out in the 8 and 14 October reports from WHO, noting "There continue to be profound problems affecting data acquisition in Liberia... it is likely that the figures will be revised upwards in due course."[20]

Characterizations of rate of growth

On October 23, 2014, WHO noted at a press conference that exponential increase of cases continued in the countries with the most intense transmission (Guinea, Liberia and Sierra Leone).[388] A study estimated during the first nine months of the outbreak the disease was transmitted onwards to approximately 1.7–2 people for each case.[13]

Understanding the data and its limitations

Each row of the table represents the best available information cross-checked from multiple sources on the day it was reported. The data may be inaccurate for the following reasons:

It is not possible to infer the rate of growth or decline in the spread of the disease from the cumulative data or the graphs; they simply reflect a timeline of the available data as reported on any given date. The real-world spread could be slowing while reported cumulative cases rise at a faster rate due to improved reporting, or the real-world spread could be increasing with flat cumulative data due to lack of reporting.

Graphs

Tables

Major Ebola virus outbreaks by country and by date – 4 January 2015 to most recent WHO / Gov update
Note: Cases include confirmed, probable and suspected per the WHO.
Date Total Guinea Liberia Sierra Leone Sources
Cases Deaths Cases Deaths Cases Deaths CasesDeaths
26 Apr 2015 26,277 10,884 3,584 2,377 ≥10,322 ≥4,608 12,371 3,899 [note 2][389]
19 Apr 2015 26,044 10,808 3,565 2,358 10,212 4,573 12,267 3,877 [note 3][390]
12 Apr 2015 25,791 10,689 3,548 2,346 ≥10,042 ≥4,486 12,201 3,857 [note 4][391]
5 Apr 2015 25,515 10,572 3,515 2,333 9,862 4,408 12,138 3,831 [note 5][392]
29 Mar 2015 25,178 10,445 3,492 2,314 9,712 4,332 11,974 3,799 [note 6][393]
22 Mar 2015 24,872 10,311 3,429 2,263 9,602 4,301 11,841 3,747 [note 7][393]
15 Mar 2015 24,666 10,179 3,389 2,224 9,526 4,264 11,751 3,691 [note 8][394]
8 Mar 2015 24,282 9,976 3,285 2,170 ≥9,343 ≥4,162 11,619 3,629 [note 9][395]
1 Mar 2015 23,934 9,792 3,219 2,129 ≥9,249 4,117 11,466 3,546 [note 10][396]
22 Feb 2015 23,694 9,589 3,155 2,091 9,238 4,037 11,301 3,461 [note 11][275]
15 Feb 2015 23,218 9,365 3,108 2,057 ≥9,007 ≥3,900 11,103 3,408 [note 12][397]
8 Feb 2015 22,859 9,162 3,044 1,995 ≥8,881 ≥3,826 10,934 3,341 [note 13][398]
1 Feb 2015 22,460 8,966 2,975 1,944 8,745 3,746 10,740 3,276 [note 14][399]
25 Jan 2015 22,057 8,795 2,917 1,910 8,622 3,686 10,518 3,199 [note 15][400]
18 Jan 2015 21,689 8,626 2,871 1,876 8,478 3,605 10,340 3,145 [note 16][7]
11 Jan 2015 21,261 8,414 2,806 1,814 8,331 3,538 10,124 3,062 [note 17][248]
4 Jan 2015 20,726 8,229 2,775 1,751 8,171 3,499 9,780 2,943 [note 18][274][401]

Notes:

  1. ↑ The mortality rate (death/case ratio) recorded in Liberia up to 26th August 2014 was 70%.[14] However, the general estimated case fatality rate (70.8%) for this ongoing epidemic differs from the ratio of the number of deaths divided by that of cases due to the estimation method used. Current infections have not run their course, and the estimate may be poor if reporting is biased towards severe cases.
  2. ↑ 26 April : All governments as per WHO. Liberia dated 23 April 2015
  3. ↑ 19 April : All governments as per WHO.
  4. ↑ 12 April : All governments as per WHO. Liberia dated 11 April 2015
  5. ↑ 5 April : All governments as per WHO.
  6. ↑ 29 March : All governments as per WHO.
  7. ↑ 22 March : All governments as per WHO.
  8. ↑ 15 March : All governments as per WHO.
  9. ↑ 8 March : All governments as per WHO. Liberia dated 5 March 2015
  10. ↑ 1 March : All governments as per WHO.
  11. ↑ 22 February : All governments as per WHO.
  12. ↑ 15 February : All governments as per WHO.Liberia dated 12 February 2015
  13. ↑ 9 February : All governments as per WHO.Liberia dated 7 February 2015
  14. ↑ 1 February : All governments as per WHO.
  15. ↑ 25 January : All governments as per WHO.
  16. ↑ 18 January : All governments as per WHO.
  17. ↑ 11 January : All governments as per WHO.
  18. ↑ 4 January : All governments as per WHO. Liberia as per Government.
  19. ↑ 29 December: All governments as per WHO. United Kingdom case dated 29 December.
  20. ↑ 14 December: Guinea as per WHO. Sierra Leone and Liberia as per government report.
  21. ↑ 28 November: Guinea governments as per WHO. Sierra Leone and Liberia as per Government report.
  22. ↑ 18 November: All governments as per WHO. Sierra Leone deaths as per Government report. Liberia dated 17 November
  23. ↑ 2 November: All governments as per WHO and Sierra Leone as per Gov.
  24. ↑ 19 October as per WHO for all except Liberia 18 October.
  25. ↑ 12 October as per WHO Spain and US as per news reports
  • Date is the "as of" date from the reference. A single source may report statistics for multiple "as of" dates.
  • Total cases and deaths before 1 July 2014 are calculated.
  • Numbers with ≥ may not be consistent due to under reporting.

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 Meltzer, Martin I.; Atkins, Charisma Y.; Santibanez, Scott et al. (26 September 2014). "Estimating the Future Number of Cases in the Ebola Epidemic — Liberia and Sierra Leone, 2014–2015". Morbidity and Mortality Weekly Report (United States: Centers for Disease Control and Prevention).
  2. ↑ "How many Ebola cases are there really?". 20 October 2014. Retrieved 26 October 2014.
  3. ↑ Christine Mai-Duc (29 October 2014). "Reported Ebola cases jump to 13,703, WHO reports". Los Angeles Times. Retrieved 3 November 2014.
  4. ↑ 4.0 4.1 4.2
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 WHO (22 Oct 2014). "Ebola Response Roadmap Situation Report" (PDF). who.int. Retrieved 22 Oct 2014.
  6. ↑ 6.0 6.1 6.2 "Mali ends last quarantines, could be Ebola-free next month" (PDF). Reuters. 16 December 2014. Retrieved 26 December 2014.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 "EBOLA SITUATION REPORT- 18 January 2015" (PDF). World Health organization. 21 January 2015. Retrieved 22 January 2015.
  8. ↑ "Ebola response roadmap - Situation report 24 December 2014". World Health organization. 26 December 2014. Retrieved 29 December 2014.
  9. ↑ 9.0 9.1 "WHO/Europe -United Kingdom is declared free of Ebola virus disease". who.int. Retrieved 11 March 2015.
  10. ↑ "Situation summary Data published on the 4th of December 2014". World Health organization. 5 December 2014. Retrieved 6 December 2014.
  11. ↑ "Chronology of Ebola Hemorrhagic Fever Outbreaks". Centers for Disease Control and Prevention. 24 June 2014. Retrieved 25 June 2014.
  12. ↑ "Ebola 2014 — New Challenges, New Global Response and Responsibility". The New England Journal of Medicine. Retrieved 18 September 2014.
  13. ↑ 13.0 13.1 13.2 13.3 13.4 13.5 13.6 WHO Ebola Response Team (23 September 2014). "Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections". New England Journal of Medicine. Retrieved 23 September 2014. ...we estimate that the case fatality rate is 70.8% (95% confidence interval [CI], 69 to 73) among persons with known clinical outcome of infection.
  14. ↑ 14.0 14.1 14.2 "Case Fatality Rate for ebolavirus". Ebola data and statistics. 2015. Retrieved 28 January 2015.
  15. ↑ 15.0 15.1 15.2 15.3 15.4 "Ebola response roadmap - Situation report - 31 December 2014" (PDF). World Health organization. 31 December 2014. Retrieved 1 January 2015. The reported case fatality rate in the three intense-transmission countries among all cases for whom a definitive outcome is known is 71%.
  16. ↑ 16.0 16.1 "Ebola Situation report". Ebola data and statistics. World Health Organization. 12 January 2015. Retrieved 28 January 2015.
  17. ↑ "EBOLA RESPONSE ROADMAP SITUATION REPORT UPDATE" (PDF). World Health organization. 7 November 2014. Retrieved 7 November 2014.
  18. ↑ 18.0 18.1 "UPDATE 1-Mali confirms new case of Ebola, locks down Bamako clinic". Retrieved 15 November 2014.
  19. ↑ "Una enfermera que atendió al misionero fallecido García Viejo, contagiada de ébola" (in Spanish). El Mundo. 6 October 2014. Retrieved 6 October 2014.
  20. ↑ 20.0 20.1 "WHO: Ebola Outbreak Situation Report" (PDF). 8 October 2014. Retrieved 15 October 2014.
  21. ↑ "Ebola data and statistics - Situation summary: Data published on 1 May 2015". 1 May 2015. Retrieved 2 May 2015.
  22. ↑ "WHO: New Ebola Cases Could Be Up To 10,000 Per Week In 2 Months". The Huffington Post. 14 October 2014. Retrieved 14 October 2014.
  23. ↑ "Ebola Response Roadmap Situation Report" (PDF). World Heath Organisation. p. 6. Retrieved 25 September 2014.
  24. ↑ "Runaway Doctors and Missing Supplies Cripple Care in Ebola-Hit Liberia". NBC news. Retrieved 8 October 2014.
  25. ↑ 25.0 25.1 25.2 "Ebola virus disease, West Africa – update 3 July 2014". WHO. Retrieved 18 September 2014.
  26. ↑ 26.0 26.1 "8 Ebola suspects freed by relatives in Sierra Leone". Global Post. 28 May 2014. Retrieved 21 June 2014.
  27. ↑ 27.0 27.1 "Growing Ebola Outbreak Threatens to Overwhelm Volunteers". Today Health. 8 June 2014. Retrieved 21 June 2014.
  28. ↑ 28.0 28.1 Cooper, Charlie (27 October 2014). "Ebola outbreak: Deaths from malaria and other diseases could soar while Africa's over-stretched healthcare systems fight the virus, expert warns". The Independent. Retrieved 28 October 2014.
  29. ↑ 29.0 29.1 Farmer, Paul (23 October 2014). "Diary". London Review of Books. Retrieved 25 October 2014.
  30. ↑ 30.0 30.1 McCauley, Lauren (3 September 2014). "As Ebola Outbreak Surges, Health Officials Slam International 'Coalition of Inaction'". Common Dreams. Retrieved 7 September 2014.
  31. ↑ 31.0 31.1 "Ebola response roadmap - Situation report" (PDF). World Health organization. 10 December 2014. Retrieved 11 December 2014.
  32. ↑ 32.0 32.1 "Ebola Situation Report - 28 January 2015". Ebola. WHO. 28 January 2015. Retrieved 5 February 2015.
  33. ↑ 33.0 33.1 33.2 33.3 33.4 "Ebola Situation Report" (PDF). WHO. 8 April 2015. Retrieved 14 April 2015.
  34. ↑ 34.0 34.1 Cheng, Maria; Satter, Raphael (20 March 2015). "Emails: UN health agency resisted declaring Ebola emergency". Associated Press. Retrieved 21 March 2015.
  35. ↑ 35.0 35.1 "Ebola: the failures of the international outbreak response". Médecins Sans Frontières. 29 August 2014. Retrieved 7 September 2014.
  36. ↑ news release (3 September 2014). "UN senior leaders outline needs for global Ebola response". WHO. Retrieved 7 September 2014.
  37. ↑ "West African economies feeling ripple effects of Ebola, says UN". United Nations Development Programme. 12 March 2015. Retrieved 20 March 2015.
  38. ↑ "The Pulitzer Prizes - Works". pulitzer.org. Retrieved 25 April 2015.
  39. ↑ 39.0 39.1 39.2 Kevin Sack, Sheri Fink, Pam Belluck and Adam Nossiter Photographs by Daniel Berehulak (December 29, 2014). "How Ebola Roared Back: For a fleeting moment last spring, the epidemic sweeping West Africa might have been stopped. But the opportunity to control the virus, which has now caused more than 7,800 deaths, was lost.". The New York Times (The Times Company). Retrieved December 30, 2014. “The messages about don’t touch the dead, wash your hands, if somebody is sick, leave them — these were all strange things, completely contrary to our tradition and culture.” Anchor cite of important article, do not remove
  40. ↑ "Ebola: Patient zero was a toddler in Guinea - CNN.com". CNN. 28 October 2014. Retrieved 29 October 2014.
  41. ↑ 41.0 41.1 41.2 Baize, Sylvain; Pannetier, Delphine; Oestereich, Lisa; Rieger, Toni (16 April 2014). "Emergence of Zaire Ebola Virus Disease in Guinea — Preliminary Report". New England Journal of Medicine 371 (15): 1418–25. doi:10.1056/NEJMoa1404505. PMID 24738640.
  42. ↑ 42.0 42.1 Grady, Denise; Fink, Sheri (9 August 2014). "Tracing Ebola's Breakout to an African 2-Year-Old". The New York Times. Retrieved 11 April 2015.
  43. ↑ Nassos Stylianou (27 November 2014). "How world’s worst Ebola outbreak began with one boy’s death". BBC News. Retrieved 11 April 2015.
  44. ↑ 44.0 44.1 44.2 44.3 44.4 "Previous Updates: 2014 West Africa Outbreak". Centers for Disease Control and Prevention. Retrieved 11 April 2015.
  45. ↑ "Seven die in Monrovia Ebola outbreak". BBC News. 17 June 2014. Retrieved 28 July 2014.
  46. ↑ "Ebola virus disease, West Africa (Situation as of 16 April 2014)". WHO. Retrieved 18 September 2014.
  47. ↑ "Ebola virus disease, West Africa – update 18 July 2014". WHO. Retrieved 18 September 2014.
  48. ↑ 48.0 48.1 "Sierra Leone hunts Ebola patient kidnapped in Freetown". BBC News. 25 July 2014. Retrieved 27 July 2014.
  49. ↑ "Ebola outbreak: Sierra Leone escaped patient dies". BBC News. 27 July 2014. Retrieved 27 July 2014.
  50. ↑ 50.0 50.1 "Ebola virus disease, West Africa – update 25 July 2014". WHO. Retrieved 18 September 2014.
  51. ↑ Wesee, Ben P. (4 August 2014). "I'm ok - Nigerian Ambassador Assures Public". The New Dawn (Liberia). Retrieved 7 August 2014.
  52. ↑ Wesee, Ben P. (4 August 2014). "I'm ok - Nigerian Ambassador Assures Public". The New Dawn (Liberia). Retrieved 29 December 2014 – via AllAfrica.com.
  53. ↑ "Worst-ever Ebola outbreak, by the numbers". CBC News. Retrieved 16 September 2014.
  54. ↑ 54.0 54.1 "Ebola crisis: Nigeria declared free of virus". BBC News. 20 October 2014. Retrieved 20 October 2014.
  55. ↑ 55.0 55.1 55.2 55.3 "Ebola virus disease – Senegal". World Health Organization. 29 March 2014. Retrieved 1 September 2014.
  56. ↑ "WHO - Are the Ebola outbreaks in Nigeria and Senegal over?". Retrieved 24 October 2014.
  57. ↑ 57.0 57.1 "Spanish Nurse Who Contracted Ebola Appears Free of Virus: Officials - NBC News". NBC News. 20 October 2014. Retrieved 24 January 2015.
  58. ↑ "Dallas nurse Nina Pham will be transferred to NIH facility in Bethesda, Md.". Washington Post. Retrieved 16 October 2014.
  59. ↑ "1st Ebola Case in W. African Nation of Mali". ABC News. Retrieved 24 October 2014.
  60. ↑ "BBC News - Ebola crisis: Mali confirms first infection case". BBC News. Retrieved 24 October 2014.
  61. ↑ 61.0 61.1 61.2 "Ebola response roadmap - Situation report". WHO. 12 November 2014. Retrieved 16 November 2014.
  62. ↑ 62.0 62.1 "EBOLA RESPONSE ROADMAP SITUATION REPORT" (PDF). World Health organization. 26 November 2014. Retrieved 27 November 2014.
  63. ↑ 63.0 63.1 "Situation summary Data published on 2 December 2014". World Health organization. 2 December 2014. Retrieved 2 December 2014.
  64. ↑ "Ebola data and statistics - Situation summary: Data published on 30 March 2015". 31 March 2015. Retrieved 31 March 2015.
  65. ↑ 65.0 65.1 "Ebola virus is surging in places where it was beaten back: experts". CTV News. 8 September 2014. Retrieved 8 September 2014.
  66. ↑ "Guinea's Grand Imam Pulls No Punches In His Ebola Message". NPR.org. 26 January 2015. Retrieved 7 February 2015.
  67. ↑ "Ebola cases double in Guinea in second week, says WHO". International Business Times UK. Retrieved 12 February 2015.
  68. ↑ "In Guinea, Ebola Infections Double as Hidden Cases Discovered". VOA. Retrieved 8 February 2015.
  69. ↑ "Crowds attack Ebola facility, health workers in Guinea". Reuters. Retrieved 19 February 2015.
  70. ↑ "Guinea declares Ebola 'health emergency' in five regions". BBC News. Retrieved 29 March 2015.
  71. ↑ "Eleven handed life sentences over Guinea Ebola worker murders". Reuters UK. Retrieved 23 April 2015.
  72. ↑ "2 of 5 Test Positive for Ebola in Liberia". Liberian Observer. 31 March 2014. Retrieved 6 July 2014.
  73. ↑ "Ebola outbreak: Liberia shuts most border points". BBC News. 28 July 2014. Retrieved 28 July 2014.
  74. ↑ Kwanue, C.Y. (1 August 2014). "In Compliance with Sirleaf's Mandate, UL Closed". Liberian Observer. Retrieved 2 August 2014.
  75. ↑ "Liberia shuts schools, quarantines communities in bid to halt Ebola". Reuters. 30 July 2014. Retrieved 30 July 2014.
  76. ↑ "Ebola outbreak: Liberia shuts most border points". BBC News. 28 July 2014. Retrieved 28 July 2014.
  77. ↑ 77.0 77.1 "Ebola outbreak: Liberia 'close to collapse' - ambassador". Katty, Kay. BBC News Africa. 7 October 2014. Retrieved 8 October 2014.
  78. ↑ "Runaway Doctors and Missing Supplies Cripple Care in Ebola-Hit Liberia". NBC News. Retrieved 8 October 2014.
  79. ↑ "Liberia Ebola SitRep no. 157" (PDF). 24 October 2014. Retrieved 24 October 2014.
  80. ↑ Cumming-Bruce, Nick (29 October 2014). "Ebola Slowing in Liberia, W.H.O. Says, but International Support Is Still Necessary". The New York Times. Retrieved 3 November 2014.
  81. ↑ "Ebola state of emergency lifted in Liberia". CBS News. 14 November 2014. Retrieved 14 November 2014.
  82. ↑ "Ebola outbreak eases as world's largest treatment centre dismantled". ABC News. Retrieved 29 January 2015.
  83. ↑ "Three New Ebola Cases in Liberia". The Disease Daily. 27 March 2015. Retrieved 28 March 2015.
  84. ↑ "Liberia names new health minister as it seeks to beat Ebola". Yahoo News. 8 April 2015. Retrieved 16 April 2015.
  85. ↑ "allAfrica.com: Liberia: MSF Hands Over ELWA - 3 to Liberian Ministry of Health". allAfrica.com. Retrieved 29 April 2015.
  86. ↑ ABC News. "US Shuts Down Ebola Treatment Center in Liberia". ABC News. Retrieved 2 May 2015.
  87. ↑ 87.0 87.1 "Sierra Leone 'hero' doctor's death exposes slow Ebola response". Sierra Leone 'hero' doctor's death exposes slow Ebola response. Fox News. 25 August 2014. Retrieved 25 August 2014.
  88. ↑ "Sierra Leone shuts borders, closes schools to fight Ebola". Reuters. 11 June 2014. Retrieved 11 April 2015.
  89. ↑ "Sierra Leone, Liberia deploy troops for Ebola". News 24. 4 August 2014. Retrieved 11 April 2015.
  90. ↑ "Ebola cases appear in last untouched district in Sierra Leone". Fox News. 16 October 2014. Retrieved 16 October 2014.
  91. ↑ "The Ebola Outbreak Is Getting Worse in Sierra Leone". VICE News. Retrieved 10 November 2014.
  92. ↑ Sarah DiLorenzoAssociated Press (4 November 2014). "Thousands in Sierra Leone break Ebola quarantine". Retrieved 5 November 2014.
  93. ↑ "‘Entire villages disappeared’: Ebola deaths in Sierra Leone ‘underreported’". Retrieved 7 November 2014.
  94. ↑ "As Ebola rages in Sierra Leone poor planning thwarts efforts". New York Times. Retrieved 7 December 2014.
  95. ↑ "Ebola crisis: Sierra Leone hit by largely hidden outbreak; WHO says scores of bodies piled up". ABC News. Retrieved 11 December 2014.
  96. ↑ "Endless Ebola Epidemic? That's The 'Risk We Face Now,' CDC Says". NPR.org. 15 December 2014. Retrieved 18 December 2014.
  97. ↑ 97.0 97.1 97.2 "Sierra Leone: EBOLA VIRUS DISEASE - SITUATION REPORT (Sit-Rep) 15 December, 2014" (PDF). 15 December 2014. Retrieved 15 December 2014.
  98. ↑ "BBC News - Ebola: Sierra Leone begins house-to-house searches". BBC News. Retrieved 18 December 2014.
  99. ↑ "EBOLA VIRUS DISEASE - SITUATION REPORT (Sit-Rep) –) 18 December, 2014" (PDF). 18 December 2014. Retrieved 19 December 2014.
  100. ↑ "Ebola Could be ‘Levelling Off’ in Sierra Leone: WHO". Newsweek. 8 January 2015. Retrieved 11 January 2015.
  101. ↑ The Christian Science Monitor. "Sierra Leone predicts no new Ebola cases by March end (+video)". The Christian Science Monitor. Retrieved 15 January 2015.
  102. ↑ Gregg Zoroya, USA TODAY (5 February 2015). "Downward Ebola trend suddenly reverses itself". USA TODAY. Retrieved 6 February 2015.
  103. ↑ "Ebola-hit Sierra Leone to Reopen Schools March 30". VOA. Retrieved 7 February 2015.
  104. ↑ "Decline in Ebola cases flattens, raising UN concern". philstar.com. Retrieved 22 February 2015.
  105. ↑ "More Ebola in Guinea, Sierra Leone last week, no Liberia cases says WHO". gnnliberia.com. Retrieved 7 March 2015.
  106. ↑ "WHO: Lowest Weekly Figure of Ebola Cases Reported in Nearly a Year". VOA. Retrieved 10 April 2015.
  107. ↑ "Ebola Death Toll in Guinea Rises to 70 as Senegal Closes Border". Bloomberg News. 29 March 2014. Retrieved 31 March 2014.
  108. ↑ "Guinean Who Brought Ebola To Senegal Recovers From Virus". Business Insider. Retrieved 20 September 2014.
  109. ↑ "WHO: Ebola Response Roadmap Update, 22 September 2014" (PDF). WHO. 22 September 2014. Retrieved 22 September 2014.
  110. ↑ "WHO congratulates Senegal on ending Ebola transmission". 17 October 2014. Retrieved 20 October 2014.
  111. ↑ "Senegal reopens land border with Ebola-hit Guinea". Reuters. Retrieved 28 January 2015.
  112. ↑ "Nigeria 'on red alert' over Ebola death in Lagos". BBC News. 26 July 2014. Retrieved 27 July 2014.
  113. ↑ Mark, Monica (6 August 2014). "Ebola Outbreak: Nurse who Treated First Victim in Nigeria Dies". The Guardian. Retrieved 7 August 2014.
  114. ↑ "Ebola strikes at the heart of Nigeria: Ameyo, daughter of Kwaku Adadevoh, grand daughter of Herbert Macaulay dies". Thisday. Retrieved 22 August 2014.
  115. ↑ "Nigeria in first step towards all-clear on Ebola". Yahoo News. 23 September 2014. Retrieved 26 September 2014.
  116. ↑ Fasina FO; Shittu A et al. (9 October 2014). "Transmission Dynamics and Control of Ebola Virus Disease Outbreak in Nigeria, July to September 2014". Rapid Communications. Eurosurveillance (Sweden: ECDC) 19 (40).
  117. ↑ Courage, Katherine Harmon (October 2014). "How Did Nigeria Quash Its Ebola Outbreak So Quickly?". Scientific American.
  118. ↑ "Muere el religioso español Miguel Pajares a causa del ébola". RTVE. 12 August 2014. Retrieved 12 August 2014.
  119. ↑ "Ebola Outbreak: Spanish Missionary Manuel Garcia Viejo Dies of Deadly Virus in Madrid". International Business Times. 25 September 2014. Retrieved 25 September 2014.
  120. ↑ "Nurse 'infected with Ebola' in Spain". BBC. Retrieved 6 October 2014.
  121. ↑ "La enfermera ingresada en Alcorcón da positivo por ébola -- La segunda prueba ha dado positivo y confirma el diagnóstico". Cadena Ser. 6 October 2014. Retrieved 11 April 2015.
  122. ↑ "WHO Says Spain Ebola-Free Following Nurse Recovery". ABC News. 2 December 2014. Retrieved 2 December 2014.
  123. ↑ "CDC and Texas Health Department Confirm First Ebola Case Diagnosed in the U.S.". cdc.gov. 1 October 2014. Retrieved 1 October 2014.
  124. ↑ Nick Allen (1 October 2014). "First Ebola victim in America was sent home with antibiotics". The Telegraph. Retrieved 11 April 2015.
  125. ↑ "Thomas Eric Duncan: First Ebola death in U.S.". CNN. 8 October 2014. Retrieved 8 October 2014.
  126. ↑ Fernandez, Manny (12 October 2014). "Texas Health Worker Tests Positive for Ebola". New York Times. Retrieved 12 October 2014.
  127. ↑ "Second Ebola-infected nurse ID'd; flew domestic flight day before diagnosis". Fox News. Retrieved 15 October 2014.
  128. ↑ "Virus Free: Ebola-Infected Nurse Nina Pham to Go Home". NBC News. October 24, 2014. Retrieved 11 April 2015.
  129. ↑ "Nurse Amber Vinson free of Ebola virus, family says". Yahoo News. 23 October 2014. Retrieved October 23, 2014.
  130. ↑ "New York Doctor Just Back From Africa Has Ebola". NBC News. 23 October 2014. Retrieved October 23, 2014.
  131. ↑ HARTOCOLLIS, ANEMONA (10 November 2014). "Craig Spencer, New York Doctor With Ebola, Will Leave Bellevue Hospital". New York Times. Retrieved 11 April 2015.
  132. ↑ "Mali case, Ebola imported from Guinea Ebola situation assessment - 10 November 2014". World Health Organisation. Retrieved 11 November 2014.
  133. ↑ "Ebola Outbreak 2014". Breaking News. NBC News Digital Network. Retrieved 24 October 2014.
  134. ↑ "Mali : Situation de la lutte contre la maladie à virus Ebola au Mali à la date du mercredi 19 novembre 2014" (in French). Retrieved 26 November 2014.
  135. ↑ "Mali confirms its second fatal case of Ebola virus disease". World Health Organisation. Retrieved 14 November 2014.
  136. ↑ "UPDATE 2-Doctor who treated source of second Mali Ebola outbreak dies". Reuters. 21 November 2014. Retrieved 21 November 2014.
  137. ↑ "Ebola crisis: Third death confirmed in Mali". BBC News. 12 November 2014. Retrieved 12 November 2014.
  138. ↑ "Mali records new Ebola case, linked to dead nurse". Reuters. Retrieved 22 November 2014.
  139. ↑ "Africa - Mali nears Ebola-free status as last patient leaves hospital". France 24. Retrieved 12 December 2014.
  140. ↑ "Mali ends quarantines, could be Ebola-free soon". News24. Retrieved 17 December 2014.
  141. ↑ 141.0 141.1 Severin Carrell, Libby Brooks and Lisa O'Carroll (29 December 2014). "Ebola case confirmed in Glasgow". The Guardian. Retrieved 11 April 2015.
  142. ↑ "Hero nurse Pauline Cafferkey could have contracted deadly Ebola at Christmas Day service". The Telegraph. 30 December 2014. Retrieved 11 April 2015.
  143. ↑ "Ebola nurse Pauline Cafferkey transferred to London unit". BBC News. 30 December 2014. Retrieved 11 April 2015.
  144. ↑ "Ebola in the UK: Infected nurse Pauline Cafferkey treated with survivors' blood plasma and experimental drugs". The Independent. Retrieved 1 January 2015.
  145. ↑ "Ebola nurse: Pauline Cafferkey 'happy to be alive'". BBC News. 24 January 2015. Retrieved 11 April 2015.
  146. ↑ "French MSF nurse cured of Ebola". Retrieved 4 October 2014.
  147. ↑ "Ebola: l'agent de l'Unicef soigné à l'hôpital Bégin a quitté la France "guéri"" (in French). Retrieved 24 November 2014.
  148. ↑ "Hamburg clinic dismisses Ebola patient" (in German). Retrieved 4 October 2014.
  149. ↑ "Ugandan doctor with Ebola named". New Vision Online. 5 October 2014. Retrieved 2 January 2015.
  150. ↑ "Ebola patient arrives in Germany from Sierra Leone -local officials". Reuters. 4 October 2014. Retrieved 4 October 2014.
  151. ↑ "Ugandan doctor cured of Ebola in German hospital". Yahoo news. 4 December 2014. Retrieved 4 December 2014.
  152. ↑ "UN employee dies of Ebola in hospital in Germany". The Telegraph. 14 October 2014. Retrieved 6 December 2014.
  153. ↑ "Germany's Third Ebola Patient Arrives for Treatment From Africa". Bloomberg. 9 October 2014. Retrieved 9 October 2014.
  154. ↑ "Infektion: Ebola-Patient in Leipziger Klinik gestorben". ZEIT ONLINE. 14 October 2014. Retrieved 14 October 2014.
  155. ↑ "Italian Doctor Tests Positive for Ebola in Sierra Leone". Wall Street Journal. Retrieved 24 November 2014.
  156. ↑ "Italian Ebola victim's condition improves". Thomson Reuters. 11 December 2014. Retrieved 12 December 2014.
  157. ↑ "Ebola, guarito il medico di Emergency: "Tornerò in Sierra Leone"". Retrieved 3 January 2015.
  158. ↑ "Italy doctor with Ebola has recovered: reports". Deccan Chronical. 2 January 2015. Retrieved 2 January 2015.
  159. ↑ "U.N. peacekeeper with Ebola arrives in Netherlands for treatment". Reuters. Retrieved 6 December 2014.
  160. ↑ "2Peacekeeper in Liberia tests positive for Ebola virus". The Belfast Telegraph. Retrieved 6 December 2014.
  161. ↑ "UN: Nigerian peacekeeper recovers from Ebola". U-T San Diego. Retrieved 28 December 2014.
  162. ↑ "25 medical staff treating Ebola victim in Norway". The Local Europe. Retrieved 14 October 2014.
  163. ↑ "Norwegian Ebola Patient Cured". Yahoo News. 20 October 2014. Retrieved 20 October 2014.
  164. ↑ "– Jeg er utrolig takknemlig". http://www.nrk.no/'' (in Norwegian). Retrieved 20 October 2014.
  165. ↑ "Ebola outbreak: Cuban doctor infected in Sierra Leona arrives at Geneva hospital". CBC News. 21 November 2014. Retrieved 21 November 2014.
  166. ↑ "Felix Baez, Cuban doctor with Ebola, recovers in Geneva". CBC News. 6 December 2014. Retrieved 6 December 2014.
  167. ↑ "British Ebola patient arrives in UK for hospital treatment". BBC News. 24 August 2014. Retrieved 25 August 2014.
  168. ↑ "Ebola: British nurse makes full recovery and leaves hospital". The Week. 3 September 2014. Retrieved 5 September 2014.
  169. ↑ "BBC News - UK female military health worker has Ebola". BBC News. Retrieved 12 March 2015.
  170. ↑ "BBC News - Ebola: Seventh British health worker sent home". BBC News. Retrieved 19 March 2015.
  171. ↑ "British medic declared free of Ebola". BBC News. 27 March 2015. Retrieved 27 March 2015.
  172. ↑ "Nebraska Hospital: Surgeon With Ebola Has Died". ABC News. 17 November 2014. Retrieved 17 November 2014.
  173. ↑ "http://www.nbcnews.com/storyline/ebola-virus-outbreak/ebola-patient-dr-martin-salia-has-died-nebraska-officials-n249956". NBC News. 17 November 2014. Retrieved 17 November 2014.
  174. ↑ Lauren Gambino. "American diagnosed with Ebola to be flown to US from Sierra Leone". the Guardian. Retrieved 13 March 2015.
  175. ↑ "U.S. healthcare worker with Ebola in 'serious' condition, NIH says". Reuters. Retrieved 14 March 2015.
  176. ↑ John Bacon and Liz Szabo, USA TODAY (16 March 2015). "American Ebola patient worsens to critical condition". USA TODAY. Retrieved 17 March 2015.
  177. ↑ "At least 10 Americans being flown to U.S. after possible Ebola exposure". Yahoo News. 15 March 2015. Retrieved 15 March 2015.
  178. ↑ "American Patient With Ebola Has Condition Upgraded". Time Inc. 26 March 2015. Retrieved 27 March 2015.
  179. ↑ 179.0 179.1 179.2 "Ebola virus disease – Democratic Republic of Congo E-mail Print Epidemiology and surveillance". World Health Organization (WHO). Retrieved 11 April 2015.
  180. ↑ "Virological analysis: no link between Ebola outbreaks in west Africa and Democratic Republic of Congo". WHO. 2 September 2014. Retrieved 7 September 2014.
  181. ↑ "Ebola sleuths scour DR Congo jungle for source of outbreak". Yahoo News. 23 October 2014. Retrieved 23 October 2014.
  182. ↑ "WHO declares end of Ebola outbreak in the Democratic Republic of Congo". WHO. Retrieved 22 November 2014.
  183. ↑ "EBOLA RESPONSE ROADMAP SITUATION REPORT UPDATE" (PDF). World Health organization. 29 October 2014. Retrieved 3 November 2014.
  184. ↑ 184.0 184.1 184.2 184.3 Gire, S. K.; Goba, A.; Andersen, K. G. et al. (28 August 2014). "Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak". Science 345 (6202): 1369–1372. doi:10.1126/science.1259657. PMID 25214632.
  185. ↑ Kuhn, Jens H.; Becker, Stephan; Ebihara, Hideki et al. (30 October 2010). "Proposal for a revised taxonomy of the family Filoviridae: classification, names of taxa and viruses, and virus abbreviations". Archives of Virology 155 (12): 2083–2103. doi:10.1007/s00705-010-0814-x. PMC 3074192. PMID 21046175. Retrieved 15 October 2014.
  186. ↑ "Sierra Leone samples: Ebola evidence in West Africa in 2006". EurekAlert!. 14 July 2014. Retrieved 7 October 2014.
  187. ↑ 187.0 187.1 Vogel, Gretchen (29 August 2014). "Genomes reveal start of Ebola outbreak". Science. Retrieved 31 January 2015.
  188. ↑ "Mutant Ebola Virus May Evade Drugs, Study Finds". NBC News. Retrieved 21 January 2015.
  189. ↑ Kevin McSpadden. "Ebola Virus has Mutated, Scientists Say". TIME.com. Retrieved 31 January 2015.
  190. ↑ 190.0 190.1 "Ebola Hemorrhagic Fever Prevention". CDC. July 31, 2014. Retrieved 2014-08-02.
  191. ↑ Gonzalez JP, Pourrut X, Leroy E (2007). "Ebolavirus and other filoviruses". Current topics in microbiology and immunology. Current Topics in Microbiology and Immunology 315: 363–387. doi:10.1007/978-3-540-70962-6_15. ISBN 978-3-540-70961-9. PMID 17848072.
  192. ↑ Almudena Marí Saéz, Sabrina Weiss, Kathrin Nowak, Vincent Lapeyre, Fee Zimmermann, Ariane Düx, Hjalmar S Kühl, Moussa Kaba, Sebastien Regnaut, Kevin Merkel, Andreas Sachse, Ulla Thiesen, Lili Villányi, Christophe Boesch, Piotr W Dabrowski, Aleksandar Radonić, Andreas Nitsche, Siv Aina J Leendertz, Stefan Petterson, Stephan Becker, Verena Krähling, Emmanuel Couacy‐Hymann, Chantal Akoua‐Koffi, Natalie Weber, Lars Schaade, Jakob Fahr, Matthias Borchert, Jan F Gogarten, Sébastien Calvignac‐Spencer, Fabian H Leendertz (December 30, 2014). "Investigating the zoonotic origin of the West African Ebola epidemic" (ONLINE). EMBO Molecular Medicine (EMBO Press) 7 (Published online): 17–23. doi:10.15252/emmm.201404792. Retrieved December 31, 2014. The severe Ebola virus disease epidemic occurring in West Africa likely stems from a single zoonotic transmission event involving a 2‐year‐old boy in Meliandou, Guinea, who might have been infected by hunting or playing with insectivorous free‐tailed bats living in a nearby hollow tree
  193. ↑ "CDC Telebriefing on Ebola outbreak in West Africa". CDC. 2014-07-28. Retrieved 2014-08-03.
  194. ↑ "Limited airborne transmission of Ebola is ‘very likely,’ new analysis says". Washington Post. Retrieved 20 February 2015.
  195. ↑ Harden, Blaine (2001-02-18). "Dr. Matthew's Passion". New York Times Magazine. Retrieved 2008-02-25.
  196. ↑ "Ebola Virus Lives 7 Days on Corpses". NBC News. Retrieved 13 February 2015.
  197. ↑ "Ebola media centre fact sheets". Ebola media centre fact sheets. WHO. Retrieved 21 September 2014.
  198. ↑ "Questions and Answers on Ebola | Ebola Hemorrhagic Fever". CDC. Retrieved 11 April 2015.
  199. ↑ Tiaji Salaam-Blyther (August 26, 2014). "The 2014 Ebola Outbreak: International and U.S. Responses" (PDF). Retrieved 9 September 2014.
  200. ↑ Ebola medics 'better trained in Sierra Leone than Spain' The Telegraph, by Fiona Govan, 11 Oct. 2014
  201. ↑ "Two Americans Stricken With Deadly Ebola Virus in Liberia". NBC News. 28 July 2014. Retrieved 2 August 2014.
  202. ↑ 202.0 202.1 "Doctors Without Borders: West Africa's Ebola Outbreak is Totally Out of Control". CTVNews. 20 June 2014. Retrieved 21 June 2014.
  203. ↑ "Ebola survivors 'safe sex warning' issued by WHO". BBC News. Retrieved 18 April 2015.
  204. ↑ "Ebola virus found in semen six months after recovery: WHO". Yahoo News. 15 April 2015. Retrieved 19 April 2015.
  205. ↑ "UN says it will try to identify all Ebola cases by June - US News". US News & World Report. Retrieved 29 April 2015.
  206. ↑ 206.0 206.1 206.2 206.3 28 August 2014 Ebola Response Roadmap
  207. ↑ "The reason Ebola isn't being stopped". CNN. Retrieved 16 September 2014.
  208. ↑ "UN senior leaders outline needs for global Ebola response". WHO. Retrieved 16 September 2014.
  209. ↑ "FACT SHEET: U.S. Response to the Ebola Epidemic in West Africa". The White House. Retrieved 2 November 2014.
  210. ↑ "Ebola virus disease Fact sheet N°103". WHO. Retrieved 2014-09-06.
  211. ↑ "Ebola – 5 tips to avoid the deadly disease". Plan International. 2014-09-06. Retrieved 11 April 2015.
  212. ↑ Diallo, Boubacar (29 March 2014). "Ebola en Guinée : l'ONG Plan Guinée craint une aggravation de l'épidemie" [Ebola in Guinea: the NGO Plan Guinea fears a worsening of the epidemic] (in French). Africa guinée. Retrieved 31 March 2014.
  213. ↑ "Encounters during the Ebola awareness campaign". PLAN International. Retrieved 2 November 2014.
  214. ↑ "FAO Launches Ebola Awareness Campaign in West Africa". FAO. Retrieved 2 November 2014.
  215. ↑ Ofeibea Quist-Arcton (6 August 2014). "Skeptics In Sierra Leone Doubt Ebola Virus Exists". NPR.
  216. ↑ Anja Wolz (15 July 2014). "Fighting fear, denial and death on Ebola frontline". New Scientist. Retrieved 11 April 2015.
  217. ↑ "Patients reported missing after Ebola clinic attacked in Liberia". The Age. 18 August 2014. Retrieved 18 August 2014.
  218. ↑ "Red Cross suspends Ebola operations in southeast Guinea after threats". Reuters. 2 July 2014. Retrieved 4 July 2014.
  219. ↑ "At least 8 Ebola aid workers reportedly killed 'in cold blood' by villagers in Guinea". Fox News. Retrieved 19 September 2014.
  220. ↑ Chan, M (Aug 20, 2014). "Ebola Virus Disease in West Africa - No Early End to the Outbreak.". The New England Journal of Medicine 371 (13): 1183–5. doi:10.1056/NEJMp1409859. PMID 25140856.
  221. ↑ "How to conduct safe and dignified burial of a patient who has died from suspected or confirmed Ebola virus disease" (PDF). Global Alert and Response. World Health Organisation. Retrieved 14 December 2014.
  222. ↑ "Ebola situation report". WHO. 21 January 2015. Retrieved 3 February 2015.
  223. ↑ "Guinea's Grand Imam Pulls No Punches In His Ebola Message". NPR.org. 26 January 2015. Retrieved 3 February 2015.
  224. ↑ McNeil, Donald G., Jr. (13 August 2014). "Using a Tactic Unseen in a Century, Countries Cordon Off Ebola-Racked Areas". The New York Times. Retrieved 14 August 2014.
  225. ↑ "In Sierra Leone’s Ebola hot zone: A series of reports". UN Office for the Coordination of Humanitarian Affairs. Retrieved 2 November 2014.
  226. ↑ "Rally around West African communities to fight Ebola". Seattle Times. Retrieved 2 November 2014.
  227. ↑
  228. ↑ "Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure". CDC. Retrieved 2 November 2014.
  229. ↑ "MSF Protocols for Staff Returning from Ebola-Affected Countries". Doctors without Borders. Retrieved 2 November 2014.
  230. ↑ "Public health recommendations for returning workers who are asymptomatic contacts of Ebola virus disease" (PDF). Public Health England. 10 December 2014. Retrieved 11 April 2015.
  231. ↑ "Ebola virus disease (EVD): Advice for returning travellers from countries/areas affected by EVD" (PDF). Public Health Ontario. Retrieved 2 November 2014.
  232. ↑ Choi JH, Croyle MA (December 2013). "Emerging targets and novel approaches to Ebola virus prophylaxis and treatment". BioDrugs 27 (6): 565–83. doi:10.1007/s40259-013-0046-1. PMC 3833964. PMID 23813435.
  233. ↑ Makiko Kitamura (8 June 2014). "Sierra Leone Is Epicenter of Ebola as Guinea Clinic Shut". Retrieved 30 July 2014.
  234. ↑ Magill, Alan (2013). Hunter's tropical medicine and emerging infectious diseases. (9th ed. ed.). New York: Saunders. p. 332. ISBN 9781416043904.
  235. ↑ 235.0 235.1 235.2 "Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone". The New England Journal of Medicine. 29 October 2014. Retrieved 2 November 2014.
  236. ↑ 236.0 236.1 Donald G. McNeil Jr. (January 1, 2015). "Ebola Doctors Are Divided on IV Therapy in Africa". The New York Times (The Times Company). Retrieved January 3, 2015.
  237. ↑ "IV Therapy for Ebola". Communities/Ebola Response. January 2015. Retrieved 7 January 2015.
  238. ↑ "A story of Ebola survival and return". TDR news item. WHO. 14 November 2014. Retrieved 5 February 2015.
  239. ↑ "Ebola outbreak: Doctors warn of 'post-Ebola syndrome' among survivors in West Africa". ABC News. Retrieved 5 February 2015.
  240. ↑ "Fact sheet". Ebola Virus Factsheet. WHO. September 2014. Retrieved 28 October 2014.
  241. ↑ Bailes, Adam (22 October 2014). "Ebola Increases Threat to Sierra Leone Pregnancies". Voice of America. Retrieved 26 October 2014.
  242. ↑ "WHO: Ebola survivors at risk of eye and joint problems". BBC News. Retrieved 11 April 2015.
  243. ↑ "Sierra Leone`s main referral hospital has been overwhelmed". StarAfrica. Retrieved 1 October 2014.
  244. ↑ "Liberia: Unheralded Fear - Ebola Pose Risks for Liberia Health Workers". FrontPage Africa. 19 June 2014. Retrieved 21 June 2014 – via AllAfrica.com.
  245. ↑ "MSFs new ebola management centers already overwhelmed". MSF. Retrieved 11 April 2015.
  246. ↑ Payne, Ed (12 September 2014). "West African health centers can't keep up with Ebola outbreak, WHO says". CNN Health. Retrieved 15 September 2014.
  247. ↑ 247.0 247.1 "WHO: Ebola Response Roadmap Situation Report 18 September 2014" (PDF). WHO. 18 September 2014. Retrieved 19 September 2014.
  248. ↑ 248.0 248.1 248.2 "EBOLA SITUATION REPORT- 14 January 2015" (PDF). World Health organization. 14 January 2015. Retrieved 15 January 2015.
  249. ↑ "An Ebola treatment center". Washington Post. Retrieved 1 October 2014.
  250. ↑ "Guidance for Safe Handling of Human Remains of Ebola Patients in U. S. Hospitals and Mortuaries". Centers for Disease Control. Retrieved 1 October 2014.
  251. ↑ "В Гвинее открылся построенный РУСАЛом медцентр по борьбе с вирусом Эбола". Sdelanounas. 17 January 2015. Retrieved 18 January 2015.
  252. ↑ "Russia opens Ebola center in Guinea". Russia Beyond The Headlines. 17 January 2015. Retrieved 18 January 2015.
  253. ↑ "Sierra Leone: MSF opens maternity unit for pregnant women with Ebola". Médecins Sans Frontières (MSF) International. Retrieved 30 January 2015.
  254. ↑ "Ebola: MSF opens new treatment centre in Kissy, Sierra Leone". Médecins Sans Frontières/Doctors without Borders. Retrieved 11 April 2015.
  255. ↑ "Frequently asked questions on Ebola virus disease". WHO. 8 August 2014. Retrieved 3 October 2014.
  256. ↑ "Woman saves three relatives from Ebola". CNN. 26 September 2014. Retrieved 14 October 2014.
  257. ↑ "Ebola Supplies Arrive in Liberia". Samaritan's Purse. 2 October 2014. Retrieved 3 October 2014.
  258. ↑ "In Order To Contain Ebola 9,000 Household Kits Arrive". Daily Observer. 25 September 2014. Retrieved 4 October 2014.
  259. ↑ "Are Hospitals Part of the Ebola Problem? Charity Wants New Strategy". NBC News. 15 September 2013. Retrieved 3 October 2014.
  260. ↑ "New effort to fight Ebola in Liberia would move infected patients out of their homes". The Washington Post. 22 September 2014. Retrieved 2 October 2014.
  261. ↑ "How not to catch Ebola". BBC. 7 October 2014. Retrieved 13 October 2014.
  262. ↑ Ebola medics 'better trained in Sierra Leone than Spain' The Telegraph, by Fiona Govan, 11 Oct. 2014
  263. ↑ "Ebola Protective Suits Are In Short Supply". npr. 7 October 2014. Retrieved 13 October 2014.
  264. ↑ "Ebola Suit Maker Triples Output". ABC-News. 9 October 2014. Retrieved 13 October 2014.
  265. ↑ "USAID seeking better Ebola protective gear". The Seattle Times. 6 October 2014. Retrieved 13 October 2014.
  266. ↑ "Innovating to Fight Ebola". The White House - Office of Science and Technology Policy. 29 October 2014. Retrieved 4 November 2014.
  267. ↑ "Obama Tries A 'Throw Everything Against The Wall' Approach To Ebola". The Huffington Post. 31 October 2014. Retrieved 10 November 2014.
  268. ↑ "USAID seeks help from ‘maker movement’ in Ebola outbreak". The Washington Post. 24 November 2014. Retrieved 26 November 2014.
  269. ↑ "United States Announces Results of Grand Challenge to Fight Ebola". USAID. 12 December 2014. Retrieved 12 January 2015.
  270. ↑ "Dreaming Up A Safer, Cooler PPE For Ebola Fighters". NPR.org. 17 December 2014. Retrieved 18 December 2014.
  271. ↑ "BBC News - 'Ebola-proof' tablet device developed". BBC News. Retrieved 21 March 2015.
  272. ↑ "Google develops Ebola-proof tablet for use by workers in Sierra Leone". IBNLive. Retrieved 23 March 2015.
  273. ↑ Chan, Margaret (12 August 2014). "WHO Director-General briefs Geneva UN missions on the Ebola outbreak". WHO. Retrieved 14 August 2014.
  274. ↑ 274.0 274.1 274.2 "Ebola Situation report on 7 January 2015" (PDF). World Health organization. 7 January 2015. Retrieved 8 January 2015.
  275. ↑ 275.0 275.1 275.2 "Ebola Situation Report - 25 February 2015" (PDF). World Health organization. 25 February 2015. Retrieved 25 February 2015.
  276. ↑ "Ebola (Ebola Virus Disease)". Ebola virus disease Information for Clinicians in U.S. Healthcare Settings. CDC. Retrieved 28 October 2014.
  277. ↑ "Liberia: top doctor becomes latest Ebola victim". The Guardian. 27 July 2014. Retrieved 28 July 2014.
  278. ↑ Cham, Kemo (10 August 2014). "Another Sierra Leone doctor contracts Ebola". Africa Review. Retrieved 14 August 2014.
  279. ↑ "Ebola-infected doctor in Sierra Leone, Sahr Rogers, dies". CBC News. 27 August 2014. Retrieved 28 August 2014.
  280. ↑ "Lagos records second Ebola case in doctor who treated victim: Nigerian health minister". Reuters. 4 August 2014. Retrieved 11 April 2015.
  281. ↑ McLaughlin, Eliott C. (10 December 2014). "Ebola fighters are Time's 'Person of the Year'". CNN World. Retrieved 10 December 2014.
  282. ↑ Getz WM., Gonzalez J.-P. and 8 others. (February 2015). "Tactics and strategies for managing ebola outbreaks and the salience of immunization". Computational and Mathematical Methods in Medicine 2015: 9. doi:10.1155/2015/736507.
  283. ↑ Roberts, Dan - News World news Ebola CDC director warns Ebola like 'forest fire' as Congress readies for hearing - Ebola crisis live updates - The Guardian. Retrieved 16 October 2014.
  284. ↑ Choi JH, Croyle MA; Croyle (December 2013). "Emerging targets and novel approaches to Ebola virus prophylaxis and treatment". BioDrugs 27 (6): 565–83. doi:10.1007/s40259-013-0046-1. PMC 3833964. PMID 23813435.
  285. ↑ Clark DV, Jahrling PB, Lawler JV; Jahrling; Lawler (September 2012). "Clinical management of filovirus-infected patients". Viruses 4 (9): 1668–86. doi:10.3390/v4091668. PMC 3499825. PMID 23170178.
  286. ↑ "Liberia-U.S. clinical research partnership opens trial to test Ebola treatments". National Institutes of Health (NIH). Retrieved 27 February 2015.
  287. ↑ Briggs, Helen (7 August 2014) "Ebola: Experimental drugs and vaccines", BBC News, Health, Retrieved 8 August 2014
  288. ↑ "Ebola virus: Clinical trials of three new treatments for disease to start in West Africa". Retrieved 13 November 2014.
  289. ↑ "Guinea to expand use of experimental anti-Ebola drugs". Reuters. Retrieved 8 February 2015.
  290. ↑ "Ebola Drug Trial is Halted For Lack of Patients". nytimes.com. Retrieved 7 February 2015.
  291. ↑ http://www.nytimes.com/2015/04/23/science/ebola-drug-works-against-west-african-strain-in-study-of-monkeys.html?_r=0
  292. ↑ Fausther-Bovendo H, Mulangu S, Sullivan NJ (June 2012). "Ebolavirus vaccines for humans and apes". Curr Opin Virol 2 (3): 324–29. doi:10.1016/j.coviro.2012.04.003. PMC 3397659. PMID 22560007.
  293. ↑ Alison P. Galvani with three others (21 August 2014). "Ebola Vaccination: If Not Now, When?". Annals of Internal Medicine 161 (10): 749–50. doi:10.7326/M14-1904. PMID 25141813.
  294. ↑ "Ebola Vaccine Trial Opens in Liberia: Study Led by Liberia-NIH Partnership Will Test Two Experimental Vaccines". National Institutes of Health (NIH). Retrieved 8 February 2015.
  295. ↑ "Ebola ring vaccination trial set for Guinea launch". CIDRAP - Center for Infectious Disease Research and Policy. Retrieved 6 March 2015.
  296. ↑ "Ebola vaccine tests to begin in Guinea on March 7: WHO". The Economic Times. Retrieved 5 March 2015.
  297. ↑ "MMS: Error". nejm.org. Retrieved 10 April 2015.
  298. ↑ http://www.nytimes.com/2015/04/09/health/2-new-ebola-vaccines-pass-important-early-test-researchers-say.html?_r=0
  299. ↑ "Ebola Experts Seek to Expand Testing". Scientific American. Retrieved 11 December 2014.
  300. ↑ Paddock PhD, Catharine (9 January 2015). "'Lab in a suitcase' set to improve Ebola virus control". Medical News Today. Retrieved 11 April 2015.
  301. ↑ Marta Falconi (29 December 2014). "Roche Secures Emergency Approval by U.S. Regulators for Ebola Test". WSJ. Retrieved 29 December 2014.
  302. ↑ "MIT designs 10-minute ebola test". gizmag.com. Retrieved 26 February 2015.
  303. ↑ "FDA approves Corgenix's Ebola test for emergency use". Reuters. Retrieved 27 February 2015.
  304. ↑ Lisa O'Carroll. "Ebola rapid diagnostic kit developed by UK scientists in Sierra Leone". the Guardian. Retrieved 10 April 2015.
  305. ↑ "Why the Ebola outbreak has been underestimated". WHO. Retrieved 9 October 2014.
  306. ↑ "West & Central Africa - Information by Country". UNICEF. Retrieved 9 October 2014.
  307. ↑ Rambaut, Andrew (7 August 2014). "Case Fatality Rate for ebolavirus". Epidemic. Retrieved 16 September 2014.
  308. ↑ 308.0 308.1 "WHO: Ebola Response Roadmap Situation Report 2, 5 September 2014". WHO. Retrieved 18 September 2014.
  309. ↑ "Basic Reproductive Rate (Ro)". University of Michigan. Retrieved 16 September 2014.
  310. ↑ Althaus, Christian L. (2014). "Estimating the Reproduction Number of Ebola Virus (EBOV) During the 2014 Outbreak in West Africa". PLoS Currents. doi:10.1371/currents.outbreaks.91afb5e0f279e7f29e7056095255b288.
  311. ↑ Hunt, Allen G. (11 October 2014). "Exponential growth in Ebola outbreak since May 14, 2014". Complexity 20 (2): 8–11. doi:10.1002/cplx.21615.
  312. ↑ Kupferschmidt, Kai. "Disease modelers project a rapidly rising toll from Ebola". Science. Retrieved 11 April 2015.
  313. ↑ Nishiura, H; Chowell, G (11 September 2014). "Early Transmission Dynamics of Ebola Virus Disease (EVD), West Africa, March to August 2014". Eurosurveillance (ECDC) 19 (36).
  314. ↑ "Virologist: Fight against Ebola in Sierra Leone and Liberia is lost". Deutsche Welle. 11 September 2014. Retrieved 11 September 2014.
  315. ↑ Szabo, Liz. "Could the Ebola outbreak last forever?". USA Today. Retrieved 22 September 2014.
  316. ↑ Farrar, Jeremy J. (23 September 2014). "The Ebola Emergency — Immediate Action, Ongoing Strategy". New England Journal of Medicine. Retrieved 23 September 2014.
  317. ↑ "OVERNIGHT HEALTH: Congress begs for attention on Ebola". The Hill. Retrieved 20 November 2014.
  318. ↑ "Fewer Ebola Cases Go Unreported Than Thought, Study Finds". New York Times. 16 December 2014. Retrieved 11 April 2015.
  319. ↑ Gomes MFC, Pastore y Piontti A, Rossi L, Chao D, Longini I, Halloran ME, Vespignani A. (2 September 2014). "Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak". PLOS Currents Outbreaks. Retrieved 7 October 2014.
  320. ↑ "Laboratory for the Modeling of Biological and Socio-Technical Systems, Northeastern University". Retrieved 7 October 2014.
  321. ↑ Mark Anderson and agencies (22 August 2014). "Ebola: airlines cancel more flights to affected countries". The Guardian. Retrieved 2014-08-25.
  322. ↑ "Ebola Wreaks Economic Woe In West Africa". NPR. 2014-07-17. Retrieved 2014-08-25.
  323. ↑ Lomax, Selma (2014-08-20). "Liberia: Ebola Outbreak Affects Agriculture in Lofa County". allAfrica.com. Retrieved 2014-08-25.
  324. ↑ 324.0 324.1 "First WHO worker infected by Ebola, DR Congo reports cases". Rappler.com. 2014-08-15. Retrieved 2014-08-25.
  325. ↑ "Ebola threatens food security in West Africa: FAO". Retrieved 3 September 2014.
  326. ↑ "Ebola Threatens Millions With Food Insecurity". VOA. Retrieved 19 December 2014.
  327. ↑ "Ebola Virus Eats Into West Africa's Economic Growth". AFKInsider. 2014-08-21. Retrieved 2014-08-25.
  328. ↑ "Ebola Reduced Lagos Hotel Patronage by 75% in 2014, Articles - THISDAY LIVE". thisdaylive.com. Retrieved 26 April 2015.
  329. ↑ Brock, Joe (20 August 2014). "Ebola fears slowing tourist flow to Africa". Reuters. Retrieved 2014-08-25.
  330. ↑ "Video: Impact of Ebola on e-commerce in Nigeria - CNBC Africa". CNBCAfrica.com. Retrieved 16 December 2014.
  331. ↑ "Mixed grill for businesses as Ebola impacts economy". Vanguard News. Retrieved 16 December 2014.
  332. ↑ "BBC News - The Gambia's tourist industry reels from Ebola fallout". BBC News. Retrieved 13 January 2015.
  333. ↑ Ghana News Agency. "Ebola scares tourist from Cape Coast Castle in 2014". spyghana.com. Retrieved 28 February 2015.
  334. ↑ Standard Reporter (8 March 2015). "Standard Digital News : : Business - Kenya Tourism Board releases Sh140 million for tourism campaigns". Standard Digital News. Retrieved 8 March 2015.
  335. ↑ "Tourism receipts down 3%". The Standard. Retrieved 10 April 2015.
  336. ↑ "Senegal scraps visas for tourists, cuts tax on air fares". reuters.com. Retrieved 10 April 2015.
  337. ↑ Sharon Gilbert-Rivett. "Africa Travel Week focuses on sustainable tourism". The M&G Online. Retrieved 16 April 2015.
  338. ↑ "UK employees leave Sierra Leone over Ebola threat". BBC News. 2014-06-03. Retrieved 2014-08-25.
  339. ↑ "West Africa Ebola outbreak forces miners to lock down operations, delay projects". MINING.com. 2014-08-10. Retrieved 2014-08-25.
  340. ↑ Jun Feng. "Mining: African Minerals begins shutdown of Sierra Leone assets as Ebola effect hits". Retrieved 21 December 2014.
  341. ↑ Clár Ní Chonghaile. "Ebola crisis could force Sierra Leone to diversify economy away from mining - Clár Ní Chonghaile". the Guardian. Retrieved 27 March 2015.
  342. ↑ Chris Kay (2014-08-20). "Africa nations sell debt for Ebola fight". BDlive. Retrieved 2014-08-25.
  343. ↑ "BBC News - Ebola crisis: Oxfam calls for recovery Marshall Plan". BBC News. Retrieved 27 January 2015.
  344. ↑ "Socio-Economic Impact of Ebola Virus Disease in West African Countries". ReliefWeb. Retrieved 16 March 2015.
  345. ↑ "Ebola epidemic continues to stagnate Liberia’s economic growth". CCTV America. Retrieved 10 April 2015.
  346. ↑ http://www.chinapost.com.tw/business/africa/2015/04/06/432928/Ebola-hit-Liberia.htm
  347. ↑ "Sierra Leone President Bemoans Ebola's Impact". VOA. Retrieved 18 April 2015.
  348. ↑ "Ebola-hit countries call for $8 bn aid plan". newvision.co.ug. Retrieved 19 April 2015.
  349. ↑ "allAfrica.com: Liberia: Ebola Handling Curbed - 'April 14' - Like Rice Riot - Min. Konneh". allAfrica.com. Retrieved 1 May 2015.
  350. ↑ "IMF says Ebola impacted West African nations may need economic assistance". Australian News.Net.
  351. ↑ "BusinessGhana - Ghana, Business Advice, Jobs, News, Business Directory, Real Estate, Finance, Forms, Auto". Retrieved 20 December 2014.
  352. ↑ "IMF policies blamed for weak Ebola response". Telegraph.co.uk. 22 December 2014. Retrieved 23 December 2014.
  353. ↑ AFP. "IMF under pressure to cancel Ebola-hit countries' debts". Times LIVE. Retrieved 5 January 2015.
  354. ↑ "IMF hopes for deal soon on debt forgiveness for Ebola countries". reuters.com. Retrieved 3 February 2015.
  355. ↑ "Britain becomes first country to donate to IMF Ebola debt relief fund". reuters.com. Retrieved 9 February 2015.
  356. ↑ Patrick Ayumu. "IMF gives Guinea extra $37.7 M to fight Ebola". starrfmonline.com. Retrieved 23 February 2015.
  357. ↑ "IMF Survey : Liberia Gets $36.5 Million From IMF’s New Trust for Disaster Recovery". imf.org. Retrieved 2 March 2015.
  358. ↑ "IMF okays $187 million to support Ebola-hit Sierra Leone". The Economic Times. Retrieved 3 March 2015.
  359. ↑ "IMF Survey : Sierra Leone Gets $102 Million in Extra IMF Financing, Debt Relief". imf.org. Retrieved 28 March 2015.
  360. ↑ IPD Group. "IMF Survey: Ebola Subsides, Economic Impact Lingers". einnews.com. Retrieved 25 April 2015.
  361. ↑ "World Bank rings alarm over £20bn worst-case Ebola scenario". Telegraph. Retrieved 8 October 2014.
  362. ↑ "New World Bank Group Study Forecasts Billions in Economic Loss". World Bank. Retrieved 8 October 2014.
  363. ↑ "Ebola costs Liberia, Guinea, Sierra Leone $2 billion: World Bank". Reuters. Retrieved 7 December 2014.
  364. ↑ "Ebola death toll hits new level in West Africa". Washington Post. 23 December 2014. Retrieved 6 January 2015.
  365. ↑ "Ebola: Most African Countries Avoid Major Economic Loss but Impact on Guinea, Liberia, Sierra Leone Remains Crippling". worldbank.org. Retrieved 26 January 2015.
  366. ↑ "World Bank to revive Agriculture in Ebola hit Countries". vibeghana.com. Retrieved 25 February 2015.
  367. ↑ Webmaster. "FrontPageAfrica - Liberia Gets US$3M for Post-Ebola Psychosocial Support". frontpageafricaonline.com. Retrieved 4 March 2015.
  368. ↑ "World Bank Boosts Fisheries in Mauritania and Guinea, Contributing to the Ebola Recovery". worldbank.org. Retrieved 22 March 2015.
  369. ↑ "allAfrica.com: Liberia: Rebuilding Ebola-Hit Economy - Focus of World Bank Spring Event". allAfrica.com. Retrieved 16 April 2015.
  370. ↑ Sylvain Baize, Ph.D., Delphine Pannetier, Ph.D., Pharm.D., Lisa Oestereich, M.Sc., Toni Rieger, Ph.D., Lamine Koivogui, Ph.D., N'Faly Magassouba, Ph.D., Barrè Soropogui, M.Sc., Mamadou Saliou Sow, M.D., Sakoba Keïta, M.D., Hilde De Clerck, M.D., Amanda Tiffany, M.P.H., Gemma Dominguez, B.Sc., Mathieu Loua, M.D., Alexis Traoré, M.D., Moussa Kolié, M.D., Emmanuel Roland Malano, M.D., Emmanuel Heleze, M.D., Anne Bocquin, M.Sc., Stephane Mély, M.Sc., Hervé Raoul, Ph.D., Valérie Caro, Ph.D., Dániel Cadar, D.V.M., Ph.D., Martin Gabriel, M.D., Meike Pahlmann, Ph.D., Dennis Tappe, M.D., Jonas Schmidt-Chanasit, M.D., Benido Impouma, M.D., Abdoul Karim Diallo, M.D., Pierre Formenty, D.V.M., M.P.H., Michel Van Herp, M.D., M.P.H., and Stephan Günther, M.D. (October 9, 2014). "Emergence of Zaire Ebola Virus Disease in Guinea". The New England Journal of Medicine 371 (15): 1418–1425. doi:10.1056/NEJMoa1404505. PMID 24738640. Retrieved December 31, 2014. In March 2014, the World Health Organization was notified of an outbreak of a communicable disease characterized by fever, severe diarrhea, vomiting, and a high fatality rate in Guinea. Virologic investigation identified Zaire ebolavirus (EBOV) as the causative agent
  371. ↑ 371.0 371.1 "Aid workers ask where was WHO in Ebola outbreak". Reuters. Retrieved 5 October 2014.
  372. ↑ "Statement on the Meeting of the International Health Regulations Emergency Committee Regarding the 2014 Ebola Outbreak in West Africa". World Health Organization. 8 August 2014. Retrieved 8 August 2014.
  373. ↑ "WHO says Ebola outbreak could strike 20,000 people". Reuters. 28 August 2014. Retrieved 28 August 2014.
  374. ↑ Dopplick, Renée (29 April 2009). "Swine Flu: Legal Obligations and Consequences When the World Health Organization Declares a "Public Health Emergency of International Concern"". Inside Justice. Retrieved 6 June 2014.
  375. ↑ "Ebola 'threat to world security'- UN Security Council". BBC News. 18 September 2014. Retrieved 18 September 2014.
  376. ↑ "WHO warns Ebola response could cost $1B". The Hill. 16 September 2014. Retrieved 16 September 2014.
  377. ↑ "WHO: Ebola Response Roadmap Situation Report 15 October 2014" (PDF). World Health Organization. p. 5. Retrieved 29 October 2014.
  378. ↑ "Global Response". United Nations Mission for Ebola Emergency Response. Retrieved 29 October 2014.
  379. ↑ "Ebola response roadmap - Situation report 17 December 2014". WHO. Retrieved 19 December 2014.
  380. ↑ ABC News. "UN Chief Names New Head of Ebola Mission as Outbreak Calms". ABC News. Retrieved 28 April 2015.
  381. ↑ "WHO chief promises transparency on Ebola failures". Associated Press. Retrieved 31 December 2014.
  382. ↑ McVeigh, Tracy (18 October 2014). "Oxfam calls for troops in Africa as criticism of 'inadequate' Ebola response mounts". The Guardian. Retrieved 24 October 2014.
  383. ↑ "WHO leadership admits failings over Ebola, promises reform". Channel NewsAsia. Retrieved 21 April 2015.
  384. ↑ "Ebola". internationalsos.com. Retrieved 22 April 2015.
  385. ↑ Miles, Tom (22 October 2014). "Official WHO Ebola toll near 5,000 with true number nearer 15,000". Reuters. Retrieved 11 April 2015.
  386. ↑ "Ebola virus disease, West Africa – update 22 August 2014". WHO. Retrieved 18 September 2014.
  387. ↑ Mehta, Salil (10 November 2014). "The Ebola epidemic is not subsiding any time soon". Significance. Wiley-Blackwell. Retrieved 11 April 2015.
  388. ↑ "WHO Virtual Press Conference on the third meeting of the International Health Regulations Emergency Committee regarding the 2014 Ebola outbreak in West Africa" (PDF). WHO. Retrieved 5 November 2014.
  389. ↑ "Ebola Situation Report - 29 April 2015" (PDF). 29 April 2015. Retrieved 30 April 2015.
  390. ↑ "Ebola Situation Report - 22 April 2015" (PDF). 22 April 2015. Retrieved 23 April 2015.
  391. ↑ "Ebola Situation Report - 15 April 2015" (PDF). 15 April 2015. Retrieved 18 April 2015.
  392. ↑ "Ebola Situation Report - 7 April 2015" (PDF). 7 April 2015. Retrieved 8 April 2015.
  393. ↑ 393.0 393.1 "Ebola Situation Report - 1 April 2015" (PDF). 1 April 2015. Retrieved 2 April 2015.
  394. ↑ "Ebola Situation Report - 17 March 2015" (PDF). World Health organization. 17 March 2015. Retrieved 17 March 2015.
  395. ↑ "Ebola Situation Report - 10 March 2015" (PDF). World Health organization. 10 March 2015. Retrieved 10 March 2015.
  396. ↑ 396.0 396.1 "Ebola Situation Report - 4 March 2015" (PDF). World Health organization. 4 March 2015. Retrieved 5 March 2015.
  397. ↑ 397.0 397.1 "Ebola Situation Report - 18 February 2015". World Health organization. 18 February 2015. Retrieved 18 February 2015.
  398. ↑ 398.0 398.1 "Ebola Situation Report - 11 February 2015". World Health organization. 11 February 2015. Retrieved 20 February 2015.
  399. ↑ 399.0 399.1 "Ebola Situation Report - 4 February 2015". World Health organization. 4 February 2015. Retrieved 20 February 2015.
  400. ↑ "EBOLA SITUATION REPORT- 28 January 2015" (PDF). World Health organization. 27 January 2015. Retrieved 28 January 2015.
  401. ↑ "Liberia Ebola SitRep no. 234" (PDF). 8 January 2015. Retrieved 9 January 2015.
  402. ↑ "EBOLA SITUATION REPORT- 25 January 2015" (PDF). World Health organization. 27 January 2015. Retrieved 28 January 2015.
  403. ↑ "EBOLA RESPONSE ROADMAP SITUATION REPORT-17 DECEMBER 2014" (PDF). World Health organization. 17 December 2014. Retrieved 18 December 2014.
  404. ↑ "Liberia Ebola SitRep no. 213" (PDF). 18 December 2014. Retrieved 18 December 2014.
  405. ↑ "Sierra Leone: EBOLA OUTBREAK UPDATES---December 01, 2014" (PDF). 1 December 2014. Retrieved 6 December 2014.
  406. ↑ "Liberia Ebola SitRep no. 199" (PDF). 5 December 2014. Retrieved 6 December 2014.
  407. ↑ "EBOLA RESPONSE ROADMAP SITUATION REPORT" (PDF). World Health organization. 21 November 2014. Retrieved 24 November 2014.
  408. ↑ "Sierra Leone: EBOLA OUTBREAK UPDATES---November 18, 2014" (PDF). 18 November 2014. Retrieved 24 November 2014.
  409. ↑ "EBOLA RESPONSE ROADMAP SITUATION REPORT UPDATE" (PDF). World Health organization. 5 November 2014. Retrieved 5 November 2014.
  410. ↑ "Sierra Leone: EBOLA VIRUS DISEASE - SITUATION REPORT (Sit-Rep) – 2 November , 2014" (PDF). 3 November 2014. Retrieved 8 November 2014.
  411. ↑ WHO : Ebola Response Roadmap Situation Report 15 October 2014
  412. ↑ WHO: Ebola Response Roadmap Situation Report – 1 October 2014
  413. ↑ Sierra Leone: EBOLA VIRUS DISEASE – SITUATION REPORT (Sit-Rep) – 29 September, 2014
  414. ↑ Liberia: Liberia Ebola SitRep no. 122, 14 September 2014
  415. ↑ Sierra Leone: EBOLA VIRUS DISEASE – SITUATION REPORT (Sit-Rep) – 15 September, 2014
  416. ↑ SIERRA LEONE: EBOLA VIRUS DISEASE – SITUATION REPORT (Sit-Rep) – 01 September, 2014
  417. ↑ "Ebola virus disease, West Africa – update 19 August 2014". WHO. Retrieved 18 September 2014.
  418. ↑ "Ebola virus disease, West Africa – update 11 August 2014". WHO. Retrieved 18 September 2014.
  419. ↑ "Ebola virus disease, West Africa – update 31 July 2014". WHO. Retrieved 18 September 2014.
  420. ↑ "Ebola virus disease, West Africa – update 17 July 2014". WHO. Retrieved 18 September 2014.
  421. ↑ "Ebola virus disease, West Africa (Situation as of 17 June 2014)". WHO. Retrieved 18 September 2014.
  422. ↑ "Ebola virus disease, West Africa (Situation as of 27 May 2014)". WHO. Retrieved 18 September 2014.
  423. ↑ "Ebola virus disease, West Africa (Situation as of 15 May 2014)". WHO. Retrieved 18 September 2014.
  424. ↑ "Ebola virus disease, West Africa (Situation as of 10 May 2014)". WHO. Retrieved 18 September 2014.
  425. ↑ "Ebola virus disease, West Africa (Situation as of 2 May 2014)". WHO. Retrieved 18 September 2014.
  426. ↑ "Ebola virus disease, West Africa (Situation as of 14 April 2014)". Retrieved 18 September 2014.
  427. ↑ "Ebola virus disease, West Africa (Situation as of 1 April 2014)". WHO. Retrieved 18 September 2014.
  428. ↑ "Ebola virus disease in Guinea". WHO. Retrieved 18 September 2014.

External links

Resources

  1. ↑ "Disease Outbreak News (DONs)". Global Alert and Response (GAR). WHO. Retrieved 11 April 2015.   Website content changes frequently.
  2. ↑ "Disease Outbreak News". Regional Office for Africa. WHO. Retrieved 11 April 2015.   Website content changes frequently.
  3. ↑ "West and Central Africa". HumanitarianResponse.info. OCHA. Retrieved 11 April 2015.