List of Ebola outbreaks

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Ebola virus (SEM)

This list of Ebola outbreaks records the known occurrences of Ebola hemorrhagic fever, a highly infectious and acutely lethal viral disease that has afflicted humans and animals primarily in equatorial Africa.[1] The pathogens responsible for the disease are the five ebolaviruses recognized by the International Committee on Taxonomy of Viruses: Ebola virus (EBOV), Sudan virus (SUDV), Reston virus (RESTV), Taï Forest virus (TAFV), and Bundibugyo virus (BDBV).[2][3][4][5] Four of the five variants have caused the disease in humans as well as other animals; RESTV has caused clinical symptoms only in non-human primates.[6][7] RESTV has caused subclinical infections in humans, producing and antibody response but no visual symptoms or disease state manifestations.[8]

Transmission of the ebolaviruses between natural reservoirs and humans is rare, and outbreaks of Ebola virus disease are often traceable to a single case where an individual has handled the carcass of a gorilla, chimpanzee, bats[9], or duiker.[10] The virus then spreads person-to-person, especially within families, hospitals and during some mortuary rituals where contact among individuals becomes more likely.[11]

Learning from failed responses, such as during the 2000 outbreak in Uganda, the World Health Organization (WHO) established its Global Outbreak Alert and Response Network, and other public health measures were instituted in areas at high risk. Field laboratories were established to confirm cases, instead of shipping samples to South Africa.[12] Outbreaks are also closely monitored by the United States Centers for Disease Control and Prevention (CDC) Special Pathogens Branch.[13]

Nigeria was the first country in western Africa to successfully curtail the virus, and its procedures have served as a model for other countries to follow.[14][15][16]

Events[edit]

The following tables of outbreaks are based upon information provided by the World Health Organization (WHO) which excludes all laboratory personnel cases, Reston virus cases (since they are all asymptomatic), or suspected cases.[17] For a complete overview, those cases are included below with footnotes and supporting sources.

Major or massive cases[edit]

Date Country[note 1] Virus Human cases Human deaths Case fatality rate Description
Jun–Nov 1976  Sudan SUDV 284 151 53% Occurred in Nzara (the source town), Maridi, Tumbura, and Juba (cities in present-day South Sudan). The index cases were workers in a cotton factory. The disease was spread by close contact with an acute case, usually from patients to their nurses. Many medical care personnel were infected.[18]
Aug 1976  Zaire EBOV 318 280 88% Occurred in Yambuku and surrounding areas in what was then Zaire (present-day Democratic Republic of the Congo). It spread through personal contact and by use of contaminated needles and syringes in hospitals and clinics.[19]
Aug–Sep 1979  Sudan SUDV 34 22 65% Occurred in Nzara and Maridi. This was a recurrent outbreak at the same site as the 1976 Sudan epidemic.[20]
Dec 1994–Feb 1995  Gabon EBOV 52 31 60% Occurred in Makokou and gold-mining camps deep in the rain forest along the Ivindo River. Until 1995, the outbreak was incorrectly classified as yellow fever.[21]
May–Jul 1995  Zaire EBOV 315 254 81% Occurred in Kikwit and surrounding areas. The outbreak was traced to a patient who worked in a forest adjoining the city. The epidemic spread through families and hospital admissions.[22][23]
Jan–Apr 1996  Gabon EBOV 31 21 68% Occurred in the village of Mayibout 2 and neighboring areas. A chimpanzee found dead in the forest was eaten by villagers hunting for food. Nineteen people involved in the butchery of the animal became ill, and other cases occurred in their family members.[21]
Jul 1996–Mar 1997  Gabon EBOV 60 45 75% Occurred in the Booué area with transport of patients to Libreville. The index case-patient was a hunter who lived in a forest timber camp. The disease was spread by close contact with infected persons. A dead chimpanzee found in the forest at the time was determined to be infected.[21]
Oct 2000–Jan 2001  Uganda SUDV 425 224 53% Occurred in the Gulu, Masindi, and Mbarara districts of Uganda. The three greatest risks associated with Sudan virus infection were attending funerals of case-patients, having contact with case-patients in one's family, and providing medical care to case-patients without using adequate personal protective measures.[24]
Oct 2001–Jul 2002  Gabon EBOV 65 53 82% Occurred on both sides of the border between Gabon and the Republic of the Congo.
Oct 2001–Jul 2002  Republic of the Congo EBOV 59 44 75% Occurred on both sides of the border between Gabon and the Republic of the Congo (RC). This outbreak included the first reported occurrence of Ebola virus disease in the RC.[25]
Dec 2002–Apr 2003  Republic of the Congo EBOV 143 128 90% Occurred in the districts of Mbomo and Kelle in the Cuvette-Ouest Department.[26]
Nov–Dec 2003  Republic of the Congo EBOV 35 29 83% Occurred in Mbomo and Mbandza villages, located in Mbomo District in the Cuvette-Ouest Department.[27]
Apr–Jun 2004  Sudan SUDV 17 7 41% Occurred in Yambio county in Western Equatoria of southern Sudan (present-day South Sudan). This outbreak was concurrent with an outbreak of measles in the same area, and several suspected EVD cases were reclassified later as measles cases.[28]
Apr-May 2005  Republic of the Congo EBOV 12 10 83% Occurred in the Etoumbi district of Cuvette Ouest Department of the Republic of the Congo [29]
Aug–Nov 2007  Democratic Republic of the Congo EBOV 264 187 71%
Dec 2007–Jan 2008  Uganda BDBV 149 37 25% Occurred in the Bundibugyo District in western Uganda. This was the first identification of the Bundibugyo virus (BDBV).[3][4]
Dec 2008–Feb 2009  Democratic Republic of the Congo EBOV 32 14 45% Occurred in the Mweka and Luebo health zones of the Kasaï-Occidental province.[30]
Jun–Aug 2012  Uganda SUDV 24 17 71% Occurred in the Kibaale District.[31]
Jun–Nov 2012  Democratic Republic of the Congo BDBV 57 29 51% Occurred in the Orientale Province.[1][32]
Dec 2013–Jan 2016 Widespread:
 Liberia
 Sierra Leone
 Guinea
Limited and local:
 Nigeria
 Mali
 United States
 Senegal
 Spain
 United Kingdom
 Italy
EBOV 28,646[33] 11,323 70–71% (general)[34][35][36][note 2]
57–59% (among hospitalized patients)[37]
This was the most severe Ebola outbreak in recorded history in regards to both the number of human cases and fatalities. It began in Guéckédou, Guinea, in December 2013 and spread abroad.[38][39][34] Flare-ups of the disease continued into 2016,[40] and the outbreak was declared over on 9 June 2016.
Aug–Nov 2014  Democratic Republic of the Congo EBOV 66[41] 49[41] 74% Occurred in Équateur province. Outbreak detected 24 August and, as of 28 October 2014, the WHO said that twenty days had passed since the last reported case was discharged and no new contacts were being followed.[41][42] Declared over on 15 November 2014.[43]
May–Jul 2018  Democratic Republic of the Congo EBOV 54 33 61%

On 8 May 2018, the government of the Democratic Republic of the Congo reported two confirmed cases of Ebola infection in the northwestern town of Bikoro.[44] On 17 May, a case was confirmed in the city of Mbandaka.[45] Health authorities are planning to ring vaccinate with rVSV-ZEBOV, a recently developed experimental Ebola vaccine, to contain the outbreak.[45][46] The outbreak is ongoing as of 24 June 2018, in 2014 a different area of Equateur province was affected[47][48] On July 24, 2018 the outbreak was declared over.[49][50][51][52]

August 2018 – present Widespread:
 Democratic Republic of the Congo
Limited and local:
 Uganda
EBOV 3,722[53][54] 2,199[53][54] ongoing

On 1 August 2018, the Democratic Republic of the Congo Ministry of Health declared an outbreak when 4 individuals tested positive for the Ebola virus.[55][56][57][58] As of 17 November 2019 the outbreak is still ongoing.[53] On 11 June 2019, the WHO confirmed that a five-year-old boy in Uganda died after being diagnosed with Ebola.[59][60]

Minor or single cases[edit]

Date Country[note 1] Virus Human cases Human deaths Description
1976  United Kingdom SUDV or EBOV[note 3] 1 0 Laboratory infection by accidental stick of contaminated needle.[61][62]
1977  Zaire EBOV 1 1 Noted retroactively in the village of Tandala.[62][63][64]
1989–1990  Philippines RESTV 3[note 4] 0 The Reston virus (RESTV) was first identified when it caused high mortality in crab-eating macaques in a primate research facility responsible for exporting animals to the United States.[65] Three workers in the facility developed antibodies to the virus but did not get sick.[66]
1989  United States RESTV 0 0 RESTV was introduced into quarantine facilities in Virginia and Pennsylvania by monkeys imported from the Philippines. No human cases were reported.[67]
1990  United States RESTV 4[note 4] 0 Monkeys imported from the Philippines introduced RESTV into quarantine facilities in Virginia and Texas. Four humans developed antibodies but did not get sick.[68]
1992  Italy RESTV 0 0 RESTV was introduced into quarantine facilities in Siena by monkeys imported from the same facility in the Philippines that was the source of the 1989 and 1990 U.S. outbreaks. No human cases resulted.[69]
1994  Côte d'Ivoire[note 5] TAFV 1 0 This case was the first and thus far only recognition of Taï Forest virus (TAFV). Approximately one week after conducting necropsies on infected western chimpanzees in Taï National Park, a scientist contracted the virus and developed symptoms similar to those of dengue fever. She was discharged from a Swiss hospital two weeks later and fully recovered after six weeks.[70]
1995  Côte d'Ivoire Unknown 1 0 One person, fleeing the civil war in neighboring Liberia, was identified as an Ebola case in Gozon. This is considered as a suspected case, excluding from the WHO outbreak counts.[71][72]
1996  South Africa EBOV 1 1
1996  United States RESTV 0 0 RESTV was again introduced into a quarantine facility in Texas by monkeys imported from the same facility in the Philippines that was the source of the 1989 and 1990 U.S. outbreaks. No human cases resulted.[73]
1996  Philippines RESTV 0 0 RESTV was identified at a monkey export facility in the Philippines. No human cases resulted.[74]
1996  Russia EBOV 1 1 Laboratory contamination.[75]
2004  Russia EBOV 1 1 Laboratory contamination.[76]
2008  Philippines RESTV 6[note 4] 0 First recognition of RESTV in pigs. Strain very similar to earlier strains. Occurred in November. Six workers from the pig farm and slaughterhouse developed antibodies but did not become sick.[77][78]
2011  Uganda SUDV 1 1
2012  Uganda SUDV 7 4
2015  Philippines RESTV 0 0 On 6 September 2015, the Philippine health secretary reported an outbreak of RESTV in a primate research and breeding facility. Twenty-five workers subsequently tested negative for the virus.[79]
2017  Democratic Republic of the Congo EBOV 8 4

On 11 May 2017, the Ministry of Public Health for the Democratic Republic of the Congo notified the WHO of an Ebola outbreak in the Likati health zone (LHZ) in Bas-Uele province, in the northern part of the country. Suspected infections were reported from Nambwa, Mouma, and Ngay. The LHZ borders the Central African Republic, which made this outbreak a moderate risk to the region.[80][81]

2018  Hungary 0 0 On April 20 a laboratory accident led to a single worker being exposed to the Ebola virus, though he did not develop symptoms[82][83]

List of other Filoviridae outbreaks[edit]

Marburg virus disease outbreaks[84]
Year Country[note 1] Virus Human cases Human deaths Case fatality rate Comments
1967  West Germany
 Yugoslavia
MARV 31 7 23% In 1967 outbreaks in Marburg, Germany where the virus was first identified (historically) and the subsequent naming of the virus per the location[85]
1975  Rhodesia
 South Africa
MARV 3 1 33% Individual had traveled to Zimbabwe[84]
1980  Kenya MARV 2 1 50% Individual(s) traveled to Kitum Cave[84]
1987  Kenya RAVV 1 1 100% RAVV(Ravn virus) one of two members of the species Marburg marburgvirus[86]
1990  Soviet Union MARV 1 1 100% Laboratory incident[84]
1998–2000  Democratic Republic of the Congo MARV & RAVV 154 128 83% Occurred in Durba[84]
2004–2005  Angola MARV 252 227 90% Largest Marburg virus outbreak ever occurred in Angola[87]
2007  Uganda MARV & RAVV 4 1 25% Occurred in Kamwenge [84]
2008  Uganda
 Netherlands
 United States
MARV 2 1 50%               -
2012  Uganda MARV 15 4 27% Occurred in Kabale[84]
2014  Uganda MARV 1 1 100%               -
2017  Uganda MARV 3 3 100% Uganda has had five outbreaks of the virus[88]

See also[edit]

Notes[edit]

  1. ^ a b c In accordance with the sovereignty at the time.
  2. ^ The mortality rate (death/case ratio) recorded in Liberia up to 26 August 2014 was 70 percent.[35] However, the general estimated case fatality rate (70.8 percent) 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.
  3. ^ The Centers for Disease Control chronology notes this infection as "Sudan virus", whereas the 1977 British Medical Journal (BMJ) article refers to it as "Ebola virus". In 1977, there was no distinction between different ebolaviruses. The BMJ article notes only that the patient received "convalescent serum from the Sudan" following similar serum from Zaire
  4. ^ a b c All cases were asymptomatic.
  5. ^ The case was repatriated to Switzerland for medical treatment.[70]

References[edit]

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Further reading[edit]

  • Pacheco, Daniela Alexandra de Meneses Rocha; Rodrigues, Acácio Agostinho Gonçalves; Silva, Carmen Maria Lisboa da (October 2016). "Ebola virus – from neglected threat to global emergency state". Revista da Associação Médica Brasileira. 62 (5): 458–467. doi:10.1590/1806-9282.62.05.458. PMID 27656857.