2014 West Africa Ebola outbreak

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2014 West Africa Ebola outbreak
Guinea Sierra Leone Ebola Map April 14 2014 png.png
Situation map of the outbreak as of 20 July 2014
Date February 2014 – Ongoing
Location West Africa
(Guinea, Liberia, Sierra Leone)
Casualties
 Guinea: 460 cases, 339 deaths
 Liberia: 329 cases, 156 deaths
 Sierra Leone: 533 cases, 233 deaths
 Nigeria: 1 case (a Liberian visiting Lagos), 1 death[1]
Total mortality:
729 deaths / 1323+ cases (55.1%)

An ongoing epidemic of the Ebola virus disease has spread throughout Guinea and beyond the nation's borders in West Africa. The outbreak, which began in Guinea in February 2014 and has spread to Liberia, Sierra Leone and Nigeria, is the most severe in recorded history, both in the number of cases and fatalities.[2] A suspected 1,323 cases with 729 deaths have been reported as of 27 July 2014, with 909 cases and 485 deaths confirmed to be Ebola.[3] Various organizations, including the Economic Community of West African States, U.S. Centers for Disease Control, and European Commission have donated funds and mobilized personnel to help counter the outbreak; charities including Médecins Sans Frontières, the Red Cross,[4] and Samaritan's Purse are also working in the area.

Evolution of the outbreak[edit]

Initial outbreak in Guinea[edit]

In February 2014, the first Ebola virus outbreak registered in the region occurred in Guinea. By 23 April, the total number of suspected and confirmed cases in the Ebola haemorrhagic fever (EHF) outbreak had increased to 242, including 142 deaths at a fatality rate of 59%.[5] Originally, the suspected cases were reported in Conakry (four cases), Guéckédougou (four), Macenta (one) and Dabola (one) prefectures. On 25 March the Ministry of Health of Guinea reported that four southeastern districts—Guekedou, Macenta, Nzerekore, and Kissidougou—were affected with an outbreak of Ebola hemorrhagic fever.[6] The following day the Pasteur Institute in Lyon, France confirmed the Ebola strain as Zaire ebolavirus.[6] An initial report suggested that it was a new strain of ebolavirus,[7] but this was refuted by later studies which placed it within the lineage of the Zaire strain.[8] One suspected case was admitted to hospital on 28 March 2014.[9] On 31 March, the US Centers for Disease Control sent a five-person team "to assist Guinea Ministry of Health (MOH) and World Health Organization (WHO) lead an international response to the Ebola outbreak".[6]

Conakry, Guinea[edit]

Around 23 May, the outbreak spread to Guinea's capital Conakry,[6] a city of about two million inhabitants. According to Ibrahima Touré, Country Director of Plan Guinea, an NGO: "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."[10]

Subsequent spread[edit]

In Liberia, the disease was reported in Lofa and Nimba counties in late March,[11] and by mid-April, the Ministry of Health and Social Welfare (MOHSW) had recorded possible cases in Margibi and Montserrado County.[12]

Sierra Leone, Mali and Ghana identified suspected cases by mid-April, but all clinical samples of suspected cases tested negative for ebola virus.[13] The overall situation with the Ebola virus infection in Guinea improved in May. For several days no new alerts, cases or nosocomial transmission were reported from Liberia and from five out of the six affected prefectures in Guinea. Gueckedou was the only hotspot where community transmission and deaths were still being reported.

From 23 to 27 May 2014, three previously affected districts (Guéckédou, Macenta and Conakry), four new districts (Boffa, Télimélé, Boke and Dubréka) and one new country (Sierra Leone) reported several new EVH clinical cases.[14] In mid-June the first cases in Liberia's capital Monrovia were reported.[15]

Médecins Sans Frontières described the situation as being "totally out of control" in late June.[16] By early July, Liberia had reported 107 infections (52 laboratory-confirmed) and at least 65 deaths from Ebola,[17] and while only four deaths had been reported outside Lofa County by mid-April,[12] in mid-June, the MOHSW announced seven additional deaths in Montserrado County alone.[18]

The outbreak has progressed rapidly in Sierra Leone. The first cases were reported on 25 May in the Kailahun District, near the border with Guéckédou in Guinea.[19] By 20 June, there were 158 suspected cases, mainly in Kailahun and the adjacent district of Kenema, but also in the Kambia, Port Loko and Western districts in the north west of the country.[20] By 17 July, the total number of suspected cases in the country stood at 442, and had overtaken those in Guinea and Liberia.[21] By 20 July, cases had additionally been reported in the Bo District;[22] the first case in Freetown, Sierra Leone's capital, was reported in late July.[23][24]

The first case in Nigeria was reported by WHO on 25 July 2014; a Liberian man arriving at the city of Lagos by air on 20 July was hospitalised and later died of the disease.[25][23]

Response[edit]

Affected countries[edit]

The national authorities of Guinea, Sierra Leone, and Liberia have activated their national emergency committees, prepared Ebola haemorrhagic fever (EHF) response plans and carried out needs assessments.[9]

WHO's Regional Director for Africa, Luis Sambo visited the affected countries from 21 to 25 July, meeting with political leaders, ministers of health, NGOs and other agencies. He stressed the need to "promote behavioural change while respecting cultural practices."[25]

Guinea[edit]

The border between Guinea and Liberia remained open in April; Guinea's ambassador in Monrovia noted his government's belief that efforts to fight the disease directly would be more effective than closing the border.[26]

Liberia[edit]

On or before 23 July, the Liberian health ministry began to implement a strategic plan in line with the Accra meeting's conclusions to improve the country's response to the outbreak.[27]

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 country's principal airport, at which screening centres are being established; the worst-affected areas in the country are to be placed under quarantine.[28] Football events were banned, because large gatherings and the nature of the sport increase transmission risks.[29] On July 30, Reuters reported that Liberia announced to shut schools, and to quarantines communities.[30]

Sierra Leone[edit]

Sierra Leone has instituted a temporary measure which includes reactivation of its "Active Surveillance Protocol" that will see all travellers into the country from either Guinea or Liberia subjected to strict screening to ascertain their state of health.[31]

Unaffected countries[edit]

On 30 March 2014, during the 44th Summit of the heads of state and government of West Africa, Economic Community of West African States (ECOWAS) disbursed USD $250,000 to deal with the outbreak.[32] The Nigerian Government donated US$500,000 to the Liberian Government at the event to to aid the fight against the Virus.[33]

Senegal's Ministry of Interior has ordered all movements of people through the southern border with Guinea to be suspended indefinitely to prevent the spread of the disease, according to a statement published on 29 March 2014 by state agency APS.[34] Since 26 March, Mauritania closed all crossings along the Senegal River, the natural border between Mauritania and Senegal, except for the Rosso and Diama points of entry.

From 1 April, Saudi Arabia stopped issuing visas for the Muslim pilgrimage to Mecca to those from Guinea and Liberia. Moreover, Morocco reinforced medical surveillance at the Casablanca airport, a regional hub for flights from and to West Africa.[35][36][37]

The European Commission (EC) gave €500,000 to help contain the spread of the virus in Guinea and its neighbouring countries. The EC has also sent a health expert to Guinea to help assess the situation and liaise with the local authorities. EU Commissioner for International Cooperation, Humanitarian Aid and Crisis Response Kristalina Georgieva said: "We are deeply concerned about the spread of this virulent disease and our support will help ensure immediate health assistance to those affected by it. It's vital that we act swiftly to prevent the outbreak from spreading, particularly to neighbouring countries."[38]

A mobile laboratory, capable of performing the molecular diagnosis of viral pathogens of risk groups 3 and 4, was deployed in Guinea by the European Mobile Laboratory consortium as part of the WHO/GOARN outbreak response. Prior samples were analyzed at the Jean Mérieux BSL-4 Laboratory in Lyon.[39]

The humanitarian aid organisation Médecins Sans Frontières (Doctors Without Borders) has a team of 300 staff working in Guinea, Sierra Leone and Liberia, has set up specialist centers to give medical care to affected people, and has sent over 40 tonnes of equipment and supplies.[40] Samaritan's Purse is also providing direct patient care in multiple locations in Liberia.[41]

In July, the WHO convened an emergency sub-regional meeting with health ministers from eleven countries in Accra, Ghana.[42] On 3 July 2014, the West African states announced collaboration on a new strategy, and the creation of a World Health Organization sub-regional centre in Guinea "to co-ordinate technical support";[43] the centre was inaugurated in Conakry on 24 July.[44]

On 24 July, WHO's Director General met with agencies and donors in Geneva to facilitate an increase in funding and manpower to respond to the outbreak.[25]

On 25 July, when a Liberian government offical died 5 days after arriving symptomatic in Lagos, the Nigerian government increased surveillance at all entry points to the country; health officials have been placed at entry points to conduct tests on people arriving in the country.[45] Subsequently Arik Air, Nigeria's main airline, stopped flying to Liberia and Sierra Leone.[28]

On 30 July, Hong Kong's health authorities stepped up surveillance against the deadly Ebola virus yesterday as a Hong Kong woman who fell ill after visiting Kenya tested negative for the disease.[46]

Media[edit]

A dance tune with a serious message became popular in Guinea and Liberia in the first quarter of 2014, warning people of the dangers and explaining how to react to the virus.[47]

Containment complications[edit]

Difficulties faced in attempting to contain the outbreak include the outbreak's multiple locations across country borders,[16] inadequate equipment given to medical personnel,[48] funeral practices,[49] and public reluctance to follow preventive practices,[50] including "freeing" suspected Ebola patients from isolation,[23][51] and suspicion that the disease is caused by witchcraft, or that doctors are killing patients.[52] In late July, the former Liberian health minister Peter Coleman stated that "people don't seem to believe anything the government now says."[28]

There has also been an attack on aid workers who were hurrying to retrieve "freed" patients and did not explain to villagers who they were,[53] and the Red Cross were forced to suspend operations in Guinea after staff were threatened by a group of men armed with knives.[54] Demonstrations outside the main hospital treating Ebola patients in Kenema, Sierra Leone, on 25 July were broken up by police.[55]

On 20 July, a Liberian government official left the country after being exposed to the virus, traveling via air through Lomé, Togo, and Accra, Ghana on his way to Lagos, Nigeria, where he was to attend a conference. He was symptomatic during the flights, collapsing upon arrival in the airport in Lagos.[56] He died on 25 July, and in response the hospital where he was being treated has been shut down and quarantined and the health officials who were treating him isolated in an attempt to stop the spread of the virus. Nigeria, Togo, and Ghana are working with WHO and other health organizations in an attempt to track down people who may have come into contact with the Liberian man during his flights.[57]

Infection of healthcare workers is another problem. Samuel Brisbane, a former advisor to the Liberian health ministry described by The Guardian as "one of Liberia's most high-profile doctors", is among the fatalities.[58] Two American aid workers at a treatment center in Monrovia run by Serving in Mission (SIM)/Samaritan's Purse have also been infected.[58][59] On 29 July, leading Ebola doctor Sheik Umar Khan from Sierra Leone died in the outbreak.[60]

Fatality rate[edit]

The infection and mortality data from Guinea, where new infections almost came to a standstill by 18 June, indicate a fatality rate of about 64%, which includes also cases of probable and suspected Ebola infections, as reported by the World Health Organization.[61] Guinea and WHO disagree on patient data, including mortality data.[62]

Treatment[edit]

According to Doctors Without Borders, early treatment may increase the survival chance, since there is no known cure. Treatment focuses on replenishing fluids, maintaining proper blood pressure, replacing lost blood, and treating related infections.[63]

Virology[edit]

Researchers performed full-length genome sequencing and phylogenetic analysis of samples from 20 patients. Results suggest that the Zaire ebolavirus (EBOV) in Guinea is a different clade than the strains from outbreaks in the Democratic Republic of Congo and Gabon.[64]

However, this was contradicted by two subsequent reports.

A subsequent analysis reached the conclusion that the outbreak "is likely caused by a Zaire ebolavirus lineage that has spread from Central Africa into Guinea and West Africa in recent decades, and does not represent the emergence of a divergent and endemic virus".[65]

A further report published in June 2014 supported the latter view, determining that it was "extremely unlikely that this virus falls outside the genetic diversity of the Zaïre lineage" and that their analysis "unambiguously supports Guinea 2014 EBOV as a member of the Zaïre lineage".[66]

Economic effects[edit]

In addition to the loss of life, the outbreak is having an economic effect. Conakry's Palm Camayenne Hotel, which is popular among businessmen and politicians, has less than a third of occupancy rate.[67] On Brussels Airlines flights between Brussels and Conakry, there are reduced numbers of people arriving in Conakry but more people leaving Conakry.[67] Regional airline Gambia Bird delayed the start of a route to Conakry due to Senegal closing "its border with Guinea because of the outbreak".[67]

Non-essential employees of British firm London Mining in Sierra Leone were transported out of the country in June following an outbreak of the virus. At the time, at least 50 suspected cases of Ebola with five deaths had been reported.[68]

The ongoing outbreak in Sierra Leone caused the closure of schools, markets, Kailahun's lone bank and stores.[69]

Timeline of the outbreak[edit]

Timeline of the outbreak, using data reported by the Centers for Disease Control and Prevention [6] and the World Health Organisation.[61]

Temporal evolution of total cases and deaths and polynomial fit.
Date of report Total Guinea Liberia Sierra Leone Nigeria
cases deaths cases deaths cases deaths cases deaths cases deaths
27 Jul 2014 1323 729 460 339 329 156 533 233 1 1
23 Jul 2014 1201 672 427 319 249 129 525 224
20 Jul 2014 1093 660 415 314 224 127 454 219
18 Jul 2014 1048 632 410 310 196 116 442 206
15 Jul 2014 964 603 406 304 172 105 386 194
10 Jul 2014 888 539 409 309 142 88 337 142
8 Jul 2014 844 518 408 307 131 84 305 127
2 Jul 2014 759 467 413 303 107 65 239 99
24 Jun 2014 599 338 390 270 51 34 158 34
18 Jun 2014 528 337 398 264 33 24 97 49
10 Jun 2014 474 252 372 236 13 9 89 7
5 Jun 2014 438 231 344 215 13 9 81 7
2 Jun 2014 354 208 291 193 13 9 50 6
27 May 2014 309 200 281 186 12 9 16 5
23 May 2014 270 181 258 174 12 9
14 May 2014 245 164 233 157 12 9
5 May 2014 243 162 231 155 12 9
30 Apr 2014 233 153 221 146 12 9
23 Apr 2014 220 143 208 136 12 9
21 Apr 2014 215 136 203 129 12 9
17 Apr 2014 209 129 197 122 12 9
10 Apr 2014 169 108 157 101 12 9
7 Apr 2014 163 102 151 95 12 7
2 Apr 2014 135 88 127 83 8 5
1 Apr 2014 130 82 122 80 8 2
31 Mar 2014 114 70 112 70 2 0
27 Mar 2014 103 66 103 66
26 Mar 2014 86 60 86 60
25 Mar 2014 86 59 86 59

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External links[edit]