| Revision as of 16:46, 22 December 2014 editLocke411 (talk | contribs)208 editsm Updating as of date.← Previous edit | Revision as of 21:59, 22 December 2014 edit undo173.22.245.201 (talk) ←Replaced content with 'Blood will come out of your eyes, your pores, and your anal cavity. Also your ears mouth, and any other orifices.'Tag: blankingNext edit → | ||
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| Blood will come out of your eyes, your pores, and your anal cavity. Also your ears mouth, and any other orifices. | |||
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| {{Use dmy dates|date=June 2014}} | |||
| {{Use British English|date=August 2014}}<!--Sierra Leonean & Nigerian English are based on British English--> | |||
| {{Infobox event | |||
| |image = ] | |||
| |caption = <small>Situation map of the outbreak in West Africa</small> | |||
| |date = December 2013 – present<ref name="Tracing Ebola's Breakout to an African 2-Year-Old" /> | |||
| <!-- One case of uncontained or locally transmitted Ebola constitutes an outbreak by definition. See: http://www.who.int/topics/disease_outbreaks/en--> | |||
| |casualties1= <!-- Please do not add a mortality percentage here because it is misleading and cannot reflect real mortality until the outbreak has ceased (see ]) --> | |||
| <!-- Please ensure this Casualty list ONLY includes data as reported in the WHO, OCHA or governments reports. Also note a DRN has concluded that WHO reports are erroneous hence it may not tie up with reports, but are correlated with government reports.--> | |||
| <!-- Please update the WHO numbers and As-Of date consistently in 5 parts of this article: (1) Infobox (here), (2) lead section, (3) Subsequent Spread section, (4) Timeline table, (5) Timeline graph(s). --> | |||
| '''Reported cases/deaths ''' | |||
| *''Note: the CDC estimates that actual cases in Liberia, Sierra Leone, and Guinea are two to three times higher than officially reported numbers.<ref name="CDC Estimating future number of cases" />''</small><ref name="How many Ebola cases are there really?">{{cite web|url=http://news.sciencemag.org/health/2014/10/how-many-ebola-cases-are-there-really|title=How many Ebola cases are there really? |accessdate=26 October 2014| date= 20 October 2014}}</ref name=WHO2014115>{{cite news|url= http://www.latimes.com/world/africa/la-fg-who-ebola-numbers-20141029-story.html|title=Reported Ebola cases jump to 13,703, WHO reports|accessdate=3 November 2014|date=29 October 2014|author=Christine Mai-Duc|work=Los Angeles Times}}</ref> | |||
| {{{!}} class="wikitable" style="width: 100%" | |||
| {{!}}- | |||
| ! Country !! Cases !! Deaths !! Last update <br><small>22 December 2014</small> | |||
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| {{!}} <!--Liberia-->{{flagicon|LBR}} ] {{!}}{{!}} 7,830 {{!}}{{!}} 3,376 {{!}}{{!}} <small> 18 December 2014</small><ref name=WHO2014_12_22 /> | |||
| {{!}}- | |||
| {{!}} <!--Sierra Leone-->{{flagicon|SLE}} ] {{!}}{{!}} 8,939 {{!}}{{!}} 2,556 {{!}}{{!}} <small>20 December 2014</small><ref name="Ebola_Outbreak_total_sl_21_Dec">{{cite web|url=http://health.gov.sl/wp-content/uploads/2014/12/Ebola-Situation-Report_Vol-207.pdf|title= EBOLA VIRUS DISEASE - SITUATION REPORT (Sit-Rep) –) 21 December, 2014 | accessdate=22 December 2014| date=21 December 2014}}</ref> | |||
| {{!}}- | |||
| {{!}} <!--Guinea-->{{flagicon|GIN}} ] {{!}}{{!}} 2,571 {{!}}{{!}} 1,586 {{!}}{{!}} <small>20 December 2014</small><ref name="WHO2014_12_22">{{cite web |url=http://apps.who.int/gho/data/view.ebola-sitrep.ebola-summary-20141222?lang=en |title=Situation summary Data published 22 December 2014|publisher=World Health organization|date=22 December 2014|accessdate =22 December 2014}}</ref> | |||
| {{!}}- | |||
| {{!}} <!--Nigeria-->{{flagicon|NGA}} ] {{!}}{{!}} 20 {{!}}{{!}} 8 {{!}}{{!}} <small>outbreak ended 20 October 2014</small><ref name=WHO2014_11_14 /> | |||
| {{!}}- | |||
| {{!}} <!--Mali-->{{flagicon|Mali}} ] {{!}}{{!}} 8 {{!}}{{!}} 6 {{!}}{{!}} <small>23 November 2014</small><ref name=WHO2014_11_23 /> | |||
| {{!}}- | |||
| <!-- Please do not edit the USA total to add the 5 medivac cases, these are included in the totals of the respective area of infection country--> | |||
| {{!}} <!--United States-->{{flagicon|USA}} ] {{!}}{{!}} 4 {{!}}{{!}} 1 {{!}}{{!}} <small> outbreak ended 21 December 2014</small><ref name=WHO2014_11_19 /> | |||
| {{!}}- | |||
| {{!}} <!--Senegal-->{{flagicon|Senegal}} ] {{!}}{{!}} 1 {{!}}{{!}} 0 {{!}}{{!}} <small>outbreak ended 17 October 2014</small><ref name=Ebola_Outbreak_total_WHO_17_Oct /> | |||
| {{!}}- | |||
| {{!}} <!--Spain-->{{flagicon|SPA}} ] {{!}}{{!}} 1 {{!}}{{!}} 0 {{!}}{{!}} <small>outbreak ended 2 December 2014</small><ref name="WHO2014_12_05">{{cite web |url=http://apps.who.int/gho/data/view.ebola-sitrep.ebola-summary-20141205?lang=en |title=Situation summary Data published on the 4th of December 2014|publisher=World Health organization|date=5 December 2014|accessdate =6 December 2014}}</ref> | |||
| {{!}}- | |||
| ! Total !! 19,374 !! 7,533 !! <small>{{As of |2014|12|22|lc=n}}</small> | |||
| {{!}}} | |||
| <!-- DO NOT ADD NORWAY OR ANY OTHER STATE WITHOUT USING THE TALKPAGE FIRST --> | |||
| }} | |||
| <!-- Per MOS:BOLDTITLE and WP:SBE, neither the article's title nor related text appears in bold. -->{{As of|2014}}, the most widespread ] of ] (commonly known as "Ebola") ] is currently ongoing in several ]n countries.<ref>{{cite web |url= http://www.cdc.gov/vhf/ebola/resources/outbreak-table.html |title=Chronology of Ebola Hemorrhagic Fever Outbreaks |publisher=Centers for Disease Control and Prevention |date=24 June 2014 |accessdate =25 June 2014}}</ref><ref>{{cite web|url=http://www.nejm.org/doi/full/10.1056/NEJMp1409903?query=featured_home&|title=Ebola 2014 — New Challenges, New Global Response and Responsibility|publisher=The New England Journal of Medicine|accessdate=18 September 2014}}</ref> It has caused significant mortality, with a reported ] of <section begin=cfr /> 70%<section end=cfr />.<section begin=cfrref /><ref name=WHO2014_12_17a /><section end=cfrref /> It began in ] in December 2013 and then spread to ] and ].<ref name=":1">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJMoa1411100?query=featured_home |title=Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections |journal=New England Journal of Medicine |date=23 September 2014 |accessdate=23 September 2014 |author=WHO Ebola Response Team}}</ref> A small outbreak of twenty cases occurred in ] and one case occurred in ], both now declared disease-free.<ref name=sitrep_7Nov2014>{{cite web |url=http://apps.who.int/iris/bitstream/10665/137592/1/roadmapsitrep_7Nov2014_eng.pdf?ua=1 |title=EBOLA RESPONSE ROADMAP SITUATION REPORT UPDATE |publisher=World Health organization|date=7 November 2014 |accessdate =7 November 2014}}</ref> Several cases have been reported in ].<ref name="health-ebola-mali-idINL6N0T15CN20141112">{{cite web|url=http://in.reuters.com/article/2014/11/12/health-ebola-mali-idINL6N0T15CN20141112|title=UPDATE 1-Mali confirms new case of Ebola, locks down Bamako clinic|publisher=|accessdate=15 November 2014}}</ref> Imported cases in the ] and ] have led to secondary infections of medical workers but have not spread further.<ref name=El_Mundo>{{cite web|title=Una enfermera que atendió al misionero fallecido García Viejo, contagiada de ébola|url=http://www.elmundo.es/madrid/2014/10/06/5432bb62e2704e347a8b4577.html?a=a733fe5654cd56f5e1d50d769a9b4204&t=1412616936|accessdate=2014-10-06|date=2014-10-06|publisher=El Mundo|language=Spanish}}</ref><ref name="Ebola_Outbreak_total_WHO_8_Oct">{{cite web|url=http://apps.who.int/iris/bitstream/10665/136020/1/roadmapsitrep_8Oct2014_eng.pdf?ua=1|title= WHO: Ebola Outbreak Situation Report | accessdate=15 October 2014| date=8 October 2014}}</ref> <!--Sections for transclusion on ], ], etc. See ]--><section begin=casesasof />{{As of|2014|12|22}}<section end=casesasof />, the ] (WHO) and respective governments<!--, the United States ] (CDC), OCHA and local governments--> have reported a total of <section begin=cases />19,374<section end=cases /> suspected cases and <section begin=deaths />7,533 <section end=deaths /> deaths,<ref name=WHO2014_12_22 /><ref name=Ebola_Outbreak_total_sl_21_Dec /> though the WHO believes that this substantially understates the magnitude of the outbreak.<ref name="CDC Estimating future number of cases" /><ref name="Reuters">{{cite web | url=http://www.reuters.com/article/2014/10/22/us-health-ebola-who-idUSKCN0IB23220141022 | title=Official WHO Ebola toll near 5,000 with true number nearer 15,000 | publisher=Reuters | date=22 October 2014 | accessdate=25 October 2014 | author=Miles, Tom}}</ref><ref name="HP New cases 10,000 per week">{{cite web|url=http://www.huffingtonpost.com/2014/10/14/who-ebola-cases_n_5982078.html|title=WHO: New Ebola Cases Could Be Up To 10,000 Per Week In 2 Months|date=14 October 2014|work=The Huffington Post|accessdate=14 October 2014}}</ref> | |||
| Some countries have encountered difficulties in their efforts to control the epidemic.<ref name=sitrep_24Sept2014>{{cite web|title=Ebola Response Roadmap Situation Report|url=http://apps.who.int/iris/bitstream/10665/134771/1/roadmapsitrep_24Sept2014_eng.pdf?ua=1|publisher=World Heath Organisation|accessdate=25 September 2014|page=6}}</ref> In some areas, people have become suspicious of both the government and hospitals, some of which have been attacked by angry protesters who believe either that the disease is a hoax or that the hospitals are responsible for the disease. Many of the seriously affected areas have ] with limited access to the soap and running water needed to help control the spread of this disease.<ref>{{cite web|title=Runaway Doctors and Missing Supplies Cripple Care in Ebola-Hit Liberia|url=http://www.nbcnews.com/storyline/ebola-virus-outbreak/runaway-doctors-missing-supplies-cripple-care-ebola-hit-liberia-n220686|publisher=NBC news|accessdate=8 October 2014}}</ref> Other factors include reliance on ] and cultural practices that involve physical contact with the deceased, especially ]s such as ] the body of the deceased.<ref name="WHO 2014-07-03" /><ref name="Global Post">{{cite web |url=http://www.globalpost.com/dispatch/news/xinhua-news-agency/140527/8-ebola-suspects-freed-relatives-sierra-leone |title=8 Ebola suspects freed by relatives in Sierra Leone |work=Global Post |date=28 May 2014 |accessdate=21 June 2014}}</ref><ref name="Today Health">{{cite web |url=http://www.today.com/health/growing-ebola-outbreak-threatens-overwhelm-volunteers-2D79775266 |title=Growing Ebola Outbreak Threatens to Overwhelm Volunteers|publisher=Today Health|date=8 June 2014 |accessdate=21 June 2014}}</ref> Some hospitals lack basic supplies and are understaffed, increasing the chance of staff catching the virus themselves. In August, the WHO reported that ten percent of the dead have been health care workers.<ref name="As Ebola Outbreak Surges, Health Officials Slam International 'Coalition of Inaction'">{{cite web |url=http://www.commondreams.org/news/2014/09/03/ebola-outbreak-surges-health-officials-slam-international-coalition-inaction |title=As Ebola Outbreak Surges, Health Officials Slam International 'Coalition of Inaction' |publisher=Common Dreams |work=As Ebola Outbreak Surges, Health Officials Slam International 'Coalition of Inaction' |date=3 September 2014 |accessdate=7 September 2014 |author=McCauley, Lauren}}</ref> By the end of August, the WHO reported that the loss of so many health workers was making it difficult for them to provide sufficient numbers of foreign medical staff.<ref name="WHO">{{cite web |url=http://www.who.int/mediacentre/news/ebola/25-august-2014/en/ |title=Unprecedented number of medical staff infected with Ebola |publisher=WHO |work=Situation assessment |date=25 August 2014 |accessdate=27 August 2014}}</ref> In September, the WHO estimated that the countries' capacity for treating Ebola patients was insufficient by the equivalent of 2,122 beds. By the end of October many of the hospitals in the affected area had become dysfunctional or had been closed, leading some health experts to state that the inability to treat other medical needs may be causing "an additional death toll likely to exceed that of the outbreak itself".<ref name=":2">{{cite web | url=http://www.independent.co.uk/news/world/africa/ebola-outbreak-deaths-from-malaria-and-other-diseases-could-soar-while-africas-overstretched-healthcare-systems-fight-the-virus-expert-warns-9667362.html | title=Ebola outbreak: Deaths from malaria and other diseases could soar while Africa's over-stretched healthcare systems fight the virus, expert warns | publisher=The Independent | date=27 October 2014 | accessdate=28 October 2014 | author=Cooper, Charlie}}</ref><ref name="Diary">{{cite news|last1=Farmer|first1=Paul|title=Diary|url=http://www.lrb.co.uk/v36/n20/paul-farmer/diary|accessdate=25 October 2014|publisher=London Review of Books|date=23 October 2014}}</ref> | |||
| By September 2014, ]/Doctors Without Borders (MSF), the ] 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 ] member countries saying, "Six months into the worst Ebola epidemic in history, the world is losing the battle to contain it."<ref name="Ebola: the failures of the international outbreak response">{{cite web |url=http://www.msf.org/article/ebola-failures-international-outbreak-response |title=Ebola: the failures of the international outbreak response |publisher=Médecins Sans Frontières |date=29 August 2014 |accessdate=7 September 2014}}</ref> On 3 September, the United Nations’ senior leadership said it could be possible to stop the Ebola outbreak in 6 to 9 months, but only if a “massive” global response is implemented.<ref name="UN senior leaders outline needs for global Ebola response" /> <!-- the nbsp is one way to prevent an unexpected and unwanted paragraph break -->The Director-General of the WHO, ], called the outbreak "the largest, most complex and most severe we've ever seen" and said that it is "racing ahead of control efforts".<ref name="UN senior leaders outline needs for global Ebola response">{{cite web |url=http://www.who.int/mediacentre/news/releases/2014/ebola-response-needs/en/ |title=UN senior leaders outline needs for global Ebola response |publisher=WHO |date=3 September 2014 |accessdate=7 September 2014 |author=news release}}</ref> 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. Never before in recorded history has a biosafety level four pathogen infected so many people so quickly, over such a broad geographical area, for so long."<ref name="Ebola situation assessment ">{{cite web |url=http://www.who.int/mediacentre/news/ebola/26-september-2014/en/ |title=Experimental therapies: growing interest in the use of whole blood or plasma from recovered Ebola patients (convalescent therapies) |publisher=] |date=26 September 2014 |accessdate=28 September 2014}}</ref> In December, Ebola healthcare workers were collectively named '']'' magazine's "]."<ref name=":3">{{cite web | url=http://www.cnn.com/2014/12/10/world/time-person-of-the-year/ | title=Ebola fighters are Time's 'Person of the Year' | publisher=CNN World | date=10 December 2014 | accessdate=10 December 2014 | author=McLaughlin, Eliott C.}}</ref> | |||
| {{Ebola virus disease epidemic}} | |||
| {{TOC limit|3}} | |||
| ==Epidemiology== | |||
| ===Outbreak=== | |||
| {{main|2014 Ebola virus epidemic timeline}} | |||
| ] | |||
| Researchers generally believe that a 2-year-old boy, later identified as Emile Ouamouno, who died in December 2013 in the village of ], ], ], was the ] of the current ] epidemic.<ref>{{cite web|url=http://edition.cnn.com/2014/10/28/health/ebola-patient-zero/index.html|title=Ebola: Patient zero was a toddler in Guinea - CNN.com|date=28 October 2014|work=CNN|accessdate=29 October 2014}}</ref><ref name="Baize-2014"/> 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.<ref name="Tracing Ebola's Breakout to an African 2-Year-Old"/><ref name=BBC-world-africa-30199004>{{cite web|url=http://www.bbc.co.uk/news/world-africa-30199004|title=How world’s worst Ebola outbreak began with one boy’s death|author=Nassos Stylianou |date=27 November 2014|publisher=BBC News}}</ref> 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.<ref name="Tracing Ebola's Breakout to an African 2-Year-Old"/><ref name="Baize-2014">{{cite journal|url=http://www.nejm.org/doi/full/10.1056/NEJMoa1404505|title=Emergence of Zaire Ebola Virus Disease in Guinea — Preliminary Report|date=16 April 2014 |DOI=10.1056/NEJMoa1404505 |last=Baize |first=Sylvain |last2=Pannetier |first2=Delphine |last3=Oestereich|first3=Lisa|last4=Rieger|first4=Toni|journal=New England Journal of Medicine |pmid=24738640 |volume=371 |issue=15 |pages=1418–25}}</ref> | |||
| On 25 March, the ] (WHO) reported that ] had reported an outbreak of Ebola virus disease in four southeastern districts, with suspected cases in the neighbouring countries of ] and ] being investigated. In Guinea, a total of 86 suspected cases, including 59 deaths had been reported as of 24 March.<ref name=Previous_Updates_2014_West_Africa_Outbreak>{{cite web|url=http://www.cdc.gov/vhf/ebola/outbreaks/guinea/recent_updates.html |title=Previous Updates: 2014 West Africa Outbreak |publisher=Centers for Disease Control and Prevention}}</ref> By late May, the outbreak had spread to ], Guinea's capital, a city of about two million inhabitants.<ref name="Previous_Updates_2014_West_Africa_Outbreak" /> On 28 May, the total number of cases reported had reached 281 with 186 deaths.<ref name="Previous_Updates_2014_West_Africa_Outbreak" /> | |||
| In Liberia, the disease was reported in four counties by mid-April and cases in Liberia's capital ] were reported in mid-June.<ref>{{cite web |url=http://www.bbc.co.uk/news/world-africa-27888363 |title=Seven die in Monrovia Ebola outbreak |work=BBC News |date=17 June 2014 |accessdate=28 July 2014}}</ref><ref name="DON 16APR14">{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4100-ebola-virus-disease-west-africa-16-april-2014.html|title=Ebola virus disease, West Africa (Situation as of 16 April 2014)|publisher=WHO|accessdate=18 September 2014}}</ref> 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.<ref name="WHO 2014-07-18">{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4225-ebola-virus-disease-west-africa-18-july-2014.html|title=Ebola virus disease, West Africa – update 18 July 2014|publisher=WHO|accessdate=18 September 2014}}</ref> By 20 July, additional cases of the disease had been reported in the ] and the first case in ], Sierra Leone's capital, was reported in late July.<ref name="BBC_Freetown">{{cite web |url=http://www.bbc.co.uk/news/world-africa-28485041 |title=Sierra Leone hunts Ebola patient kidnapped in Freetown |publisher=BBC News |date=25 July 2014 |accessdate=27 July 2014}}</ref><ref>{{cite web |url=http://www.bbc.co.uk/news/world-africa-28505061 |title=Ebola outbreak: Sierra Leone escaped patient dies |publisher=BBC News |date=27 July 2014 |accessdate=27 July 2014}}</ref> | |||
| The first death in ] was reported on 25 July:<ref name="WHO 2014-07-25" /> a Liberian-American with Ebola flew from Liberia to Nigeria and died in ] soon after arrival.<ref>{{cite news|last=Wesee|first=Ben P.|url=http://www.thenewdawnliberia.com/index.php?view=article&id=12289|title=I'm ok - Nigerian Ambassador Assures Public|publisher=The New Dawn, Monrovia|date=4 August 2014|accessdate=7 August 2014}}</ref> As part of the effort to contain the disease, possible contacts were monitored – 353 in Lagos and 451 in ].<span class="plainlinks"></span><ref name="cbc1.2767239">{{cite web|title=Worst-ever Ebola outbreak, by the numbers|url=http://www.cbc.ca/news/health/worst-ever-ebola-outbreak-by-the-numbers-1.2767239|publisher=CBC News|accessdate=16 September 2014}}</ref> 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.<ref name=":4">{{cite news| url=http://www.bbc.com/news/world-africa-29685127 | title=Ebola crisis: Nigeria declared free of virus | publisher =BBC News | date = 20 October 2014 | accessdate = 20 October 2014}}</ref> | |||
| On 29 August, ] 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.<ref name="Ebola virus disease – Senegal" /> This person subsequently recovered, and on 17 October, the WHO officially declared that the outbreak in Senegal had ended.<ref>{{cite web|url=http://www.who.int/mediacentre/news/ebola/14-october-2014/en/|title=WHO - Are the Ebola outbreaks in Nigeria and Senegal over?|publisher=|accessdate=24 October 2014}}</ref> | |||
| Two Spanish health care workers contracted Ebola 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.<ref name="NBC News">{{cite web|url=http://www.nbcnews.com/storyline/ebola-virus-outbreak/spanish-nurse-who-contracted-ebola-appears-free-virus-officials-n229326|title=Spanish Nurse Who Contracted Ebola Appears Free of Virus: Officials - NBC News|work=NBC News}}</ref> | |||
| 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 ] was declared to have Ebola and subsequently died on 8 October. Two nurses who had cared for the patient contracted the disease;<ref name="Washington Post">{{cite web|title=Dallas nurse Nina Pham will be transferred to NIH facility in Bethesda, Md.|url=http://www.washingtonpost.com/news/to-your-health/wp/2014/10/16/dallas-nurse-nina-pham-will-be-transferred-to-nih-facility-in-bethesda-maryland/|publisher=Washington Post|accessdate=16 October 2014}}</ref> both of the nurses have subsequently recovered and tested Ebola-free on 27 October 2014. On 23 October, the first case of ] was confirmed, a two year-old girl who had returned from Guinea,<ref name="ABC News">{{cite web|url=http://abcnews.go.com/Health/wireStory/threat-break-isolation-liberia-food-26399022|title=1st Ebola Case in W. African Nation of Mali|work=ABC News|accessdate=24 October 2014}}</ref><ref name="BBC News">{{cite web|url=http://www.bbc.com/news/world-africa-29750723|title=BBC News - Ebola crisis: Mali confirms first infection case|work=BBC News|accessdate=24 October 2014}}</ref> and further cases were reported in November.<ref name="health-ebola-mali-idINL6N0T15CN20141112" /> | |||
| According to a WHO report released on 19 November 72% of patients in Guinea are recorded and isolated, while the figure for Sierra Leone and Liberia is still dire. During the week of 9 November only 20% of cases were in isolation or treatment in Liberia, and in Sierra Leone the figure was as low as 13%. Most of these cases not in treatment or isolation are not counted in the official reports, while patients at home were also excluded.<ref name=WHO2014_11_19 /> | |||
| In mid-November the WHO reported that while all cases and deaths continue 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".<ref name=":5">{{cite web | url=http://www.who.int/csr/disease/ebola/situation-reports/en/?m=20141112&file=sitreps/20141112/20141112.html | title=Ebola response roadmap - Situation report | publisher=WHO | date=12 November 2014 | accessdate=16 November 2014}}</ref> The decline in Liberia cases is contradicted in the latest reports from WHO with 439 new cases reported between 23 and 28 November. Sierra Leone also noted a sharp increase in new cases between 23 and 30 November according to the same reports with an increase of 713 new cases in that week.<ref name=WHO2014_11_23 /><ref name="WHO2014_11_30">{{cite web |url=http://apps.who.int/gho/data/view.ebola-sitrep.ebola-summary-20141202?lang=en |title=Situation summary Data published on 2 December 2014|publisher=World Health organization|date=2 December 2014|accessdate =2 December 2014}}</ref> | |||
| By the end of November the total number of cases exceeded 17,000 since the outbreak started nearly a year ago.<ref name=WHO2014_11_30 /> One year into the outbreak the total number of cases exceeded 19,000 on 18 December. Sierra Leone has reported a surge in numbers with 8,759 cases reported.<ref name=Ebola_Outbreak_total_lr_14_Dec /><ref name=Ebola_Outbreak_total_sl_18_Dec /><ref name=WHO2014_12_17a /> | |||
| ===Countries with widespread transmission=== | |||
| ] | |||
| ====Guinea==== | |||
| {{Main|Ebola virus epidemic in Guinea}} | |||
| On 25 March, the ] (WHO) reported an outbreak of Ebola virus disease in four southeastern districts with a total of 86 suspected cases, including 59 deaths. MSF was helping the Ministry of Health of Guinea in establishing Ebola treatment centers in the epicenter of the outbreak.<ref name=Previous_Updates_2014_West_Africa_Outbreak>{{cite web|url=http://www.cdc.gov/vhf/ebola/outbreaks/guinea/recent_updates.html|publisher=Centers for Disease Control and Prevention |title=March 25, 2014 - Initial Announcement}}</ref> On 31 March, the ] (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.<ref name=Previous_Updates_2014_West_Africa_Outbreak /> | |||
| Thinking that the virus was contained, ] closed its treatment centers in May leaving only a small skeleton staff to handle the ] region. However, high numbers of new cases reappeared in the region in late August. According to Marc Poncin, a coordinator for MSF, the new cases were related to persons returning to Guinea from neighbouring Liberia or Sierra Leone.<ref name=Guinea_Ebola_Sep_Update>{{cite news |url=http://www.ctvnews.ca/health/ebola-virus-is-surging-in-places-where-it-was-beaten-back-experts-1.1996179 |title=Ebola virus is surging in places where it was beaten back: experts |publisher=CTV News |date=8 September 2014 |accessdate=8 September 2014}}</ref> | |||
| On 19 October, the WHO reported that although disease transmission remained intense, of the three districts affected, transmission remained the lowest in Guinea.<ref name="WHO20141022">{{cite web |url=http://apps.who.int/iris/bitstream/10665/137091/1/roadmapsitrep22Oct2014_eng.pdf |accessdate=22 Oct 2014 |title=Ebola Response Roadmap Situation Report |date=22 Oct 2014 |author=WHO |work=who.int}}</ref> 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.<ref name=":5"/> 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 past 7 weeks. | |||
| ====Liberia==== | |||
| {{Main|Ebola virus epidemic in Liberia}} | |||
| ] | |||
| In Liberia, the disease was reported in ] and ] counties in late March.<ref name="liberianobserver.com">{{cite news |url=http://www.liberianobserver.com/security-health/2-5-test-positive-ebola-liberia |title=2 of 5 Test Positive for Ebola in Liberia |newspaper=] |date=31 March 2014 |accessdate=6 July 2014}}</ref> On 27 July, ], 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.<ref name=BBC_28_July_2014>{{cite web |url=http://www.bbc.co.uk/news/world-africa-28522824 |title=Ebola outbreak: Liberia shuts most border points |publisher=BBC News |date=28 July 2014 |accessdate=28 July 2014}}</ref> Schools and universities were closed,<ref>{{cite news|last=Kwanue|first=C.Y.|url=http://www.liberianobserver.com/security/compliance-sirleaf%E2%80%99s-mandate-ul-closed|title=In Compliance with Sirleaf's Mandate, UL Closed|work=Liberian Observer|date=1 August 2014|accessdate=2 August 2014}}</ref><ref>{{cite web|url=http://www.reuters.com/article/2014/07/30/health-ebola-africa-idUSL6N0Q56DX20140730|title=Liberia shuts schools, quarantines communities in bid to halt Ebola|publisher=Reuters|date=30 July 2014|accessdate=30 July 2014}}</ref> and the worst-affected areas in the country were placed under quarantine.<ref name="BBC_28_July_20142">{{cite web |url = http://www.bbc.co.uk/news/world-africa-28522824|title = Ebola outbreak: Liberia shuts most border points|publisher = BBC News|date = 28 July 2014|accessdate = 28 July 2014}} | |||
| </ref> | |||
| With only 50 physicians in the entire country—one for every 70,000 Liberians—Liberia already faced a health crisis even before the outbreak.<ref name=":6">{{cite web | url=http://www.bbc.com/news/world-africa-29516663 | title=Ebola outbreak: Liberia 'close to collapse' - ambassador | publisher=BBC News Africa | work=Katty, Kay | date=7 October 2014 | accessdate=8 October 2014}}</ref> In September the US CDC reported that some hospitals had been abandoned while those which were still functioning lacked basic facilities and supplies.<ref>{{cite web|title=Runaway Doctors and Missing Supplies Cripple Care in Ebola-Hit Liberia|url=http://www.nbcnews.com/storyline/ebola-virus-outbreak/runaway-doctors-missing-supplies-cripple-care-ebola-hit-liberia-n220686|publisher=NBC News|accessdate=8 October 2014}}</ref> In October, the Liberian ambassador in Washington was reported as saying that he feared that his country may be "close to collapse".<ref name=":6"/> By 24 October, all of the 15 Liberian districts had reported Ebola cases.<ref name=WHO20141022 /><ref name="Ebola_Outbreak_total_lr_24_Oct">{{cite web|url=http://www.mohsw.gov.lr/documents/SITREP%20162%20Oct%2024th%202014_1.pdf|title=Liberia Ebola SitRep no. 157 |accessdate=24 October 2014| date= 24 October 2014}}</ref> | |||
| On 29 October, the ] announced that the rate of new infections in Liberia was declining, but urged continued vigilance against a reversal of this trend.<ref>{{cite news |last=Cumming-Bruce |first=Nick |date=29 October 2014 |title=Ebola Slowing in Liberia, W.H.O. Says, but International Support Is Still Necessary |url=http://www.nytimes.com/2014/10/30/world/africa/ebola-liberia-who.html |newspaper=] |accessdate=3 November 2014 }}</ref> A report by CDC released on 14 November, based on data collected from Lofa county, indicates that there has been a genuine reduction in new infections. This is credited to an integrated strategy combining isolation and treatment with community behaviour change including safe burial practices, case finding and contact tracing. This strategy might serve as a model to implement in other affected areas to accelerate control of Ebola.<ref name="CDC_Evidence_Decrease_Transmission">{{cite web|title=Evidence for a Decrease in Transmission of Ebola Virus — Lofa County, Liberia, June 8–November 1, 2014|url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e1114a1.htm?s_cid=mm63e1114a1_w|publisher=Centers for Disease Control and Prevention|accessdate=16 November 2014}}</ref> | |||
| On 10 November MSF announced that isolation units in some parts of the country now have adequate capacity. However Ebola hotspots are expected to emerge in towns and villages in Liberia, and the international response should be modified to a flexible approach that allows a rapid response to new outbreaks and gets the regular healthcare system safely up and running again.<ref>{{cite web|title=Ebola outbreak: MSF says new Liberia tactics needed|url=http://www.bbc.co.uk/news/health-29991092|publisher=BBC News|accessdate=11 November 2014}}</ref> On 13 November, the Liberian president announced the lifting of the state of emergency in the country following the decrease in the number of new cases.<ref>{{cite news|title=Ebola state of emergency lifted in Liberia|url=http://www.cbsnews.com/news/ebola-vaccine-trials-to-begin-in-west-africa-amid-threat-of-mali-outbreak/|publisher=CBS News|date=14 November 2014|accessdate=14 November 2014}}</ref> On December 14, elections were | |||
| postponed again due to Ebola; "we think that it is important for us to be able to ensure that elections are held in ways that are credible so that the results are accepted by everybody in the country so that we avoid crisis," one government source indicated.<ref>{{cite web|url=http://abcnews.go.com/Health/wireStory/sierra-leonean-doctor-sick-ebola-27588102|title=Liberia Postpones Elections Again Because of Ebola|author=ABC News|work=ABC News|accessdate=15 December 2014}}</ref> On December 15, Liberia started treating patients with serum therapy; as one medical source said, "this will empower local health care systems to become more self-sufficient and better serve their patients during this current epidemic."<ref>{{cite web|url=http://www.bbc.com/news/health-30478512|title=BBC News - Ebola serum supply reaches Liberia|work=BBC News|accessdate=15 December 2014}}</ref> On December 16, the German Red Cross opened a new treatment center in Monrovia. One source indicated, "the rate of new infections is very stable at the moment, but we don't know what will happen in the following days or weeks ... we are working with high pressure so that our treatment center can operate soon. We want to be ready if the number of cases rises again."<ref>{{cite web|url=http://www.dw.de/german-red-cross-opens-new-ebola-treatment-center-in-liberia/a-18135343|title=German Red Cross opens new Ebola treatment center in Liberia|work=DW.DE|accessdate=17 December 2014}}</ref> On December 20, there is low voter turn out, due to | |||
| virus.<ref>http://www.nytimes.com/2014/12/21/world/africa/few-liberians-turn-out-for-vote-delayed-by-ebola.html?_r=0</ref> | |||
| ====Sierra Leone==== | |||
| {{Main|Ebola virus epidemic in Sierra Leone}} | |||
| ] Hospital, Sierra Leone]] | |||
| The first person reported infected in the spread to Sierra Leone was a ]. She had treated one or more infected people and died on 26 May. According to tribal tradition, her body was washed for burial and this appears to have led to infections in women from neighbouring towns.<ref name="Fox News">{{cite web |url=http://www.foxnews.com/health/2014/08/25/sierra-leone-hero-doctor-death-exposes-slow-ebola-response/ |title=Sierra Leone 'hero' doctor's death exposes slow Ebola response |publisher=Fox News |work=Sierra Leone 'hero' doctor's death exposes slow Ebola response |date=25 August 2014 |accessdate=25 August 2014}}</ref> On 11 June, ] shut its borders for trade with Guinea and Liberia and closed some schools in an attempt to slow the spread of the virus.<ref>{{cite news |url=http://uk.reuters.com/article/2014/06/11/us-health-ebola-leone-idUKKBN0EM2CG20140611|title=Sierra Leone shuts borders, closes schools to fight Ebola |publisher=Reuters |date=11 June 2014}}</ref> On 30 July, the government began to deploy troops to enforce quarantines.<ref>{{cite news |url=http://www.news24.com/Africa/News/Sierra-Leone-Liberia-deploy-troops-for-Ebola-20140804 |title=Sierra Leone, Liberia deploy troops for Ebola|publisher=News 24 |date=4 August 2014}}</ref> By 15 October, the last district in Sierra Leone untouched by the disease had declared Ebola cases.<ref>{{cite web|url=http://www.foxnews.com/world/2014/10/16/ebola-cases-appear-in-last-untouched-district-in-sierra-leone|title=Ebola cases appear in last untouched district in Sierra Leone|publisher=Fox News|date=16 October 2014|accessdate=16 October 2014}}</ref> | |||
| ] lies on the ground after being infected by Ebola]] | |||
| ] | |||
| 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.<ref>{{cite web|url=https://news.vice.com/article/the-ebola-outbreak-is-getting-worse-in-sierra-leone|title=The Ebola Outbreak Is Getting Worse in Sierra Leone|work=VICE News|accessdate=10 November 2014}}</ref> On 4 November, it was reported that thousands violated quarantine in search for food in the town of Kenema.<ref>{{cite web|url=http://www.detroitnews.com/story/news/world/2014/11/04/ebola-west-africa/18463943/|title=Thousands in Sierra Leone break Ebola quarantine|author=Sarah DiLorenzoAssociated Press|date=4 November 2014|publisher=|accessdate=5 November 2014}}</ref> 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."<ref>{{cite web|url=http://rt.com/news/201567-ebola-sierra-leone-toll-underreported/|title=‘Entire villages disappeared’: Ebola deaths in Sierra Leone ‘underreported’|publisher=|accessdate=7 November 2014}}</ref> 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.<ref name=":5"/> 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.<ref>{{cite web|title=As Ebola rages in Sierra Leone poor planning thwarts efforts|url=http://www.nytimes.com/2014/12/07/world/africa/as-ebola-rages-in-sierra-leone-poor-planning-thwarts-efforts.html?_r=0|publisher=New York Times|accessdate=7 December 2014}}</ref> | |||
| On 9 December, Sierra Leone authorities placed the remote Eastern ] in a two week lock-down following the alarming rate of infection and deaths there. The lock-down followed the WHO discovery of what news reports described as "a grim scene: piles of bodies, overwhelmed medical personnel and exhausted burial teams" in the only hospital in the area. Using a local proverb equated to "the tip of the iceberg" to describe fears of what remained to be discovered, the WHO reported fear of a major outbreak in the area saying, "We are only seeing the ears of the hippo".<ref>{{cite web|url=http://abcnews.go.com/Health/wireStory/sierra-leone-area-hold-week-ebola-lockdown-27497818|title=Sierra Leone Area to Hold 2-Week Ebola 'Lockdown'|work=AB News|accessdate=11 December 2014}}</ref> The district with 350,000 inhabitants buried 87 bodies in 11 days, with 25 patients dying in the 5 days before the WHO arrived.<ref>{{cite web|url=http://www.abc.net.au/news/2014-12-11/sierra-leone-hit-by-largely-hidden-ebola-outbreak/5959596|title=Ebola crisis: Sierra Leone hit by largely hidden outbreak; WHO says scores of bodies piled up|work=ABC News|accessdate=11 December 2014}}</ref> During the week ending 7 December, the number of cases in Sierra Leone surpassed those of Liberia. However, Sierra Leone has reported only 1,768 deaths, far below Liberia's 3,177 dead, likely due to the fact that Sierra Leone reports only laboratory confirmed cases. | |||
| <ref name="WHO2014_12_11">{{cite web |url=http://apps.who.int/gho/data/view.ebola-sitrep.ebola-summary-20141211?lang=en |title=Situation summary Data published on 11 December 2014|publisher=World Health organization|date=10 December 2014|accessdate =11 December 2014}}</ref> On 12 December, Sierra Leone banned all public festivities for Christmas or New Year, because of the outbreak.<ref>{{cite web|url=http://www.bbc.com/news/world-africa-30455248|title=BBC News - Ebola crisis: Sierra Leone bans Christmas celebrations|work=BBC News|accessdate=13 December 2014}}</ref> On 15 December, the CDC indicated the main problem now is Sierra Leone where the epidemic has given no proof of halting, and cases continue 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 that Ebola will simmer along, become endemic and be a problem for Africa and the world, for years to come." <ref>{{cite web|url=http://www.npr.org/blogs/goatsandsoda/2014/12/15/370446566/endless-ebola-endemic-thats-the-risk-we-face-now-cdc-says|title=Endless Ebola Epidemic? That's The 'Risk We Face Now,' CDC Says|date=15 December 2014|work=NPR.org|accessdate=18 December 2014}}</ref> On December 17, in Sierra Leone, treatment centers filled as health workers went through the streets of the capital city looking for any possible patients, literally going door-to-door, after the government launched an operation to contain the Ebola virus. President Koroma indicated on television that travel within the country had been restricted, "operation Western Area Surge" had begun and public gatherings would be controlled.<ref>{{cite web|url=http://www.bbc.com/news/world-africa-30511208|title=BBC News - Ebola: Sierra Leone begins house-to-house searches|work=BBC News|accessdate=18 December 2014}}</ref><ref>{{cite web|url=http://news.sky.com/story/1393826/sierra-leone-braced-for-more-ebola-cases|title=Sierra Leone Braced For More Ebola Cases|work=Sky News|accessdate=18 December 2014}}</ref> "Operation Western Area Surge" led to a surge in the number of cases, with 403 new cases reported between 14 to 17 December.<ref name="Ebola_Outbreak_total_sl_18_Dec">{{cite web|url=http://health.gov.sl/wp-content/uploads/2014/12/Ebola-Situation-Report_Vol-204.pdf|title= EBOLA VIRUS DISEASE - SITUATION REPORT (Sit-Rep) –) 18 December, 2014 | accessdate=19 December 2014| date=18 December 2014}}</ref><ref name=Ebola_Outbreak_total_sl_14_Dec /> | |||
| ===Countries with successfully contained spread=== | |||
| ====Senegal==== | |||
| In March, the ] Ministry of Interior closed the southern border with Guinea,<ref>{{cite web |url=http://www.bloomberg.com/news/2014-03-29/ebola-virus-death-toll-in-guinea-outbreak-rises-to-70-people.html|title=Ebola Death Toll in Guinea Rises to 70 as Senegal Closes Border |publisher=]|date=29 March 2014 |accessdate=31 March 2014}}</ref> but on 29 August the Senegal health minister announced Senegal's first case, a university student from Guinea who was being treated in a ] hospital.<ref name="Ebola virus disease – Senegal">{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4265-ebola-virus-disease-senegal.html|title= Ebola virus disease – Senegal |publisher=World Health Organization|date=29 March 2014 |accessdate=1 September 2014}}</ref> 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.<ref name="Ebola virus disease – Senegal" /> | |||
| On 28 August, authorities in ] 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.<ref name="Ebola virus disease – Senegal" /> On 10 September, it was reported that the student had recovered but health officials would continue to monitor his contacts for 21 days.<ref>{{cite web|title=Guinean Who Brought Ebola To Senegal Recovers From Virus|url=http://www.businessinsider.com/r-guinean-who-brought-ebola-to-senegal-recovers-from-virus-2014-9|publisher=Business Insider|accessdate=20 September 2014}}</ref> No further cases were reported.<ref name="Ebola_Outbreak_total_20_Sept">{{cite web|url=http://apps.who.int/iris/bitstream/10665/134449/1/roadmapupdate22sept14_eng.pdf?ua=1|title=WHO: Ebola Response Roadmap Update, 22 September 2014 |publisher=WHO|date=22 September 2014|accessdate=22 September 2014}}</ref> and on 17 October, the WHO officially declared that the outbreak in Senegal had ended.<ref name=Ebola_Outbreak_total_WHO_17_Oct /> | |||
| The WHO have officially commended the Senegalese government, and in particular the President ] and the Minister of Health Dr ], for their quick 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.<ref>{{cite web|url=http://who.int/mediacentre/news/statements/2014/senegal-ends-ebola/en/|title=WHO congratulates Senegal on ending Ebola transmission|date=17 October 2014|accessdate=20 October 2014}}</ref> | |||
| ====Nigeria==== | |||
| ] | |||
| ] | |||
| The first case in Nigeria was a Liberian-American, ], who flew from Liberia to Nigeria's commercial capital ] on 20 July. 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.<ref>{{cite web |url=http://www.bbc.co.uk/news/world-africa-28498665 |title=Nigeria 'on red alert' over Ebola death in Lagos |publisher=BBC News |date=26 July 2014 |accessdate=27 July 2014}}</ref> On 6 August, 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 cases are being treated at an isolation ward."<ref name="theguardian1">{{cite news|last=Mark|first=Monica|url=http://www.theguardian.com/world/2014/aug/06/ebola-outbreak-nurse-nigeria-dies|title=Ebola Outbreak: Nurse who Treated First Victim in Nigeria Dies|work=]|date=6 August 2014|accessdate=7 August 2014}}</ref> | |||
| On 19 August, it was reported that the doctor who treated Sawyer, ], had also died of Ebola disease. Adadevoh was posthumously praised for preventing the index case (Sawyer) from leaving the hospital at the time of diagnosis, thereby playing a key role in curbing the spread of the virus in Nigeria.<ref name="reuters1">{{cite web|url=http://www.reuters.com/article/2014/08/04/us-health-ebola-nigeria-idUSKBN0G413H20140804|author=Reuters|title=Lagos records second Ebola case in doctor who treated victim: Nigerian health minister|date=4 August 2014}}</ref><ref>{{cite web|website=Thisday|url=http://www.thisdaylive.com/articles/ebola-strikes-at-the-heart-of-nigeria-ameyo-daughter-of-kwaku-adadevoh-great-grand-daughter-of-herbert-macaulay-dies/186843/|title=Ebola strikes at the heart of Nigeria: Ameyo, daughter of Kwaku Adadevoh, grand daughter of Herbert Macaulay dies|accessdate=22 August 2014}}</ref> | |||
| On 22 September, 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.<ref name="Nigeria in first step towards all-clear on Ebola">{{cite web |url=http://news.yahoo.com/nigeria-first-step-towards-clear-ebola-203222268.html |title=Nigeria in first step towards all-clear on Ebola |publisher=Yahoo News |date=23 September 2014 |accessdate=26 September 2014}}</ref> 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".<ref name=":4"/> | |||
| On 9 October, the ] (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.<ref>{{cite journal | author=Fasina FO | author2=Shittu A | author3=Lazarus D | author4=Tomori O | author5=Simonsen L | author6=Viboud C | author7=Chowell G. | display-authors=2 | url=http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20920 | title=Transmission Dynamics and Control of Ebola Virus Disease Outbreak in Nigeria, July to September 2014 | work=] | publisher=] | location=Sweden | date=9 October 2014 | volume=19 | issue=40 | department=Rapid Communications }}</ref> Complimenting Nigeria's successful efforts to control the outbreak, "the usually measured WHO declared the feat 'a piece of world-class epidemiological detective work'."<ref>{{cite journal | url=http://www.scientificamerican.com/article/how-did-nigeria-quash-its-ebola-outbreak-so-quickly/ | title=How Did Nigeria Quash Its Ebola Outbreak So Quickly? | author=Courage, Katherine Harmon | journal=Scientific American |date=October 2014 }}</ref> | |||
| ==== Spain ==== | |||
| {{main|Ebola virus disease cases in Spain}} | |||
| On 5 August 2014, the ] confirmed that Brother Miguel Pajares, who had been volunteering in Liberia, had become infected. He was evacuated to Spain on 6 August, and died on 12 August.<ref>{{cite web |title=Muere el religioso español Miguel Pajares a causa del ébola |url=http://www.rtve.es/noticias/20140812/muere-religioso-espanol-miguel-pajares-causa-del-ebola/991420.shtml |publisher=RTVE |date=12 August 2014 |accessdate=12 August 2014}}</ref> On 21 September it was announced that Brother Manuel García Viejo, another Spanish citizen who was medical director at the ] in ], had been evacuated to Spain from Sierra Leone after being infected with the virus. His death was announced on 25 September.<ref>{{cite news|url=http://www.ibtimes.co.uk/ebola-outbreak-spanish-missionary-manuel-garcia-viejo-dies-deadly-virus-madrid-1467233|title=Ebola Outbreak: Spanish Missionary Manuel Garcia Viejo Dies of Deadly Virus in Madrid|date=25 September 2014|accessdate=25 September 2014|work=International Business Times}}</ref> | |||
| In October, a nursing assistant, later identified as Teresa Romero, who had cared for these patients became unwell and on 6 October tested positive for Ebola.<ref>{{cite news|title=Nurse 'infected with Ebola' in Spain|url=http://www.bbc.com/news/world-europe-29514920|accessdate=6 October 2014|agency=BBC}}</ref> A second test confirmed the diagnosis,<ref>{{cite web|url=http://www.cadenaser.com/sociedad/articulo/enfermera-ingresada-alcorcon-da-positivo-ebola/csrcsrpor/20141006csrcsrsoc_5/Tes|title=La enfermera ingresada en Alcorcón da positivo por ébola -- La segunda prueba ha dado positivo y confirma el diagnóstico |publisher=Cadena Ser|date=6 October 2014}}</ref> making this the first confirmed case of Ebola transmission outside Africa. On 19 October, it was reported that Romero had recovered and was officially declared to be Ebola free.<ref name="NBC News" /> | |||
| On 2 December the WHO declared Spain Ebola-free following the passage of 42 days since Teresa Romero was found to be cured of Ebola on 21 October.<ref name ="Spain_Ebola_outbreak_2_Dec">{{cite news|url=http://abcnews.go.com/Health/wireStory/spain-ebola-free-nurse-recovery-27300284|title=WHO Says Spain Ebola-Free Following Nurse Recovery|date=2 December 2014|accessdate=2 December 2014|publisher=ABC News}}</ref> | |||
| ==== United States ==== | |||
| {{Main|Ebola virus disease in the United States}} | |||
| {{see also|#Travel restrictions and quarantines}} | |||
| On 30 September, the United States ] (CDC) declared its first case of Ebola virus disease. The CDC disclosed that ] became infected in Liberia and traveled to ] 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.<ref name="First_Us_case">{{cite news|url=http://www.cdc.gov/media/releases/2014/s930-ebola-confirmed-case.html|title= CDC and Texas Health Department Confirm First Ebola Case Diagnosed in the U.S.|publisher=cdc.gov |date=1 October 2014| accessdate=1 October 2014}}</ref><ref>{{cite news| url=http://www.telegraph.co.uk/news/worldnews/ebola/11132475/First-Ebola-victim-in-America-was-sent-home-with-antibiotics.html| author=Nick Allen| title=First Ebola victim in America was sent home with antibiotics|work=The Telegraph| date=1 October 2014}}</ref> Thomas Duncan died on 8 October.<ref>{{cite web|url=http://www.cnn.com/2014/10/08/health/thomas-eric-duncan-ebola/|title=Thomas Eric Duncan: First Ebola death in U.S.|date=8 October 2014|work=CNN|accessdate=8 October 2014}}</ref> Two additional cases stemmed from Thomas Eric Duncan, when Nina Pham and Amber Vinson tested positive for Ebola on October 10th and 14th<ref name="NYT-20141012-MF">{{cite news|last=Fernandez|first=Manny|title=Texas Health Worker Tests Positive for Ebola|url=http://www.nytimes.com/2014/10/13/us/texas-health-worker-tests-positive-for-ebola.html|date=October 12, 2014|work=]|accessdate=October 12, 2014}}</ref><ref>{{cite web|url=http://www.foxnews.com/health/2014/10/15/family-identifies-2nd-health-care-worker-infected-with-ebola/|title=Second Ebola-infected nurse ID'd; flew domestic flight day before diagnosis|work=Fox News|accessdate=October 15, 2014}}</ref> and ended when they were declared Ebola free on October 24th and 22nd, respectively.<ref>{{cite news|url=http://www.nbcnews.com/storyline/ebola-virus-outbreak/virus-free-ebola-infected-nurse-nina-pham-go-home-n233171|title=Virus Free: Ebola-Infected Nurse Nina Pham to Go Home|date=October 24, 2014|work=NBC News}}</ref><ref>{{cite web|url=http://news.yahoo.com/nurse-amber-vinson-free-of-ebola-virus-family-says-001502702.html|title=Nurse Amber Vinson free of Ebola virus, family says|date=October 23, 2014|work=Yahoo News|accessdate=October 23, 2014}}</ref> | |||
| A fourth case of Ebola was identified October 23rd 2014 when Dr. Craig Spencer, a physician who had treated Ebola patients in West Africa, himself tested positive for Ebola.<ref name="nbc-spencer 20141023">{{cite web|url=http://www.nbcnews.com/storyline/ebola-virus-outbreak/new-york-doctor-just-back-africa-has-ebola-n232561|title=New York Doctor Just Back From Africa Has Ebola|work=]|date=October 23, 2014|accessdate=October 23, 2014}}</ref> This case had no relation to the cases originating from Thomas Eric Duncan. He was declared Ebola free on November 7th, 2014.<ref>{{cite news | |||
| |url=http://www.nytimes.com/2014/11/11/nyregion/craig-spencer-new-york-doctor-with-ebola-will-leave-bellevue-hospital.html?_r=0 | |||
| |publisher=] | |||
| |date=10 November 2014 | |||
| |title=Craig Spencer, New York Doctor With Ebola, Will Leave Bellevue Hospital | |||
| |first=ANEMONA | |||
| |last=HARTOCOLLIS}}</ref> Spencer was released from the hospital on November 11.<ref>{{cite web | url=http://www.reuters.com/article/2014/11/11/health-ebola-usa-new-york-idUSL2N0T10YT20141111 | title=UPDATE 1-New York doctor now free of Ebola discharged from hospital | work=Reuters | date=11 November 2014 | accessdate=11 November 2014 | author=Malo, Sebastien}}</ref> He was cheered and applauded by medical staff members, and hugged by the Mayor of New York, ] as he walked out of the hospital. The Mayor also declared: “New York City is Ebola free".<ref name="cnn 11/10/14">{{cite web|url=http://newyork.cbslocal.com/2014/11/11/after-recovery-nyc-ebola-patient-to-leave-bellevue-hospital/|title=Dr. Craig Spencer, NYC Ebola Patient, Released From Bellevue Hospital|publisher=CBS NewYork|date=November 11, 2014}}</ref> | |||
| ===Countries with limited local transmission=== | |||
| ==== Mali ==== | |||
| [[File:Mali- Ebola districts.png|thumb|250x250px| | |||
| Mali regions with Ebola cases (Kayes, Bamako) | |||
| ]] | |||
| {{Main|Ebola virus disease in Mali}} | |||
| On 23 October, the first case of Ebola disease in ] was confirmed in the city of ]; 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 {{convert|1200|km}}. On 23 October, the girl tested positive for Ebola but died the next day.<ref name="WHO_sitrep_Mali_10_nov">{{cite web|title=Mali case, Ebola imported from Guinea Ebola situation assessment - 10 November 2014|url=http://www.who.int/mediacentre/news/ebola/10-november-2014-mali/en/|publisher=World Health Organisation|accessdate=11 November 2014}}</ref><ref>{{cite web|title=Ebola Outbreak 2014|url=http://www.breakingnews.com/item/2014/10/24/2-year-old-girl-who-was-malis-1st-ebola-case-has/|website=Breaking News|publisher=NBC News Digital Network|accessdate=24 October 2014}}</ref> All contacts were followed for 21 days, with no further spread of the disease reported.<ref>{{cite web|title=Mali : Situation de la lutte contre la maladie à virus Ebola au Mali à la date du mercredi 19 novembre 2014|url=http://maliactu.net/mali-situation-de-la-lutte-contre-la-maladie-a-virus-ebola-au-mali-a-la-date-du-mercredi-19-novembre-2014/|accessdate=26 November 2014|language=French}}</ref> | |||
| On 12 November, Mali reported deaths from Ebola in an outbreak which is not connected with the first case in Kayes. The first probable case was an ] who had fallen ill on 17 October in Guinea and was transferred to the Pasteur Clinic in Mali's capital city ] 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.<ref>{{cite web|title=Mali confirms its second fatal case of Ebola virus disease|url=http://www.who.int/mediacentre/news/ebola/12-november-2014-mali/en/|publisher=World Health Organisation|accessdate=14 November 2014}}</ref> A nurse and a doctor who had treated the imam subsequently fell ill with Ebola and died.<ref>{{cite news|title=UPDATE 2-Doctor who treated source of second Mali Ebola outbreak dies|url=http://www.reuters.com/article/2014/11/20/health-ebola-mali-idUSL6N0TA62R20141120|publisher=Reuters|accessdate=21 November 2014|date=21 November 2014}}</ref><ref name="Ebola_case_mali_12_nov">{{cite news|title=Ebola crisis: Third death confirmed in Mali|url=http://www.bbc.co.uk/news/world-africa-30019895|publisher=BBC News|date=12 November 2014 |accessdate=12 November 2014}}</ref> 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.<ref>{{cite web|url=http://www.reuters.com/article/2014/11/22/us-health-ebola-mali-idUSKCN0J60EI20141122|title=Mali records new Ebola case, linked to dead nurse|work=Reuters|accessdate=22 November 2014}}</ref> 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.<ref>{{cite web|url=http://www.france24.com/en/20141212-mali-nears-ebola-free-status-last-patient/|title=Africa - Mali nears Ebola-free status as last patient leaves hospital|work=France 24|accessdate=12 December 2014}}</ref> On 16 December, Mali released the final 13 individuals that were being quarantined, and the country is expected to be declared free of the virus on 18 January.<ref>{{cite web|url=http://www.news24.com/Africa/News/Mali-ends-quarantines-could-be-Ebola-free-soon-20141216|title=Mali ends quarantines, could be Ebola-free soon|work=News24|accessdate=17 December 2014}}</ref> | |||
| === Countries with medically evacuated cases === | |||
| A number of people who had become infected with Ebola virus disease have been ] to treatment in ]s 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. After successful treatment at ] near Paris, she was discharged on 4 October.<ref>{{cite web|title=French MSF nurse cured of Ebola|url=http://www.france24.com/en/20141004-french-nurse-cured-ebola-health-minister-msf-touraine/|accessdate=4 October 2014}}</ref> | |||
| On 1 November 2014, a United Nations employee suffering from 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 from the disease.<ref>{{cite web|title=Ebola: l'agent de l'Unicef soigné à l'hôpital Bégin a quitté la France "guéri"|url=http://www.bfmtv.com/societe/l-agent-de-l-unicef-atteint-d-ebola-a-quitte-la-france-gueri-848374.html|accessdate=24 November 2014|language=French}}</ref> | |||
| ====Germany==== | |||
| On 27 August, a ] ] working for the WHO in Sierra Leone became the first patient. On 4 October he was discharged after being declared noninfectious.<ref>{{cite web|title=Hamburg clinic dismisses Ebola patient|url=http://www.berliner-zeitung.de/panorama/universitaetsklinikum-eppendorf-klinik-entlaesst-hamburger-ebola-patient,10808334,28645204.html|accessdate=4 October 2014|language=German}}</ref> | |||
| On 4 October, a Ugandan doctor working in Sierra Leone was flown to Germany for treatment at the University Hospital in ].<ref>{{cite news |url=http://www.reuters.com/article/2014/10/03/health-ebola-germany-idUSL6N0RY11E20141003 |title=Ebola patient arrives in Germany from Sierra Leone -local officials |publisher=Reuters |date=4 October 2014 |accessdate=4 October 2014}}</ref> The doctor was released on 19 November after seven weeks of intensive treatment. The doctor suffered multiple organ failure and received intensive treatment "including organ replacement procedures."<ref>{{cite news |url=https://uk.news.yahoo.com/ugandan-doctor-cured-ebola-german-hospital-181422896.html#AWJipQ5 |title=Ugandan doctor cured of Ebola in German hospital |publisher=Yahoo news |date=4 December 2014 |accessdate=4 December 2014}}</ref> | |||
| On 9 October, a Sudanese doctor working with the United Nations ] peacekeeping force in Liberia<ref>{{cite web|url=http://www.telegraph.co.uk/news/worldnews/ebola/11160790/UN-employee-dies-of-Ebola-in-hospital-in-Germany.html|title=UN employee dies of Ebola in hospital in Germany|publisher=The Telegraph|date=14 October 2014|accessdate=6 December 2014}}</ref> was transported to the ] in Leipzig for treatment.<ref>{{cite web|url=http://www.bloomberg.com/news/2014-10-09/germany-s-third-ebola-patient-arrives-for-treatment-from-africa.html |title=Germany's Third Ebola Patient Arrives for Treatment From Africa |publisher=Bloomberg |date=9 October 2014 |accessdate=9 October 2014}}</ref> He died on 14 October, becoming the first person on German soil to die of Ebola.<ref>{{cite web|url=http://www.zeit.de/gesellschaft/2014-10/ebola-patient-in-leipzig-gestorben|title=Infektion: Ebola-Patient in Leipziger Klinik gestorben|date=14 October 2014|work=ZEIT ONLINE|accessdate=14 October 2014}}</ref> | |||
| ====Italy==== | |||
| On 24 November the ] announced that an Italian doctor working for ] in ], Sierra Leone, contracted Ebola.<ref>{{cite web|url=http://online.wsj.com/articles/italian-doctor-tests-positive-for-ebola-in-sierra-leone-1416832350| title=Italian Doctor Tests Positive for Ebola in Sierra Leone|publisher=Wall Street Journal|accessdate=24 November 2014}}</ref> On 25 November a military plane carrying the 50-year-old doctor landed at ], from which he was transferred to the Lazzaro Spallanzani National Institute for Infectious Diseases in ]. The doctor was reportedly still not showing symptoms and in good health on arrival.<ref>{{cite web|url=http://www.news24.com/World/News/Italian-doctor-with-Ebola-arrives-in-Rome-20141125|title=Italian doctor with Ebola arrives in Rome|publisher=News24 |date=25 November 2014}}</ref> On November 29, it was reported the condition of the doctor, the first Italian to contract Ebola, has worsened according to Lazzaro Spallanzani hospital. The hospital has "declined" to indicate which experimental drug it has given the patient.<ref>{{cite news|url=http://www.bloomberg.com/news/2014-11-29/italian-ebola-patient-s-condition-worsens-rome-hospital-says.html|title=Italian Ebola Patient’s Condition Worsens, Rome Hospital Says|publisher=Bloomberg News |date=29 November 2014|accessdate=2 December 2014}}</ref> On December 10, the infectious disease unit of the hospital reported that the patient's conditions improved, as he was reported as not feverish and able to positively interact with the hospital staff.<ref>{{cite news|url=http://newsdaily.com/2014/12/italian-ebola-victims-condition-improves/|title=Italian Ebola victim's condition improves|publisher=Thomson Reuters|date=11 December 2014|accessdate=12 December 2014}}</ref> On December 18, according to the Lazzaro Spallanzani National Institute for Infectious Diseases in Rome, Italy, it was indicated in their latest press bulletin that "the clinical condition of the patient is enhanced ... the patient breathes, he walks and eats independently". The next report is scheduled for Monday, December 22, according to the press officer, Lorella Saloe.<ref>http://www.inmi.it/bollettini_ebola.html</ref> | |||
| ====Netherlands ==== | |||
| A United Nations ] Peacekeeper who contracted the disease in Liberia has arrived in the ] on 6 December according to the Health Ministry.<ref>{{cite news|title=U.N. peacekeeper with Ebola arrives in Netherlands for treatment|url=http://www.dailymail.co.uk/wires/reuters/article-2863484/U-N-peacekeeper-Ebola-arrives-Netherlands-treatment.html|work=Reuters |accessdate=6 December 2014}}</ref> The Nigerian soldier will be treated at the ] in ]. This is the third peacekeeper who contracted the disease. The first two cases were fatal.<ref>{{cite news|title=2Peacekeeper in Liberia tests positive for Ebola virus|url=http://www.belfasttelegraph.co.uk/news/world-news/peacekeeper-in-liberia-tests-positive-for-ebola-virus-30803235.html|publisher=The Belfast Telegraph |accessdate=6 December 2014}}</ref> On December 19, it was reported that the Nigerian UN peacekeeper is cured of Ebola; he will be transferred to the military hospital in Utrecht. The soldier was the first Ebola patient that the country of the Netherlands had taken in. "Until today the patient was in strict isolation nursed in the night by specially trained medical staff ... Specific laboratory testing, performed by Erasmus MC and Bernhard Nor Institut in Hamburg, confirm that the man (is) no longer contagious", a hospital source indicated. "The attending medical (doctor) of the UMC Utrecht said ... this hospital is part of the Ministry of defence", the source concluded. Edith Schippers, current Health Minister to the Netherlands, had indicated on December 6 that at the behest of WHO, they would treat the peacekeeper.<ref>{{cite web|url=http://www.microsofttranslator.com/BV.aspx?ref=IE8Activity&a=http%3A%2F%2Fwww.umcutrecht.nl%2Fnl%2FOver-ons%2FNieuws%2F2014%2FEbolapatient-in-Calamiteitenhospitaal-genezen|title=www.umcutrecht.nl/nl/Over-ons/Nieuws/2014/Ebolapatient-in-Calamiteitenhospitaal-genezen - Translator|publisher=|accessdate=20 December 2014}}</ref> | |||
| ====Norway==== | |||
| On 6 October, 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 ].<ref>{{cite news|title=25 medical staff treating Ebola victim in Norway|url=http://www.thelocal.no/20141014/25-medical-staff-treating-ebola-victim-in-norway|publisher=The Local Europe|accessdate=16 October 2014 |accessdate=14 October 2014}}</ref><ref name="Yahoo News">{{cite web | url=http://news.yahoo.com/norwegian-ebola-patient-cured-aid-group-150617578.html | title=Norwegian Ebola Patient Cured | publisher=Yahoo News | date=20 October 2014 | accessdate=20 October 2014}}</ref> On 20 October, it was announced that she had been successfully treated and had been discharged. It was reported that Michalsen had received an unspecified drug as part of her treatment plan.<ref>{{cite web|title=– Jeg er utrolig takknemlig|url=http://www.nrk.no/norge/_-jeg-er-utrolig-takknemlig-1.11996836|website=http://www.nrk.no/|accessdate=20 October 2014|language=Norwegian}}</ref> | |||
| ====Switzerland==== | |||
| On 18 November a ] doctor, Felix Baez, tested positive for Ebola in Sierra Leone. He arrived in Geneva on Friday 21 Nov for treatment at the ]. Dr Baez was able to step off the plane unaided.<ref>{{cite news|url=http://www.cbc.ca/news/health/ebola-outbreak-cuban-doctor-infected-in-sierra-leona-arrives-at-geneva-hospital-1.2844518|title=Ebola outbreak: Cuban doctor infected in Sierra Leona arrives at Geneva hospital|work=CBC News|accessdate=21 November 2014|date=21 November 2014}}</ref> On November 25, it was reported, Dr. Baez was being treated with ], an experimental drug related to ZMapp.<ref>{{cite web|url=http://www.thelocal.ch/20141125/cuban-ebola-virus-patient-in-geneva-improving|title=Cuban Ebola patient in Geneva 'improving'|publisher=|accessdate=28 November 2014}}</ref> On December 6 it was announced that he had recovered and left the country.<ref>{{cite web|url=http://www.cbc.ca/news/health/felix-baez-cuban-doctor-with-ebola-recovers-in-geneva-1.2862976|title=Felix Baez, Cuban doctor with Ebola, recovers in Geneva|publisher=CBC News|date=6 December 2014|accessdate=6 December 2014}}</ref> | |||
| ====United Kingdom==== | |||
| An isolation unit at the ], London, received its first case on 24 August. William Pooley, a British nurse, was evacuated from Sierra Leone by the ] on a specially-equipped ] aircraft. He was released from hospital on 3 September.<ref name=united_Kingdom_Ebola>{{cite news|url=http://www.bbc.com/news/uk-28919831 |title=British Ebola patient arrives in UK for hospital treatment |publisher=BBC News |date=24 August 2014|accessdate=25 August 2014}}</ref><ref>{{cite news|url=http://www.theweek.co.uk/world-news/ebola/57952/ebola-british-nurse-makes-full-recovery-and-leaves-hospital |title=Ebola: British nurse makes full recovery and leaves hospital|publisher=The Week |date=3 September 2014|accessdate=5 September 2014}}</ref> | |||
| ====United States==== | |||
| A number of people who contracted Ebola virus disease while working in the affected areas have been ] for treatment; most recovered, but one has died.<ref name="Ebola_us_death_17_nov">{{cite news|url=http://abcnews.go.com/Health/wireStory/surgeon-ebola-died-nebraska-hospital-26964965|title=Nebraska Hospital: Surgeon With Ebola Has Died|work=ABC News |date=17 November 2014|accessdate=17 November 2014}}</ref> On 17 November 2014 Dr. Martin Salia, evacuated from Sierra Leone to the US, died of the Ebola virus, aged 44 years.<ref>{{cite news|url=http://www.nbcnews.com/storyline/ebola-virus-outbreak/ebola-patient-dr-martin-salia-has-died-nebraska-officials-n249956|title=http://www.nbcnews.com/storyline/ebola-virus-outbreak/ebola-patient-dr-martin-salia-has-died-nebraska-officials-n249956|work=NBC News |date=17 November 2014|accessdate=17 November 2014}}</ref> | |||
| ===Separate outbreak in the Democratic Republic of the Congo=== | |||
| {{main|2014 Democratic Republic of the Congo Ebola virus outbreak}} | |||
| In August 2014, the WHO reported an outbreak of Ebola virus in the ], ] (DRC).<ref name="WHO EVD in DRC"> By the WHO in the African Region</ref> They confirmed that the virus is of the Zaire Ebola species, which is common in the DRC ("]" is the former name of the DRC). The virology results and epidemiological findings indicate no connection to the current epidemic in West Africa. This is the country's seventh Ebola outbreak since 1976.<ref name="who.int">{{cite web |url=http://www.who.int/mediacentre/news/ebola/2-september-2014/en/ |title=Virological analysis: no link between Ebola outbreaks in west Africa and Democratic Republic of Congo |publisher=WHO |date=2 September 2014 |accessdate=7 September 2014}}</ref><ref name=DRC_Ebola_case>{{cite web |url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4263-ebola-virus-disease-drc.html |title=Ebola virus disease – Democratic Republic of Congo |publisher=World Health Organization |date=26 August 2014 |accessdate=27 August 2014}}</ref> | |||
| In August, 13 people were reported to have died of Ebola-like symptoms in the remote northern ] province.<ref name=DRC_Ebola_case /> The initial case was reported to have been a woman from Ikanamongo Village who became ill with symptoms of Ebola after she had butchered a bush animal that her husband had killed.<ref name=DRC_Ebola_case /> However, more recent findings suggest that there may have been several previous cases, and an investigation is ongoing.<ref>{{cite web|url=http://news.yahoo.com/ebola-sleuths-scour-dr-congo-jungle-source-outbreak-060715032.html|title=Ebola sleuths scour DR Congo jungle for source of outbreak|date=23 October 2014|work=Yahoo News|accessdate=23 October 2014}}</ref> According to the WHO, {{As of |2014|10|28|lc=y}}, there had been 66 cases with 49 deaths including eight healthcare workers. Twenty days had passed since the last reported case was discharged and no new contacts were being followed.<ref name=WHO20141029>{{cite web |url=http://apps.who.int/iris/bitstream/10665/137376/1/roadmapsitrep_29Oct2014_eng.pdf?ua=1 |title=EBOLA RESPONSE ROADMAP SITUATION REPORT UPDATE |publisher=World Health organization|date=29 October 2014 |accessdate =3 November 2014}}</ref> The government of Congo declared the outbreak over on 15 November 2014, after 42 days without any new cases.<ref>{{cite news|url=http://uk.reuters.com/article/2014/11/15/health-ebola-congodemocratic-idUKL6N0T50F720141115|title=Congo declares its Ebola outbreak over|publisher=reuters|date=15 November 2014|accessdate=18 November 2014}}</ref> This was confirmed by WHO on 21 November.<ref name=WHO-drc-ends-ebola>{{cite web|title=WHO declares end of Ebola outbreak in the Democratic Republic of Congo|url=http://www.who.int/mediacentre/news/statements/2014/drc-ends-ebola/en/|publisher=WHO|accessdate=22 November 2014}}</ref> | |||
| ==Virology== | |||
| Ebola virus disease is caused by four of five viruses classified in the genus '']''. Of the four disease-causing viruses, ] (formerly and often still called the Zaire virus), is the most dangerous and is the species responsible for the ongoing epidemic in West Africa.<ref name="Gire 2014">{{cite journal|last1=Gire|first1=S. K.|last2=Goba|first2=A.|last3=Andersen|first3=K. G.|last4=Sealfon|first4=R. S. G.|last5=Park|first5=D. J.|last6=Kanneh|first6=L.|last7=Jalloh|first7=S.|last8=Momoh|first8=M.|last9=Fullah|first9=M.|last10=Dudas|first10=G.|last11=Wohl|first11=S.|last12=Moses|first12=L. M.|last13=Yozwiak|first13=N. too primaryL.|last14=Winnicki|first14=S.|last15=Matranga|first15=C. B.|last16=Malboeuf|first16=C. M.|last17=Qu|first17=J.|last18=Gladden|first18=A. D.|last19=Schaffner|first19=S. F.|last20=Yang|first20=X.|last21=Jiang|first21=P.-P.|last22=Nekoui|first22=M.|last23=Colubri|first23=A.|last24=Coomber|first24=M. R.|last25=Fonnie|first25=M.|last26=Moigboi|first26=A.|last27=Gbakie|first27=M.|last28=Kamara|first28=F. K.|last29=Tucker|first29=V.|last30=Konuwa|first30=E.|last31=Saffa|first31=S.|last32=Sellu|first32=J.|last33=Jalloh|first33=A. A.|last34=Kovoma|first34=A.|last35=Koninga|first35=J.|last36=Mustapha|first36=I.|last37=Kargbo|first37=K.|last38=Foday|first38=M.|last39=Yillah|first39=M.|last40=Kanneh|first40=F.|last41=Robert|first41=W.|last42=Massally|first42=J. L. B.|last43=Chapman|first43=S. B.|last44=Bochicchio|first44=J.|last45=Murphy|first45=C.|last46=Nusbaum|first46=C.|last47=Young|first47=S.|last48=Birren|first48=B. W.|last49=Grant|first49=D. S.|last50=Scheiffelin|first50=J. S.|last51=Lander|first51=E. S.|last52=Happi|first52=C.|last53=Gevao|first53=S. M.|last54=Gnirke|first54=A.|last55=Rambaut|first55=A.|last56=Garry|first56=R. F.|last57=Khan|first57=S. H.|last58=Sabeti|first58=P. C.|title=Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak|journal=Science|date=28 August 2014|volume=345|issue=6202|pages=1369–1372|doi=10.1126/science.1259657|accessdate=15 October 2014|displayauthors=3}}</ref><ref name=KuhnArch>{{cite journal|last1=Kuhn|first1=Jens H.|last2=Becker|first2=Stephan|last3=Ebihara|first3=Hideki|last4=Geisbert|first4=Thomas W.|last5=Johnson|first5=Karl M.|last6=Kawaoka|first6=Yoshihiro|last7=Lipkin|first7=W. Ian|last8=Negredo|first8=Ana I.|last9=Netesov|first9=Sergey V.|last10=Nichol|first10=Stuart T.|last11=Palacios|first11=Gustavo|last12=Peters|first12=Clarence J.|last13=Tenorio|first13=Antonio|last14=Volchkov|first14=Viktor E.|last15=Jahrling|first15=Peter B.|title=Proposal for a revised taxonomy of the family Filoviridae: classification, names of taxa and viruses, and virus abbreviations|journal=Archives of Virology|date=30 October 2010|volume=155|issue=12|pages=2083–2103|doi=10.1007/s00705-010-0814-x|accessdate=15 October 2014|displayauthors=3|pmid=21046175|pmc=3074192}}</ref> | |||
| 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.<ref name="Baize-2014" /> However, further studies have shown that the current outbreak is likely caused by an Ebola virus lineage that has spread from Central Africa into West Africa, with the first viral transfer to humans in Guinea.<ref name="Gire 2014" /><ref name="EurekAlert!">{{cite web|url=http://www.eurekalert.org/pub_releases/2014-07/uamr-sls071414.php|title=Sierra Leone samples: Ebola evidence in West Africa in 2006|date=14 July 2014|work=EurekAlert!|accessdate=7 October 2014}}</ref> | |||
| In a study done by ], the ] and ], in partnership with the ], 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 ] were collected and ] 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.<ref name="Gire 2014" /> Five members of the research team became ill and died from Ebola before the study was published in August.<ref name="Gire 2014" /> | |||
| ==Transmission== | |||
| ]]] | |||
| It is not entirely clear how an Ebola outbreak starts.<ref name=CDC2014P>{{cite web|title=Ebola Hemorrhagic Fever Prevention|url=http://www.cdc.gov/vhf/ebola/prevention/index.html|publisher=CDC|accessdate=2014-08-02|date=July 31, 2014}}</ref> 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 ]s feed on these fallen fruits. This chain of events forms a possible indirect means of transmission from the natural host to animal populations.<ref>{{cite journal |author=Gonzalez JP, Pourrut X, Leroy E |title=Ebolavirus and other filoviruses |journal=Current topics in microbiology and immunology |volume=315 |pages=363–387 |year=2007 |pmid=17848072 |doi=10.1007/978-3-540-70962-6_15 |isbn=978-3-540-70961-9 |series=Current Topics in Microbiology and Immunology }}</ref> | |||
| 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.<ref name=CDCPress2014>{{cite web|title=CDC Telebriefing on Ebola outbreak in West Africa|url=http://www.cdc.gov/media/releases/2014/t0728-ebola.html|website=CDC|accessdate=2014-08-03|date=2014-07-28}}</ref> Airborne transmission has not been documented during Ebola outbreaks. 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.<ref name="nyt">{{cite news|first=Blaine|last=Harden|title=Dr. Matthew's Passion|url=http://www.nytimes.com/library/magazine/home/20010218mag%2debola.html|work=] Magazine|date=2001-02-18|accessdate=2008-02-25}}</ref> Semen and possibly other body fluids (e.g., breast milk) may be infectious in survivors for months.<ref name="Ebola media centre fact sheets">{{cite web |url=http://www.who.int/mediacentre/factsheets/fs103/en/ |title=Ebola media centre fact sheets |publisher=WHO |work=Ebola media centre fact sheets |accessdate=21 September 2014}}</ref><ref name=CDCQA2014>{{cite web |url=http://www.cdc.gov/vhf/ebola/outbreaks/guinea/qa.html |title=Questions and Answers on Ebola | Ebola Hemorrhagic Fever |publisher=CDC}}</ref> | |||
| One of the primary reasons for spread is the poorly-functioning health systems in the part of Africa where the disease occurs.<ref>{{cite web|author1=Tiaji Salaam-Blyther|title=The 2014 Ebola Outbreak: International and U.S. Responses|url=http://fas.org/sgp/crs/row/R43697.pdf|accessdate=9 September 2014|format=pdf|date=August 26, 2014}}</ref> The risk of transmission is increased among those caring for people infected. Recommended measures when caring for those who are infected include ] via the proper use of boots, gowns, gloves, masks and goggles, and ].<ref name=CDC2014P /> | |||
| Even with proper isolation equipment available, working conditions such as no running water, no climate control, and no floors may continue to make direct care more difficult. Two American health workers who had 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.<ref name="nbcnews.com">{{cite web |url=http://www.nbcnews.com/storyline/ebola-virus-outbreak/two-americans-stricken-deadly-ebola-virus-liberia-n166281 |title=Two Americans Stricken With Deadly Ebola Virus in Liberia |publisher=NBC News |date=28 July 2014 |accessdate=2 August 2014}}</ref> | |||
| Successfully addressing one of the "biggest danger(s) of infection" faced by medical staff requires their learning how to properly suit up with, and later remove, personal protective equipment. In Sierra Leone, the typical training period for the use of such safety equipment lasts approximately 12 days.<ref> The Telegraph, by Fiona Govan, 11 Oct. 2014</ref> | |||
| Difficulties in attempting to contain the outbreak include its multiple locations across country borders.<ref name="Control" /> ], 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.<ref name=Guinea_Ebola_Sep_Update /> 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.<ref name="WHO" /> | |||
| ==Containment and control== | |||
| {{Main|Prevention of viral hemorrhagic fever}} | |||
| {{See also|Ebola virus disease#Prevention}} | |||
| ] | |||
| On 28 August the WHO published a roadmap of the steps required to bring the epidemic under control and to prevent further transmission of the disease within West Africa; the coordinated ] is working to realise this plan.<ref name=28_August_2014_WHO_roadmap/> Key elements required to prevent transmission are contact tracing and follow-up as well as social mobilisation and public awareness. | |||
| ===Surveillance and 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.<ref>{{cite web|title=The reason Ebola isn't being stopped|url=http://edition.cnn.com/2014/09/11/health/ebola-contact-tracing/|publisher=CNN|accessdate=16 September 2014}}</ref> 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."<ref name="WHO 2014-9-3 Ebola response needs">{{cite web|title=UN senior leaders outline needs for global Ebola response|url=http://www.who.int/mediacentre/news/releases/2014/ebola-response-needs/en/|publisher=WHO|accessdate=16 September 2014}}</ref> There is a massive ongoing effort to train volunteers and health workers, sponsored by ].<ref>{{cite web|title=FACT SHEET: U.S. Response to the Ebola Epidemic in West Africa|url=http://www.whitehouse.gov/the-press-office/2014/09/16/fact-sheet-us-response-ebola-epidemic-west-africa|publisher=The White House|accessdate=2 November 2014}}</ref> According to WHO reports 25,926 contacts from Guinea, 35,183 from Liberia and 104,454 from Sierra Leone are listed and being traced as of 23 November.<ref name=WHO2014_11_23 /> | |||
| ===Community awareness=== | |||
| In order to reduce the spread, the ] recommends raising community awareness of the risk factors for Ebola infection and the protective measures individuals can take.<ref name=WHOFS103>{{cite web|title= Ebola virus disease Fact sheet N°103 |url=http://www.who.int/mediacentre/factsheets/fs103/en/|website=WHO|accessdate=2014-09-06 }}</ref> These include avoiding contact with infected people and regular ] using soap and water.<ref>{{cite web |url=https://plan-international.org/about-plan/resources/news/ebola-outbreak-5-tips-to-avoid-the-deadly-disease/|title=Ebola – 5 tips to avoid the deadly disease |publisher= Plan International|date=2014-09-06}}</ref> A condition of ] exists in many of the areas that have experienced a high incidence of infections. According to the director of the ] ] in Guinea, "The poor ] and lack of ] and ] in most districts of Conakry pose a serious risk that the epidemic escalates into a crisis. People do not think to ] when they do not have enough ]."<ref name="Diallo">{{cite web |title=Ebola en Guinée : l'ONG Plan Guinée craint une aggravation de l'épidemie|url=http://www.africaguinee.com/articles/2014/03/30/ebola-en-guinee-l-ong-plan-guinee-craint-une-aggravation-de-l-epidemie |language=fr |trans_title=Ebola in Guinea: the NGO Plan Guinea fears a worsening of the epidemic |publisher=Africa guinée |date=29 March 2014 |accessdate=31 March 2014|first=Boubacar |last=Diallo}}</ref> | |||
| A number of organisations have enrolled local people to conduct public awareness campaigns among the communities in West Africa.<ref>{{cite web|title=Encounters during the Ebola awareness campaign|url=http://plan-international.org/about-plan/resources/blogs/encounters-during-the-ebola-awareness-campaign/|publisher=PLAN International|accessdate=2 November 2014}}</ref> "...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, ]’s representative in Senegal.<ref>{{cite web|title=FAO Launches Ebola Awareness Campaign in West Africa|url=http://www.voanews.com/content/ebola-fao-17oct14/2487282.html|publisher=FAO|accessdate=2 November 2014}}</ref> | |||
| Containment efforts have been hindered because there is reluctance among residents of rural areas to recognize the danger of infection related to person-to-person spread of disease, such as burial practices which include ].<ref name="WHO 2014-07-03" /><ref name="Global Post"/><ref name="Today Health" /><ref name=BBC_Freetown /> An August 2014 study found that nearly two thirds of Ebola cases in Guinea are believed to be due to burial practices.<ref>{{cite journal|last1=Chan|first1=M|title=Ebola Virus Disease in West Africa - No Early End to the Outbreak.|journal=The New England Journal of Medicine|date=Aug 20, 2014|pmid=25140856|doi=10.1056/NEJMp1409859|volume=371|issue=13|pages=1183–5}}</ref> 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.<ref>{{cite web | title=How to conduct safe and dignified burial of a patient who has died from suspected or confirmed Ebola virus disease | website= | url=http://apps.who.int/iris/bitstream/10665/137379/1/WHO_EVD_GUIDANCE_Burials_14.2_eng.pdf | format=PDF | publisher=] | accessdate=14 December 2014 }}</ref> | |||
| Denial in some affected countries has also made containment efforts difficult.<ref>{{cite web|author=Ofeibea Quist-Arcton|url=http://www.npr.org/blogs/goatsandsoda/2014/08/06/338234063/skeptics-in-sierra-leone-doubt-ebola-virus-exists|title=Skeptics In Sierra Leone Doubt Ebola Virus Exists|publisher=NPR|date=6 August 2014}}</ref> Language barriers and the appearance of medical teams in protective suits has sometimes increased fears of the virus.<ref>{{cite web |author=Anja Wolz|url=http://www.newscientist.com/article/mg22329774.600-fighting-fear-denial-and-death-on-ebola-frontline.html|title=Fighting fear, denial and death on Ebola frontline|work=New Scientist |date=15 July 2014}}</ref> In Liberia, a mob attacked an Ebola isolation centre, stealing equipment and "freeing" patients while shouting "There's no Ebola."<ref>{{cite web |url=http://www.theage.com.au/world/patients-reported-missing-after-ebola-clinic-attacked-in-liberia-20140818-10573f.html |title=Patients reported missing after Ebola clinic attacked in Liberia|work=The Age |date=18 August 2014 |accessdate=18 August 2014}}</ref> Red Cross staff were forced to suspend operations in southeast Guinea after they were threatened by a group of men armed with knives.<ref>{{cite web |url=http://www.reuters.com/article/2014/07/02/health-ebola-westafrica-redcross-idUSL6N0PD2GH20140702 |title=Red Cross suspends Ebola operations in southeast Guinea after threats |publisher=Reuters |date=2 July 2014 |accessdate=4 July 2014}}</ref> On 18 September in the town of ] in Guinea, suspicious inhabitants wielding machetes murdered at least eight aid workers and dumped their bodies in a ].<ref>{{cite web|url=http://www.foxnews.com/world/2014/09/19/at-least-8-ebola-aid-workers-reportedly-killed-in-cold-blood-by-villagers-in/|title=At least 8 Ebola aid workers reportedly killed 'in cold blood' by villagers in Guinea|publisher=Fox News|accessdate=19 September 2014}}</ref> | |||
| {{reflistp}} | |||
| ===Travel restrictions and quarantines=== | |||
| There is serious concern that the disease may spread further within West Africa or elsewhere in the world. | |||
| ====West Africa==== | |||
| On 8 August, a '']'', 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.<ref name=cordon>{{cite news |url=http://www.nytimes.com/2014/08/13/science/using-a-tactic-unseen-in-a-century-countries-cordon-off-ebola-racked-areas.html |last=McNeil |first=Donald G., Jr. |title=Using a Tactic Unseen in a Century, Countries Cordon Off Ebola-Racked Areas |work=The New York Times |date=13 August 2014 |accessdate=14 August 2014}}</ref> 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.<ref>{{cite web|title=In Sierra Leone’s Ebola hot zone: A series of reports|url=http://www.irinnews.org/report/100706/in-sierra-leone-s-ebola-hot-zone-a-series-of-reports|publisher=UN Office for the Coordination of Humanitarian Affairs|accessdate=2 November 2014}}</ref><ref>{{cite web|title=Rally around West African communities to fight Ebola|url=http://seattletimes.com/html/opinion/2024924352_maxweihecolumnebola02xml.html|publisher=Seattle Times|accessdate=2 November 2014}}</ref> | |||
| ====International==== | |||
| Many countries have considered imposing restrictions on travel to or from the region. On 2 September, 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".<ref name="As Ebola Outbreak Surges, Health Officials Slam International 'Coalition of Inaction'" /> ], 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."<ref name="Ebola: the failures of the international outbreak response" /> | |||
| In early August, airports in Guinea, Liberia and Sierra Leone began screening departing passengers for symptoms of Ebola. A study of the effectiveness of this has concluded that it has probably prevented 3 cases of Ebola per month from leaving the affected countries.<ref>{{cite journal|title=Assessment of the potential for international dissemination of Ebola virus via commercial air travel during the 2014 west African outbreak|journal=The Lancet|date=October 2014|doi=10.1016/S0140-6736(14)61828-6|accessdate=2 November 2014}}</ref><ref>{{cite web|title=Ebola Airport Screening Prevents 3 Cases Per Month from Traveling|url=http://www.livescience.com/48363-ebola-cases-air-travel.html|publisher=Livescience|accessdate=2 November 2014}}</ref> | |||
| ====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,<ref>{{cite web|title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html|publisher=CDC|accessdate=2 November 2014}}</ref> MSF,<ref>{{cite web|title=MSF Protocols for Staff Returning from Ebola-Affected Countries|url=http://www.doctorswithoutborders.org/article/msf-protocols-staff-returning-ebola-affected-countries|publisher=Doctors without Borders|accessdate=2 November 2014}}</ref> Public Health England,<ref>{{cite web|title=Public health recommendations for returning workers who are asymptomatic contacts of Ebola virus disease|url=https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/385769/Ebola_recommendations_for_workers_who_are_asymptomatic_contacts.pdf|publisher=Public Health England|date=10 December 2014}}</ref> and Public Health Ontario.<ref>{{cite web|title=Ebola virus disease (EVD): Advice for returning travellers from countries/areas affected by EVD|url=http://www.publichealthontario.ca/en/eRepository/EVD_advice_returning_traveller_temp_recording.pdf|publisher=Public Health Ontario|accessdate=2 November 2014}}</ref> 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. | |||
| The US Centers for Disease Control and Prevention recommends monitoring of exposed people for 21 days but does not require quarantine, in which they are kept away from others. However, in October some states in the United States made a decision to ignore the CDC guidelines and issued orders for a mandatory 21-day quarantine.<ref>{{cite web|url=http://news.yahoo.com/connecticut-ebola-scare-quarantine-150928265.html|title=Yahoo news article|date=28 October 2014|work=Yahoo News|accessdate=30 October 2014}}</ref> In compliance with the new orders, Kaci Hickox, a nurse who was returning after working with Doctors Without Borders, was quarantined in a tent in the parking lot of a ] hospital, one of the states that had adopted the stricter quarantine rules.<ref>{{cite news | author=Davis, Mark | date=7 October 2014 | title=Malloy signs Ebola emergency declaration | url=http://wtnh.com/2014/10/07/malloy-signs-ebola-emergency-declaration/ | work=WTNH News | publisher=] | location=United States | type=video and derived text }}</ref><ref>{{cite news | title=Tested Negative for Ebola, Nurse Criticizes Her Quarantine | author=Hartocollis, Anemoma | author2=Fitzsimmons, Emma G. | date=25 October 2014 | work=] | url=http://www.nytimes.com/2014/10/26/nyregion/nurse-in-newark-tests-negative-for-ebola.html | department=N.Y. / Region }}</ref><ref>{{cite news | author=Santora, Marc | title=First Patient Quarantined Under Strict New Policy Tests Negative for Ebola | date=24 October 2014 | work=] | department=N.Y. / Region | url=http://www.nytimes.com/2014/10/25/nyregion/new-york-ebola-case-craig-spencer.html }}</ref> | |||
| After threat of a legal action, Hickox was allowed to return to her home in ], where she again faced mandatory quarantine.<ref>{{cite web|url=http://www.bloomberg.com/news/2014-10-29/nurse-kaci-hickox-says-she-won-t-follow-maine-s-ebola-quarantine.html|title=Maine Governor Seeks to Make Nurse Abide by Quarantine|author= Michelle Kaske and Esme E. Deprez|date=October 29, 2014|work=Bloomberg}}</ref> Hickox again took legal measures to allow her to follow the recommended CDC guidelines rather than an enforced state mandatory quarantine. The court ruled for Hickox saying, "The court is fully aware of the misconceptions, misinformation, bad science and bad information being spread from shore to shore in our country with respect to Ebola. The court is fully aware that people are acting out of fear and that this fear is not entirely rational."<ref name=MainJudge>{{cite web|url=http://www.upi.com/Top_News/US/2014/10/31/Judge-wont-allow-Maine-to-quarantine-Ebola-nurse-Kaci-Hickox/2201414776312/|website=www.upi.com|publisher=UPI|accessdate=2 November 2014|title=Judge won't allow Maine to quarantine Ebola nurse|author=Gabrielle Levy|date=31 October 2014}}</ref> | |||
| Speaking on lengthy quarantines for health care workers, US President Barack Obama said that "subjecting returning health-care workers to lengthy quarantines is motivated by fear, not science, and will be counterproductive because it will dissuade people from joining the fight against the disease in West Africa."<ref name="Portland Press Herald">{{cite web | url=http://www.pressherald.com/2014/10/30/kaci-hickox-and-boyfriend-leave-home-on-bikes/ | title=Kaci Hickox and boyfriend leave home on bikes, defying Ebola quarantine | publisher=Portland Press Herald | date=30 October 2014 | accessdate=30 October 2014}}</ref> | |||
| ] expert ] has also urged against these mandatory quarantines, warning that they would further discourage American healthcare workers from traveling to affected areas.<ref>{{cite web|url=http://www.cbsnews.com/news/white-house-concerned-about-state-imposed-ebola-quarantines/|title=White House concerned about state-imposed Ebola quarantines|date=26 October 2014|publisher=|accessdate=27 October 2014}}</ref><ref>{{cite web|url=http://www.reuters.com/article/2014/10/24/us-health-ebola-newarkairport-idINKCN0ID2GD20141024?|title=Heathcare worker at Newark airport to be quarantined on Ebola fears|work=Reuters|accessdate=24 October 2014}}</ref> | |||
| The United Nations is concerned about travel restrictions placed on medical workers returning from West Africa and has issued a statement disapproving of the excessive ] of medical personnel.<ref>{{cite web|url=http://www.un.org/press/en/2014/sgsm16281.doc.htm|title=United Nations press release|publisher=|accessdate=30 October 2014}}</ref> | |||
| ==Treatment== | |||
| {{See also|Ebola virus disease#Research|l1=Research into the Ebola virus disease|Ebola virus disease#Treatment|l2=Treatment of the Ebola virus disease}} | |||
| No proven Ebola virus-specific treatment presently exists,<ref name=Choi-2013>{{cite journal |author=Choi JH, Croyle MA |title=Emerging targets and novel approaches to Ebola virus prophylaxis and treatment |journal=BioDrugs |volume=27 |issue=6 |pages=565–83 |date=December 2013 |pmid=23813435 |doi=10.1007/s40259-013-0046-1 |url=http://link.springer.com/article/10.1007/s40259-013-0046-1#page-1 |pmc=3833964}}</ref> however there are measures that can be taken that will improve a patient's chances of survival.<ref>{{cite web |author= Makiko Kitamura |title=Sierra Leone Is Epicenter of Ebola as Guinea Clinic Shut |date=8 June 2014 |url=http://www.businessweek.com/news/2014-07-29/sierra-leone-is-epicenter-of-ebola-as-guinea-clinic-shut |accessdate=30 July 2014}}</ref> 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 ]-like stage characterized by ], ], and pain in the ] and ]. Later symptoms may include headache, ], and abdominal pain.<ref name=Hun2012>{{cite book|last1=Magill|first1=Alan|title=Hunter's tropical medicine and emerging infectious diseases.|date=2013|publisher=Saunders|location=New York|isbn=9781416043904|page=332|edition=9th ed.|url=http://books.google.ca/books?id=UgvdM8WRld4C&pg=PA332}}</ref> This is often followed by severe vomiting and ].<ref name=Hun2012/> | |||
| Without fluid replacement, such extreme loss of fluids leads to ] which may lead to ], 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, ] may be given, but patients who are vomiting or are ] must be treated with ]. 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.<ref name=":7">{{cite web | url=http://www.nejm.org/doi/full/10.1056/NEJMoa1411680#t=articleBackground | title=Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone | publisher=The New England Journal of Medicine | date=29 October 2014 | accessdate=2 November 2014}}</ref> | |||
| ===Prognosis=== | |||
| Ebola virus disease has a high ] which varies between 25 percent and 90 percent of those who have contracted the disease. The case fatality rate (CFR), in previous Ebola infections is 50%, however it is known that the Zaire species, which is responsible for the current outbreak, carries a higher death rate.<ref name="Ebola Virus Disease">{{cite web | url=http://www.who.int/mediacentre/factsheets/fs103/en/ | title=Fact sheet | publisher=WHO | work=Ebola Virus Factsheet | date=September 2014 | accessdate=28 October 2014}}</ref> Care settings that have access to medical expertise may increase survival by providing maintenance of hydration, circulatory volume, and blood pressure.<ref name=":7"/> | |||
| The disease affects males and females equally and the majority of those that contract Ebola disease are between 15 and 45 years of age.<ref name=":1"/><section end=cfrref /> 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.<ref name=":7"/> | |||
| 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."<ref name="/Voice of America">{{cite web | url=http://www.voanews.com/content/ebola-increases-threat-to-sierra-leone-pregnancies/2492783.html | title=Ebola Increases Threat to Sierra Leone Pregnancies | publisher=Voice of America | date=22 October 2014 | accessdate=26 October 2014 | author=Bailes, Adam}}</ref> | |||
| 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 ] said in October that "the additional death toll from malaria and other diseases likely to exceed that of the outbreak itself".<ref name=":2"/> Doctor ] 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."<ref name="Diary"/> | |||
| ===Level of care=== | |||
| Local authorities have not had resources to contain the disease, with health centres closing and hospitals overwhelmed.<ref>{{cite web|title=Sierra Leone`s main referral hospital has been overwhelmed|url=http://en.starafrica.com/news/sleones-main-referral-hospital-overwhelmed.html|publisher=StarAfrica|accessdate=1 October 2014}}</ref> In late June, the Director-General of ] 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."<ref name="Control">{{cite web |url=http://www.ctvnews.ca/health/west-africa-s-ebola-outbreak-is-totally-out-of-control-1.1878133 |title=Doctors Without Borders: West Africa's Ebola Outbreak is Totally Out of Control |publisher=CTVNews |date=20 June 2014 |accessdate=21 June 2014}}</ref> Adequate equipment has not been provided for medical personnel,<ref>{{cite web |url=http://allafrica.com/stories/201406190779.html|title=Liberia: Unheralded Fear - Ebola Pose Risks for Liberia Health Workers |work=] |via=] |date=19 June 2014 |accessdate=21 June 2014}}</ref> with even a lack of soap and water for hand-washing and disinfection.<ref>{{cite web|url=http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php |title=Ebola virus - Pathogen Safety Data Sheets |publisher=Phac-aspc.gc.ca |date=1 August 2014 |accessdate=20 August 2014}}</ref> | |||
| In late August, ] 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 have had to 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.<ref name="doctorswithoutborders.org">{{cite web|url=http://www.doctorswithoutborders.org/news-stories/field-news/liberia-msfs-new-ebola-management-centers-already-overwhelmed|title=MSFs new ebola management centers already overwhelmed|publisher=MSF}}</ref> | |||
| 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."<ref name="West African health centers can't keep up with Ebola outbreak, WHO says">{{cite web |url=http://www.cnn.com/2014/09/12/health/ebola-outbreak/index.html |title=West African health centers can't keep up with Ebola outbreak, WHO says |publisher=CNN Health |date=12 September 2014 |accessdate=15 September 2014 |author=Payne, Ed}}</ref> According to a WHO report released on 19 September, Sierra Leone is currently meeting only 35% of its need for patient beds, and Liberia is meeting only 20% of its need.<ref name="roadmapsitrep4_eng">{{cite web|url=http://apps.who.int/iris/bitstream/10665/133833/1/roadmapsitrep4_eng.pdf?ua=1|title=WHO: Ebola Response Roadmap Situation Report 18 September 2014|publisher=WHO |date=18 September 2014 |accessdate=19 September 2014}}</ref> The WHO has 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 was now a sufficient number of beds in treatment facilities to treat and isolate all reported Ebola cases, although the uneven distribution of cases is resulting in serious shortfalls in some areas. Similarly, all affected countries now have sufficient and widespread capacity to bury all | |||
| reported deaths; however, because not all deaths are reported, it is possible that some areas still have insufficient burial capacity. Every district now has access to a laboratory to confirm cases of Ebola | |||
| within 24 hours from sample collection. All three countries report that more than 80% of registered contacts | |||
| associated with known cases of EVD are being traced, although contact tracing is still a challenge in areas of | |||
| intense transmission and in areas of community resistance. | |||
| <ref name=WHO2014_12_10 /> | |||
| {|class="wikitable" style="text-align: right;" | |||
| |+Current bed capacity in countries with active cases as of 14 Dec 2014.<ref name=WHO2014_12_17a /> | |||
| |- | |||
| ! Countries ||Existing beds || Planned beds || Percentage of<br>existing/planned beds | |||
| |- | |||
| |style="text-align: left;"| '''Guinea''' || 230|| 695 || 37% | |||
| |- | |||
| |style="text-align: left;"| '''Liberia'''|| 650 || 1,219 || 53% | |||
| |- | |||
| |style="text-align: left;"| '''Sierra Leone''' || 615|| 2,020 || 30% | |||
| |- | |||
| |style="text-align: center;"| '''Total'''|| '''1,525''' || '''3,934'''|| '''39%''' | |||
| |} | |||
| ===Healthcare settings=== | |||
| ] | |||
| 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 ] 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.<ref>{{cite news|title=An Ebola treatment center|url=http://apps.washingtonpost.com/g/page/national/an-ebola-treatment-center/1333/|work=Washington Post|accessdate=1 October 2014}}</ref><ref>{{cite web|title=Guidance for Safe Handling of Human Remains of Ebola Patients in U. S. Hospitals and Mortuaries|url=http://www.cdc.gov/vhf/ebola/hcp/guidance-safe-handling-human-remains-ebola-patients-us-hospitals-mortuaries.html|publisher=Centers for Disease Control|accessdate=1 October 2014}}</ref> | |||
| Although the WHO does not advise caring for Ebola patients at home, it is an option and even a necessity when no hospital treatment beds are available. For those being treated at home, the WHO advises informing the local public health authority and acquiring appropriate training and equipment.<ref>{{cite web|url=http://www.who.int/csr/disease/ebola/faq-ebola/en/|title=Frequently asked questions on Ebola virus disease|publisher=WHO|date=8 August 2014|accessdate=3 October 2014}}</ref><ref>{{cite web|url=http://edition.cnn.com/2014/09/25/health/ebola-fatu-family/|title=Woman saves three relatives from Ebola |publisher=CNN | date=26 September 2014 |accessdate=14 October 2014}}</ref> ], ] and the ] ] have begun to take measures to provide support for families that are forced to care for patients at home by supplying caregiver kits intended for interim home-based interventions. The kits include protective clothing, hydration items, medicines, and disinfectant, among other items.<ref>{{cite web|url=http://www.samaritanspurse.org/article/hope-takes-flight-across-the-atlantic/|title=Ebola Supplies Arrive in Liberia|publisher=Samaritan's Purse|date=2 October 2014|accessdate=3 October 2014}}</ref><ref>{{cite web|url=http://www.liberianobserver.com/news/order-contain-ebola-9000-household-kits-arrive/|title=In Order To Contain Ebola 9,000 Household Kits Arrive|work=Daily Observer|date=25 September 2014|accessdate=4 October 2014}}</ref> 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.<ref>{{cite web|url=http://www.nbcnews.com/storyline/ebola-virus-outbreak/are-hospitals-part-ebola-problem-charity-wants-new-strategy-n202486|title=Are Hospitals Part of the Ebola Problem? Charity Wants New Strategy|publisher=NBC News|date=15 September 2013|accessdate=3 October 2014}}</ref> The WHO and non-profit partners have launched a program in Liberia to move infected people out of their homes into ad hoc centres that will provide rudimentary care.<ref>{{cite web|url=http://www.washingtonpost.com/national/health-science/new-effort-to-fight-ebola-in-liberia-would-move-infected-patients-out-of-their-homes/2014/09/22/f869dc08-4281-11e4-b47c-f5889e061e5f_story.html|title=New effort to fight Ebola in Liberia would move infected patients out of their homes|work=The Washington Post|date=22 September 2014|accessdate=2 October 2014}}</ref> | |||
| ====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.<ref>{{cite web|url=http://www.bbc.com/news/health-29518703|title=How not to catch Ebola |publisher=BBC | date=7 October 2014 |accessdate=13 October 2014}}</ref> | |||
| The protective clothing set that ] 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."<ref> ''The Telegraph'', by Fiona Govan, 11 Oct. 2014</ref><ref>{{cite web|url=http://www.npr.org/2014/10/07/354230895/ebola-protective-suits-are-in-short-supply|title=Ebola Protective Suits Are In Short Supply |publisher=npr | date=7 October 2014 |accessdate=13 October 2014}}</ref> According to some reports, protective outfits are beginning to be in short supply and manufacturers have started to increase their production,<ref>{{cite web|url=http://abcnews.go.com/Business/ebola-enterovirus-flu-fuel-demand-protective-gear/story?id=26070092|title=Ebola Suit Maker Triples Output |publisher=ABC-News | date=9 October 2014 |accessdate=13 October 2014}}</ref> but the need to find better types of suits has also been raised.<ref>{{cite web|url=http://seattletimes.com/html/localnews/2024716171_ebolasidexml.html|title=USAID seeking better Ebola protective gear |publisher=The Seattle Times | date=6 October 2014 |accessdate=13 October 2014}}</ref> | |||
| ] 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".<ref>{{cite web|url=http://www.usaid.gov/grandchallenges/ebola|title=Fighting Ebola: A Grand Challenge for Development |publisher=USAID|date=9 October 2014|accessdate=14 October 2014}}</ref><ref>{{cite web|url=http://www.whitehouse.gov/blog/2014/10/29/innovating-fight-ebola|title=Innovating to Fight Ebola|publisher=The White House - Office of Science and Technology Policy|date=29 October 2014|accessdate=4 November 2014}}</ref><ref>{{cite web|url=http://www.huffingtonpost.com/2014/10/31/obama-ebola-strategy_n_6082454.html|title=Obama Tries A 'Throw Everything Against The Wall' Approach To Ebola|publisher=The Huffington Post|date=31 October 2014|accessdate=10 November 2014}}</ref><ref>{{cite web|url=http://www.washingtonpost.com/business/on-it/usaid-seeks-help-from-maker-movement-in-ebola-outbreak/2014/11/23/1c8d9a4a-6611-11e4-bb14-4cfea1e742d5_story.html|title=USAID seeks help from ‘maker movement’ in Ebola outbreak|publisher=The Washington Post|date=24 November 2014|accessdate=26 November 2014}}</ref> On December 17, 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.<ref>{{cite web|url=http://www.npr.org/2014/12/17/371413804/dreaming-up-a-safer-cooler-ppe-for-ebola-fighters|title=Dreaming Up A Safer, Cooler PPE For Ebola Fighters|date=17 December 2014|work=NPR.org|accessdate=18 December 2014}}</ref> | |||
| ====Healthcare workers==== | |||
| In August, 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 of doctors.<ref>{{cite web |url=http://www.who.int/dg/speeches/2014/ebola-briefing/en/ |title=WHO Director-General briefs Geneva UN missions on the Ebola outbreak |last=Chan |first=Margaret |publisher=WHO |date=12 August 2014 |accessdate=14 August 2014}}</ref> 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.<ref name="WHO" /> | |||
| 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 current outbreak, care may be provided in clinics with limited resources, and workers could be in these areas for several hours with a number of Ebola infected patients.<ref name="CDC">{{cite web | url=http://www.cdc.gov/vhf/ebola/hcp/clinician-information-us-healthcare-settings.html | title=Ebola (Ebola Virus Disease) | publisher=CDC | work=Ebola virus disease Information for Clinicians in U.S. Healthcare Settings | accessdate=28 October 2014}}</ref> 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".<ref name="WHO" /> | |||
| 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".<ref name=guardian_27_July_2014>{{cite web |url=http://www.theguardian.com/world/2014/jul/27/liberia-ebola-first-doctor-dies-brisbane-virus-outbreak |title=Liberia: top doctor becomes latest Ebola victim |work=The Guardian |date=27 July 2014 |accessdate=28 July 2014}}</ref> In July, leading Ebola doctor ] from Sierra Leone died in the outbreak. Khan had long worked with ], a disease that kills over 5,000 a year in Africa. He had expanded his clinic to accept Ebola patients. Sierra Leone's president, ], celebrated Khan as a "national hero".<ref name="Fox News" /> His death was followed by two more deaths in Sierra Leone: Modupe Cole, a senior physician at the country's main referral facility,<ref>{{cite news |url=http://www.africareview.com/News/Another-Sierra-Leone-doctor-contracts-Ebola/-/979180/2414158/-/kfkk7cz/-/index.html |title=Another Sierra Leone doctor contracts Ebola |last=Cham |first=Kemo |work=Africa Review |date=10 August 2014 |accessdate=14 August 2014}}</ref> and Sahr Rogers, who worked in ].<ref name="CBC News">{{cite news |url=http://www.cbc.ca/news/health/ebola-infected-doctor-in-sierra-leone-sahr-rogers-dies-1.2748090 |title=Ebola-infected doctor in Sierra Leone, Sahr Rogers, dies |publisher=CBC News |date=27 August 2014 |accessdate=28 August 2014}}</ref><ref name="Dr. Khan Daily News">{{cite news |url=http://www.nydailynews.com/life-style/health/top-ebola-doctor-dead-african-outbreak-local-airline-suspends-flights-article-1.1884545?false |title=Top Ebola doctor dead in African outbreak; local airline suspends flights |work=New York Daily News |agency=Associated Press |date=29 July 2014 |accessdate=29 July 2014}}</ref><ref>{{cite news |url=http://www.foxnews.com/health/2014/08/02/dr-kent-brantly-named-first-ebola-patient-on-plane-back-to-us/ |title=Dr. Kent Brantly, one of two American Ebola patients, arrives safely at Emory University |publisher=Fox News |date=2 August 2014}}</ref> In August, a well-known Nigerian physician, ], died. She was posthumously praised for preventing the Nigerian index case from leaving the hospital at the time of diagnosis, thereby playing a key role in curbing the spread of the virus in Nigeria.<ref name="reuters1">{{cite web|url=http://www.reuters.com/article/2014/08/04/us-health-ebola-nigeria-idUSKBN0G413H20140804|publisher=Reuters|title=Lagos records second Ebola case in doctor who treated victim: Nigerian health minister|date=4 August 2014}}</ref> | |||
| 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 the editors of '']'' magazine named the Ebola health workers as ]. 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."<ref name=":3"/> | |||
| By 14 December, the WHO reported 649 workers had been infected and 365 had died. Liberia has been especially hard hit with over half the total cases (365 with 177 deaths) reported. Sierra Leone registered 142 cases with 109 fatalities, thus indicating a death toll of 79.5% in Sierra Leone. Guinea reported 125 infected cases with 72 deaths. One infected case in Spain was reported, as well as three in the United States. In Nigeria 11 healthcare workers were also infected and 5 deaths were recorded. Mali reported 2 with 1 death to date.<ref name=WHO2014_12_17a /> | |||
| ===Experimental interventions=== | |||
| ====Experimental treatments==== | |||
| ] to avoid infection]] | |||
| There is as yet no known effective medication or vaccine. 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.<ref name=":8">Roberts, Dan - - Ebola crisis live updates - The Guardian. Retrieved 16 October 2014.</ref> | |||
| The unavailability of treatments in the most-affected regions has spurred controversy, with some calling for experimental drugs to be made more widely available in Africa on a humanitarian basis, and others warning that making unproven drugs widely available would be unethical, especially in light of past experimentation conducted in developing countries by Western drug companies.<ref name=LAtimes>{{cite web|date=6 August 2014|url=http://www.latimes.com/world/africa/la-fg-three-ebola-experts-release-drugs-20140806-story.html|title=Three leading Ebola experts call for release of experimental drug|work=Los Angeles Times}}</ref><ref name=NYTwho>{{cite news|url=http://www.nytimes.com/2014/08/09/health/in-ebola-outbreak-who-should-get-experimental-drug.html|date=8 August 2014|work=The New York Times|title=In Ebola Outbreak, Who Should Get Experimental Drug?}}</ref> As a result of the controversy, on 12 August an expert panel of the WHO endorsed the use of interventions with as-yet-unknown effects for both treatment and prevention of Ebola, and also said that deciding which treatments should be used and how to distribute them equitably were matters that needed further discussion.<ref>{{cite web|url=http://www.who.int/mediacentre/news/statements/2014/ebola-ethical-review-summary/en/|title=Ethical considerations for use of unregistered interventions for Ebola viral disease (EVD)|date=12 August 2014|publisher=World Health Organization}}</ref> | |||
| A number of experimental treatments are being considered for use in the context of this outbreak, and are currently or will soon undergo ]s,<ref>Briggs, Helen (7 August 2014) , BBC News, Health, Retrieved 8 August 2014</ref> but it will still be some time before sufficient quantities have been produced for widespread trials.<ref name=":8"/> On 13 November, MSF announced that trials of three possible treatments - serum, brincidofovir and favipiravir (see below) - would start during November in Ebola treatment centres.<ref>{{cite web|title=Ebola virus: Clinical trials of three new treatments for disease to start in West Africa|url=http://www.independent.co.uk/news/world/africa/ebola-virus-clinical-trials-of-three-new-treatments-for-disease-to-start-in-west-africa-9857729.html|accessdate=13 November 2014}}</ref> On December 17, it was reported in a new study in the Nature Press journal ''Emerging Microbes and Infections'', that researchers at the Icahn School and National Institutes of Health (NIH) indicated 53 promising drug compounds have been identified to possibly treat Ebola. The team used technology to go through a library of almost 3,000 U.S. Food and Drug Administration compounds that are used to treat other ailments. The drugs could prevent Ebola from infecting human cells by 50%; it is possible Ebola could be treated similarly to what has been developed for the viruses HIV and hepatitis C.<ref>{{cite web|url=http://time.com/3638494/ebola-drugs/|title=Ebola: There Are 53 Drugs That Could Treat the Disease|author=Alexandra Sifferlin|work=TIME.com|accessdate=18 December 2014}}</ref> | |||
| *] - Identified as a promising method since the early 1970s days of Ebola research,<ref name="urlwhqlibdoc.who.int">{{cite web | url = http://whqlibdoc.who.int/offset/WHO_OFFSET_36.pdf | title = Marburg and Ebola virus infections: a guide for their diagnosis, management, and control | format = PDF | author = Simpson DIH | work = WHO Offset Publication No. 36 | year = 1977 | page = 24 }}</ref> the WHO has recognised that transfusion of whole blood or purified serum from Ebola survivors is the therapy with the greatest potential to be implemented in the short term, although there is little information on its efficacy.<ref>{{cite web|title=Blood transfusion named as priority treatment for Ebola|url=http://www.nature.com/news/blood-transfusion-named-as-priority-treatment-for-ebola-1.15854|publisher=Nature|accessdate=11 September 2014}}</ref> The first ] of this therapy, involving 70 patients, started at the ELWA 2 treatment Centre in Liberia during December with funding from the ] in coordination with national health authorities and WHO. Further trials are scheduled to start in late December or early January in Guinea and Sierra Leone.<ref>{{cite journal|last1=Butler|first1=Declan|title=First trials of blood-based Ebola therapy kick off|journal=Nature|date=15 December 2014|doi=10.1038/nature.2014.16564}}</ref> | |||
| * ], a combination of monoclonal antibodies. The limited supply of the drug has been used to treat 7 individuals infected with the Ebola virus.<ref>{{cite news|title=US signs contract with ZMapp maker to accelerate development of the Ebola drug|url=http://dx.doi.org/10.1136/bmj.g5488|accessdate=9 October 2014|agency=BMJ|publisher=BMJ|date=2014}}</ref> Although some of them have recovered, the outcome is not considered to be ].<ref>{{cite web|title=How Will We Know If The Ebola Drugs Worked?|url=http://www.forbes.com/sites/davidkroll/2014/08/26/how-will-we-know-if-the-ebola-drugs-worked/|work=Forbes|accessdate=10 September 2014}}</ref> ZMapp has proved highly effective in a trial involving rhesus macaque monkeys.<ref name=Nature-ZMapp-2014>{{cite journal | author=Qui, Xiangguo | author2=Wong, Gary | author3=24 additional authors | title=Reversion of advanced Ebola virus disease in nonhuman primates with ZMapp | journal=] | date=29 August 2014 | volume=514 | issue=7520 | pages=47–53 | doi=10.1038/nature13777 | pmid=25171469 }}{{closed access}}</ref> ] stated on 8 October that it was preparing to mass-produce the drug, in its Center for Innovation in Advanced Development and Manufacturing, pending final approval.<ref>{{cite web|url=http://abc13.com/health/a-m-ready-to-mass-produce-ebola-drug/342554/|title=Texas A&M ready to mass produce Ebola drug waiting for FDA approval|work=ABC13 Houston|accessdate=12 October 2014}}</ref> | |||
| * ], an ] drug.<ref name="NYTimes08082014">{{cite news |author=Andrew Pollack |title=Second Drug Is Allowed for Treatment of Ebola |work=The New York Times |date=7 August 2014 |url=http://www.nytimes.com/2014/08/08/health/second-experimental-drug-allowed-for-treating-ebola.html?_r=1 |accessdate=2014-08-22}}</ref> A ] involving healthy volunteers was started in early 2014 but suspended because of concern over side effects; however the ] has approved emergency use to treat patients actually infected with the virus.<ref>{{cite web|url=http://online.wsj.com/articles/experimental-ebola-drug-gets-nod-from-fda-1411423058|title=Experimental Ebola Drug Gets Nod From FDA|date=22 September 2014|work=Wall Street Journal|accessdate=4 October 2014}}</ref><ref>{{cite web|url=http://online.wsj.com/articles/ebola-drug-race-ramps-up-in-earnest-1413561290|title=Ebola Drug Race Ramps Up in Earnest|author=Peter Loftus|date=17 October 2014|work=WSJ|accessdate=18 October 2014}}</ref> On December 4, it was reported that TKM-Ebola is "on a partial clinical hold because the U.S. Food and Drug Administration"<ref>{{cite web|url=http://www.scientificamerican.com/article/ebola-free-for-all-could-trigger-bad-science-and-wasted-efforts/|title=Ebola Free-for-All Could Trigger Bad Science and Wasted Efforts|author=Helen Branswell|work=scientificamerican.com|accessdate=8 December 2014}}</ref> has concerns in regards to the safety data it has put forth. | |||
| * ] (Avigan), a drug approved in ] for use against influenza; the drug appears to be useful in a mouse model of Ebola disease,<ref name="Gatherer 2014">{{cite journal |author=Gatherer D |title=The 2014 Ebola virus disease outbreak in West Africa |journal=J. Gen. Virol. |volume=95 |issue=Pt 8 |pages=1619–1624 |year=2014 |pmid=24795448 |doi=10.1099/vir.0.067199-0 }}</ref><ref>{{cite pmid|24583123}}</ref> and a clinical trial is being planned for Ebola patients in Guinea, due November. The drug has been tried on four Ebola patients who subsequently recovered, but this outcome is not ].<ref>{{cite web|title=Fujifilm says its Avigan may be approved as Ebola drug by end-2014|url=http://www.trust.org/item/20141111093511-fdopa|accessdate=11 November 2014}}</ref> | |||
| * ] is a broad-spectrum ] developed by ] and currently being researched as a potential treatment for Ebola by ].<ref>{{cite web|url=http://www.forbes.com/sites/davidkroll/2014/08/29/biocryst-to-launch-nhp-ebola-drug-safety-studies-within-weeks/|title=BioCryst to Launch NHP Ebola Drug Safety, Efficacy Studies 'Within Weeks'. David Kroll, Forbes Magazine. 29 August 2014|date=29 August 2014|work=Forbes|accessdate=5 October 2014}}</ref> The drug has been approved to progress to ] trials, expected late in 2014.<ref>{{cite web|url=http://www.wncn.com/story/26569197/biocryst-receives-additional-money-to-ramp-development-of-ebola-drug|title=DURHAM: BioCryst receives additional funding for Ebola drug - WNCN: News, Weather|date=18 September 2014|publisher=WNCN|accessdate=5 October 2014}}</ref> | |||
| * ], another antiviral drug, has been granted an emergency FDA approval as an investigational new drug for the treatment of Ebola after it was found to be effective against Ebola virus in ''in vitro'' tests.<ref>{{cite web|url=http://www.wncn.com/story/26438036/chimerix-experimental-drug-shows-promise-in-fighting-ebola-virus|title=Chimerix experimental drug shows promise in fighting Ebola virus. WNCN News, 4 September 2014|author=WNCN Staff|date=3 September 2014|publisher=|accessdate=7 October 2014}}</ref> On 16 October, it was cleared to start clinical trials.<ref>{{cite web|url=http://www.xconomy.com/raleigh-durham/2014/10/16/chimerix-antiviral-to-start-in-ebola-clinical-trial/|title=Chimerix Antiviral to Start in Ebola Clinical Trial|work=Xconomy}}</ref> A November 17 report indicated that Chimerix sent its experimental drug to west Africa, so it can be evaluated in clinical studies of patients with the Ebola virus.<ref>{{cite web|url=http://www.bizjournals.com/triangle/news/2014/11/17/ebola-chimerix-west-africa-drugs.html|title=Durham's Chimerix sends drug to west Africa for Ebola treatment|date=17 November 2014|work=Triangle Business Journal|accessdate=8 December 2014}}</ref> | |||
| * ] is an ] developed by the Chinese company Sihuan Pharmaceutical along with the Chinese Academy of Military Medical Sciences. In tests on mice, JK-05 shows efficacy against a range of viruses, including Ebola. It is claimed to have a simple molecular structure, which should be readily amenable to synthesis scale-up for mass production. The drug has been given preliminary approval by the Chinese authorities to be available for Chinese health workers involved in combating the outbreak, and Sihuan are preparing to conduct clinical trials in West Africa.<ref>{{cite web|url=http://www.bioworld.com/content/china-approves-ebola-drug-emergency-use-0|title=China approves Ebola drug for emergency use. Kristine Yang, Bioworld.com|work=BioWorld}}</ref><ref>{{cite web|title=China sends Ebola drug to Africa, eyes clinical trials|url=http://in.reuters.com/article/2014/10/16/health-ebola-china-idINL3N0SB2CH20141016|publisher=Reuters|accessdate=31 October 2014}}</ref> | |||
| ====Experimental preventative vaccines==== | |||
| * In September, an experimental vaccine, now known as the ] vaccine, commenced ] trials, being administered to volunteers in Oxford, Bethesda and Mali. The vaccine was developed jointly by ] and the ]. During November it was reported that the initial results were promising and it is hoped that it will be possible to offer the vaccine, initially to health workers, from January 2015.<ref>{{cite web|title=Ebola vaccine 'promising' say scientists after human trial|url=http://www.bbc.co.uk/news/health-30217573|publisher=BBC|accessdate=27 November 2014}}</ref> In preparation for this, GSK is preparing a stockpile of 10,000 doses.<ref>{{cite news|title=First British volunteer injected with trial Ebola vaccine in Oxford|url=http://www.theguardian.com/society/2014/sep/17/ruth-atkins-first-british-volunteer-injected-trial-ebola-vaccine-oxford|accessdate=17 September 2014|work=Guardian}}</ref><ref name="University of Maryland School of Medicine begins Ebola vaccine trials in Mali">{{cite web|title=University of Maryland School of Medicine begins Ebola vaccine trials in Mali|url=http://www.eurekalert.org/pub_releases/2014-10/uoms-uom100914.php|publisher=University of Maryland School of Medicine|accessdate=11 October 2014}}</ref> On December 4, it was reported that scientists at Oxford University had begun the first tests (clinical) of a new Ebola vaccine method, a booster made by Bavarian Nordic that may bolster the effects of the GlaxoSmithKline injection. Furthermore, "if a single dose of an Ebola vaccine is sufficient, it makes absolute sense to use that. But it also makes sense at this early stage of trials to see if a second booster vaccine can greatly increase the levels of immune responses produced," sources indicated.<ref>{{cite web|url=http://www.reuters.com/article/2014/12/04/us-health-ebola-vaccine-idUSKCN0JI0QV20141204|title=Ebola booster vaccine starts first trials in Oxford|work=Reuters|accessdate=8 December 2014}}</ref> On December 19, it was reported that trials of GlaxoSmithKline's Ebola vaccine will be moving into the second phase on February, after a meeting of national regulators indicated more time was needed to review the available information. "Reviewing countries requested additional documentation from the manufacturer of the vaccine, GlaxoSmithKline, before authorization of the trials," a WHO source indicated in a press release. Still there are several unresolved questions in regards to the use of experimental vaccines, such as whether patients might need one or two injections.<ref>{{cite web|url=http://www.reuters.com/article/2014/12/19/us-health-ebola-gsk-idUSKBN0JX13S20141219|title=GSK Ebola vaccine trial seen moving to wider phase in February|work=Reuters|accessdate=20 December 2014}}</ref> | |||
| * A second vaccine candidate, ], has been developed by the ], with development subsequently taken over by Merck Inc.<ref>{{cite web|url=http://www.cbc.ca/news/health/canadian-ebola-vaccine-development-taken-over-by-merck-1.2847128|title=Canadian Ebola vaccine development taken over by Merck|date=24 November 2014|publisher=|accessdate=25 November 2014}}</ref> On 29 October, the ] announced the start of multiple trials in healthy volunteers in Europe, Gabon, Kenya, and the USA.<ref>{{cite web|title=Multiple trials of VSV Ebola vaccine accelerated by international collaborative|url=http://www.wellcome.ac.uk/News/Media-office/Press-releases/2014/WTP057790.htm|publisher=Wellcome Trust|accessdate=29 October 2014}}</ref> On 2 December, researchers announced early results from the trials indicating no serious side effects.<ref>{{cite web|title=No serious side effects in Merck/Newlink Ebola vaccine test|url=http://www.reuters.com/article/2014/12/02/us-health-ebola-vaccine-idUSKCN0JG0WY20141202|publisher=Reuters|accessdate=3 December 2014}}</ref> However, on 11 December, the trial was temporarily halted, due to some side effects in four of the 59 participants, including joint pains in the hands and feet. The trial may resume on 5 January, if the symptoms are found to be "benign and temporary", according to the University of Geneva Hospital.<ref>{{cite web|title=Ebola vaccine trial halted temporarily for checks after joint pains - Geneva hospital|url=http://in.reuters.com/article/2014/12/11/health-ebola-vaccine-idINKBN0JP1G820141211|publisher=Reuters|accessdate=11 December 2014|date=11 December 2014}}</ref><ref>{{cite web|title=Merck hits a hiccup with its new Ebola vaccine|url=http://www.fiercebiotech.com/story/merck-hits-hiccup-its-new-ebola-vaccine/2014-12-11|accessdate=11 December 2014}}</ref> | |||
| * A third vaccine candidate, consisting of a prime-boost regimen of an adenovirus vaccine component from Crucell (]) and a ] component from ] is being prepared for clinical trials in early 2015.<ref>{{cite web|url=http://www.thepharmaletter.com/article/johnson-johnson-fast-tracking-its-ebola-efforts-with-crucell-and-bavarian-nordic|title=Johnson & Johnson fast-tracking its Ebola efforts with Crucell and Bavarian Nordic|work=The Pharma Letter|accessdate=29 October 2014}}</ref> Johnson & Johnson have announced their commitment to accelerate the development of the vaccine and will produce more than 1 million doses of the vaccine during 2015.<ref>{{cite web|url=http://www.jnj.com/news/all/Johnson-Johnson-Announces-Major-Commitment-to-Speed-Ebola-Vaccine-Development-and-Significantly-Expand-Production|title=Johnson & Johnson Announces Major Commitment to Speed Ebola Vaccine Development and Significantly Expand Production |work=Johnson & Johnson press release|accessdate=29 October 2014}}</ref> | |||
| * A fourth vaccine candidate, made by the government of China has been approved to begin clinical trials, the official government news agency Xinhua indicated on Thursday. The vaccine is made by the Academy of Military Medical Sciences, a military research unit. Chinese biotechnology firm Tianjin CanSino Biotechnology Inc is involved. Trials will begin this month. "This follows American and Canadian vaccines to become the third Ebola vaccine to enter clinical trials," one source indicated. It is based on the 2014 mutant gene and targets the strain plaguing west Africa.<ref>{{cite web|url=http://news.xinhuanet.com/english/china/2014-12/18/c_133864720.htm|title=China's Ebola vaccine enters clinical trials|publisher=|accessdate=19 December 2014}}</ref><ref>{{cite web|url=http://www.reuters.com/article/2014/12/18/us-health-ebola-china-idUSKBN0JW14020141218|title=China approves experimental Ebola vaccine for clinical trials|work=Reuters|accessdate=19 December 2014}}</ref> | |||
| ====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 ], 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.<ref>{{cite web|title=Ebola Experts Seek to Expand Testing|url=http://www.scientificamerican.com/article/ebola-experts-seek-to-expand-testing/|publisher=Scientific American|accessdate=11 December 2014}}</ref> | |||
| On 29 November, a new 15-minute Ebola test was reported that if successful, "not only gives patients a better chance of survival, but it prevents transmission of the virus to other people." The new equipment, about the size of a laptop and solar-powered, allows testing to be done in remote areas. The equipment is currently being tested in Guinea.<ref>{{cite web|url=http://www.independent.co.uk/news/world/africa/ebola-outbreak-new-15minute-test-trialled-in-guinea-offers-hope-for-thousands-9892543.html|title=Ebola outbreak: New 15-minute test offers hope for thousands|work=The Independent|accessdate=1 December 2014}}</ref> | |||
| ==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.<ref name=WHO22August>{{cite web|title=Why the Ebola outbreak has been underestimated|url=http://www.who.int/mediacentre/news/ebola/22-august-2014/en/|publisher=WHO|accessdate=9 October 2014}}</ref> The three countries which are most affected, ], ] and ], 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.<ref>{{cite web|title=West & Central Africa - Information by Country|url=http://www.unicef.org/infobycountry/centralafrica.html|publisher=UNICEF|accessdate=9 October 2014}}</ref> | |||
| One effect of the epidemic has been to weaken the institutions which already exist as healthcare and government workers become overwhelmed by the workload, in some cases abandoning their posts or succumbing to infection. Since the symptoms of Ebola resemble other diseases such as malaria which are common in the area, even diagnosis is uncertain unless a blood sample can reach one of the few testing centres which are equipped to perform ] or ] tests. WHO, MSF and the CDC have warned that the official counts of Ebola cases and deaths are not consistent with field observations, and are likely to understate the extent of the epidemic.<ref name="CDC Estimating future number of cases" /><ref name=Ebola_Outbreak_total_WHO_8_Oct /><ref>{{cite web|title=A concrete response to the Ebola outbreak cannot wait|url=http://www.msf.org/article/concrete-response-ebola-outbreak-cannot-wait|publisher=MSF|accessdate=9 October 2014}}</ref> | |||
| ===Statistical measures=== | |||
| Calculating an accurate ] (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 late August, the WHO made an initial CFR estimate of 53% though this included suspected cases.<ref>{{cite web|title=Case Fatality Rate for ebolavirus|url=http://epidemic.bio.ed.ac.uk/ebolavirus_fatality_rate|publisher=epidemic|accessdate=16 September 2014}}</ref><ref name="WHO_31Aug" /> On 23 September, the WHO released a revised and more accurate CFR of 70.8% (with 95% confidence intervals of 68.6%-72.8%), derived using data from patients with definitive clinical outcomes.<ref name=":1" /> The latest 1014 estimate was released in December. On 7 December, the WHO reported a CFR for the current epidemic of cases with a "recorded definitive outcome" at <section begin=cfr />76%<section end=cfr />.<section begin=cfrref /><ref name="WHO_cfr_7_Dec">{{cite web | url=http://apps.who.int/iris/bitstream/10665/145198/1/roadmapsitrep_10Dec2014_eng.pdf?ua=1 | title=EBOLA RESPONSE ROADMAP SITUATION REPORT 10 DECEMBER 2014 | publisher=WHO | accessdate=11 December 2014}}</ref> | |||
| The ] ''R''<sub>0</sub> 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 in the long run; if the rate is greater than 1, the infection will continue to spread in a population.<ref>{{cite web|title=Basic Reproductive Rate (Ro)|url=http://practice.sph.umich.edu/micphp/epicentral/basic_reproduc_rate.php|publisher=University of Michigan|accessdate=16 September 2014}}</ref> For the current outbreak, ''R''<sub>0</sub> is estimated to be between 1.5 and 2.5.<ref name=":1" /><ref>{{cite journal|last1=Althaus|first1=Christian L.|title=Estimating the Reproduction Number of Ebola Virus (EBOV) During the 2014 Outbreak in West Africa|journal=PLoS Currents|date=2014|doi=10.1371/currents.outbreaks.91afb5e0f279e7f29e7056095255b288}}</ref> According to the WHO Ebola response team, "once infection has become established, the number of people still at risk declines, so the reproduction number falls from its maximum value of ''R''<sub>0</sub> to a smaller, net reproduction number, ''R''<sub>t</sub>. When ''R''<sub>t</sub> falls below 1, infection cannot be sustained. Estimates of ''R''<sub>0</sub> and ''R''<sub>t</sub> help in evaluating the magnitude of the effort required to control the disease, the way in which transmission rates have fluctuated."<ref>{{cite web|url=http://www.nejm.org/doi/full/10.1056/NEJMoa1411100#t=abstract|title=Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections|publisher=|accessdate=21 December 2014}}</ref> Many factors contribute to ''R''<sub>0</sub>, such as how long an infected person is infectious and how many virus particles are needed to make another person sick. With the Ebola virus, the way the virus is transmitted keeps its ''R''<sub>0</sub> low. Ebola isn't spread through the air; it requires close contact with some bodily fluid, blood or vomit, that have the virus. An example of ''R''<sub>0</sub> using HIV, is this could take years to be fatal, but for Ebola, that time is about a week. Therefore, even though they have about the same ''R''<sub>0</sub>s, Ebola has an -infections per unit of time- greater than HIV's.<ref>http://www.npr.org/blogs/health/2014/10/02/352983774/no-seriously-how-contagious-is-ebola</ref> | |||
| ===Projections of future cases=== | |||
| On 28 August, 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.<ref name=28_August_2014_WHO_roadmap></ref> 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."<ref name=28_August_2014_WHO_roadmap /> It includes an assumption that some country or countries will pay the required cost of their plan, estimated at half a billion dollars.<ref name=28_August_2014_WHO_roadmap /> | |||
| 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.<ref>{{cite web|last1=Kupferschmidt|first1=Kai|title=Disease modelers project a rapidly rising toll from Ebola|url=http://news.sciencemag.org/health/2014/08/disease-modelers-project-rapidly-rising-toll-ebola|work=Science}}</ref><ref>{{cite journal |url=http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20894 |title=Early Transmission Dynamics of Ebola Virus Disease (EVD), West Africa, March to August 2014 | work=] | publisher=] | date=11 September 2014 | author=Nishiura, H | author2=Chowell, G | volume=19 | issue=36 }}</ref> On 9 September, Jonas Schmidt-Chanasit of the ] 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".<ref>{{cite news|title=Virologist: Fight against Ebola in Sierra Leone and Liberia is lost|url=http://www.dw.de/virologist-fight-against-ebola-in-sierra-leone-and-liberia-is-lost/a-17915090|date=11 September 2014|accessdate=11 September 2014|publisher=]}}</ref> | |||
| 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.<ref name=":1" /> They further stated, that if the disease is not adequately contained it could become ] in Guinea, Sierra Leone and Liberia, "spreading as routinely as malaria or the flu",<ref>{{cite web|last1=Szabo|first1=Liz|title=Could the Ebola outbreak last forever?|url=http://www.usatoday.com/story/news/nation/2014/09/22/ebola-last-forever/16072019/|website=USA Today|accessdate=22 September 2014}}</ref> and according to an editorial in the New England Journal of Medicine, eventually to other parts of Africa and beyond.<ref name="The Ebola Emergency — Immediate Action, Ongoing Strategy">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJMe1411471?query=featured_home |title=The Ebola Emergency — Immediate Action, Ongoing Strategy |work=New England Journal of Medicine |author=Farrar, Jeremy J. |date=23 September 2014 |accessdate=23 September 2014}}</ref> | |||
| A report on 23 September by CDC analyses the impact of underreporting - 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.<ref name="CDC Estimating future number of cases" /> 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.<ref>{{cite web|title=OVERNIGHT HEALTH: Congress begs for attention on Ebola|url=http://thehill.com/policy/healthcare/overnights/224766-overnight-health-congress-begs-for-attention-on-ebola|publisher=The Hill|accessdate=20 November 2014}}</ref> | |||
| The Laboratory for the Modeling of Biological and Socio-Technical Systems (MoBS) at ] 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 twice in September, October and November, with the latest update on 24 November.<ref>{{cite web|url=http://currents.plos.org/outbreaks/article/assessing-the-international-spreading-risk-associated-with-the-2014-west-african-ebola-outbreak/|title=Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak|work=PLOS Currents Outbreaks|date=2 September 2014|accessdate=7 October 2014|author=Gomes MFC, Pastore y Piontti A, Rossi L, Chao D, Longini I, Halloran ME, Vespignani A.}}</ref><ref>{{cite web|url=http://www.mobs-lab.org/ebola.html|title=Laboratory for the Modeling of Biological and Socio-Technical Systems, Northeastern University|accessdate=7 October 2014}}</ref> On December 16th, it was reported that according to a recent Yale study, transmission of the Ebola virus occurs within families, and at funerals, not randomly, and far fewer cases are actually unreported than what had been been estimated in prior projections. What this means is that the virus is unlikely to reach the stratospheric numbers previously projected by several organizations in September, namely the CDC. When looking at virus samples from Sierra Leone and contact-tracing information, the scientists have estimated that 17 percent of cases in West Africa are unreported, up to a maximum of 70 percent. In practice, that means that in 100 known cases, there are 120 actual ones, according to Jeffrey Townsend, the study's lead author. The study concludes that the epidemic is not as difficult to control as feared, if quarantines are employed. In the case of Nigeria and Mali, health workers traced hundreds of contacts of three initial cases – the outbreaks were stopped. In Guinea, Liberia and Sierra Leone it had spread to many people in the months before it was identified as the virus.<ref>http://www.nytimes.com/2014/12/16/science/fewer-ebola-cases-go-unreported-than-thought-study-finds-.html?_r=0</ref> | |||
| ==Economic effects== | |||
| In addition to the loss of life, the outbreak is having a number of significant economic impacts. | |||
| * Markets and shops are closing, due to travel restrictions, a '']'', or fear of human contact, which leads to loss of income for producers and traders.<ref>{{cite web|url=http://www.npr.org/2014/07/17/332351578/ebola-wreaks-economic-woe-in-west-africa |title=Ebola Wreaks Economic Woe In West Africa |publisher=NPR |date=2014-07-17 |accessdate=2014-08-25}}</ref> | |||
| * Movement of people away from affected areas has disturbed agricultural activities.<ref>{{cite web|last=Lomax |first=Selma |url=http://allafrica.com/stories/201408200742.html |title=Liberia: Ebola Outbreak Affects Agriculture in Lofa County |publisher=allAfrica.com |date=2014-08-20 |accessdate=2014-08-25}}</ref><ref name="rappler1">{{cite web|url=http://www.rappler.com/world/regions/africa/67128-who-un-first-staff-ebola-infection |title=First WHO worker infected by Ebola, DR Congo reports cases |publisher=Rappler.com |date=2014-08-15 |accessdate=2014-08-25}}</ref> The UN ] (FAO) has warned that the outbreak could endanger harvest and food security in West Africa.<ref>{{cite web |url=http://uk.reuters.com/article/2014/09/02/us-health-ebola-food-idUKKBN0GX0HB20140902 |title=Ebola threatens food security in West Africa: FAO |accessdate=3 September 2014}}</ref> On December 17, it was reported that Ebola continues its attack on Guinea, Liberia and Sierra Leone; the disease is posing a greater threat to food security. United Nations agencies are warning that more than 1 million people could be food insecure by March. "With all the quarantines and movement limitations placed on them ... there’s an absolute lack of labor force in this area", one source indicated. The UN agency must "re-establish the farm system in the three countries," the source concluded.<ref>{{cite web|url=http://www.voanews.com/content/ebola-food-security-17dec14/2562832.html|title=Ebola Threatens Millions With Food Insecurity|work=VOA|accessdate=19 December 2014}}</ref> | |||
| * Tourism is directly impacted in affected countries.<ref>{{cite web|url=http://afkinsider.com/69855/ebola-virus-eats-west-africas-economic-growth/ |title=Ebola Virus Eats Into West Africa's Economic Growth |publisher=AFKInsider |date=2014-08-21 |accessdate=2014-08-25}}</ref> Other countries in Africa which are not directly affected by the virus have also reported adverse effects on tourism.<ref>{{cite web|last=Brock |first=Joe |url=http://uk.reuters.com/article/2014/08/20/us-health-ebola-africatourism-idUKKBN0GK1GG20140820 |title=Ebola fears slowing tourist flow to Africa |publisher=Reuters |date=20 August 2014 |accessdate=2014-08-25}}</ref><ref>{{cite web|url=http://www.cnbcafrica.com/video/?bctid=3807923516001|title=Video: Impact of Ebola on e-commerce in Nigeria - CNBC Africa|work=CNBCAfrica.com|accessdate=16 December 2014}}</ref><ref>{{cite web|url=http://www.vanguardngr.com/2014/09/mixed-grill-businesses-ebola-impacts-economy/|title=Mixed grill for businesses as Ebola impacts economy|work=Vanguard News|accessdate=16 December 2014}}</ref> | |||
| * Many airlines have suspended flights to the area.<ref>{{cite web|author=Mark Anderson and agencies |url=http://www.theguardian.com/society/2014/aug/22/ebola-airlines-cancel-flights-guinea-liberia-sierra-leone |title=Ebola: airlines cancel more flights to affected countries |work=The Guardian |date=22 August 2014 |accessdate=2014-08-25}}</ref> | |||
| * Foreign mining companies have withdrawn non-essential personnel, deferred new investment, and cut back operations.<ref name="rappler1"/><ref>{{cite web|url=http://www.bbc.co.uk/news/uk-27675747 |title=UK employees leave Sierra Leone over Ebola threat |publisher=BBC News |date=2014-06-03 |accessdate=2014-08-25}}</ref><ref>{{cite web|url=http://www.mining.com/west-africa-ebola-outbreak-forces-miners-to-lock-down-operations-delay-projects-69246/ |title=West Africa Ebola outbreak forces miners to lock down operations, delay projects |publisher=MINING.com |date=2014-08-10 |accessdate=2014-08-25}}</ref> On December 1st, it was reported that,iron ore mining company, African Minerals had started the shutdown of its Sierra Leone operations, because it was running low on income.There has been a 50 percent plunge in iron ore in 2014,and its London-listed shares have been suspended since November 20th, perhaps because of failure to make loan repayments. "In the absence of sufficient working capital AML has commenced a temporary controlled shutdown of its operations in Sierra Leone," the company indicated, adding, "without a significant injection of working capital, African Minerals is unable to initiate the cost reduction strategies which would return the operations to cash flow positive status even at recent low iron ore prices."<ref>{{cite web|url=http://www.theafricareport.com/West-Africa/mining-african-minerals-begins-shutdown-of-sierra-leone-assets-as-ebola-effect-hits.html|title=Mining: African Minerals begins shutdown of Sierra Leone assets as Ebola effect hits|author=Jun Feng|publisher=|accessdate=21 December 2014}}</ref> | |||
| * The outbreak is straining the finances of governments, with Sierra Leone using Treasury bills to fund the fight against the virus.<ref>{{cite web|author=Chris Kay |url=http://www.bdlive.co.za/africa/africanbusiness/2014/08/20/africa-nations-sell-debt-for-ebola-fight |title=Africa nations sell debt for Ebola fight|publisher=BDlive |date=2014-08-20 |accessdate=2014-08-25}}</ref> | |||
| * The IMF is considering expanding assistance to Guinea, Sierra Leone, and Liberia as their national deficits are ballooning and their economies contract sharply.<ref>{{cite web|url=http://www.australiannews.net/index.php/sid/225466201|publisher=Australian News.Net|title=IMF says Ebola impacted West African nations may need economic assistance}}</ref> On December 17, it was reported that the International Monetary Fund (IMF) had been asked to provide debt relief to the three worst Ebola-hit countries, which will spend $100 million by this year's end. "They can't afford to have millions of dollars flowing out of their economies now when every day counts in fighting this frightening disease," one source was quoted as saying, adding, "yet the IMF, which has made a $9 billion surplus from its lending over the last three years, is considering offering loans, not debt relief and grants, in response".<ref>{{cite web|url=http://www.businessghana.com/portal/news/index.php?op=getNews&id=202154|title=BusinessGhana - Ghana, Business Advice, Jobs, News, Business Directory, Real Estate, Finance, Forms, Auto|publisher=|accessdate=20 December 2014}}</ref> | |||
| * On 8 October, the ] issued a report which estimated overall economic impacts of between $3.8 billion and $32.6 billion, depending on the extent of the outbreak and the speed with which it can be contained. The economic impact would be felt most severely in the three affected countries, with a wider impact felt across the broader West African region.<ref>{{cite web|title=World Bank rings alarm over £20bn worst-case Ebola scenario|url=http://www.telegraph.co.uk/finance/economics/11149117/World-Bank-rings-alarm-over-20bn-worst-case-Ebola-scenario.html|publisher=Telegraph|accessdate=8 October 2014}}</ref><ref>{{cite web|title=New World Bank Group Study Forecasts Billions in Economic Loss|url=http://www.worldbank.org/en/news/press-release/2014/10/08/ebola-new-world-bank-group-study-forecasts-billions-in-economic-loss-if-epidemic-lasts-longer-spreads-in-west-africa|publisher=World Bank|accessdate=8 October 2014}}</ref> On December 2, it was reported that the epidemic would cost about $2 billion across the west African region, causing robust economies to slow down to a stall.<ref>{{cite web|url=http://www.reuters.com/article/2014/12/02/us-health-ebola-worldbank-idUSKCN0JG23K20141202|title=Ebola costs Liberia, Guinea, Sierra Leone $2 billion: World Bank|work=Reuters|accessdate=7 December 2014}}</ref> | |||
| ==Responses== | |||
| {{Main|Responses to the Ebola virus epidemic in West Africa}} | |||
| In July, the ], a United Nations agency which coordinates international response to disease outbreaks, 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 ].<ref name=WHO_PHEIC_8Aug2014>{{cite web |url=http://www.who.int/mediacentre/news/statements/2014/ebola-20140808/en/ |title=Statement on the Meeting of the International Health Regulations Emergency Committee Regarding the 2014 Ebola Outbreak in West Africa |publisher=World Health Organization |date=8 August 2014 |accessdate=8 August 2014}}</ref> This is a legal designation used only twice before (for the ] and the 2014 resurgence of ]) which invokes legal measures on disease prevention, surveillance, control, and response, by 194 signatory countries.<ref name="Reuters">{{cite news |url=http://www.reuters.com/article/2014/08/28/us-health-ebola-who-plan-idUSKBN0GS0XC20140828|title=WHO says Ebola outbreak could strike 20,000 people|publisher=Reuters|date=28 August 2014|accessdate=28 August 2014}}</ref><ref name="urlInside Justice-WHO-PHEIC">{{cite web |url=http://www.insidejustice.com/intl/2009/04/30/swine_flu_who_pheic/ |work=Inside Justice |title=Swine Flu: Legal Obligations and Consequences When the World Health Organization Declares a "Public Health Emergency of International Concern" |first=Renée |last=Dopplick |date=29 April 2009 |accessdate=6 June 2014}}</ref> | |||
| 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.<ref>{{cite web|title=Aid workers ask where was WHO in Ebola outbreak|url=http://uk.reuters.com/article/2014/10/05/us-health-ebola-who-idUKKCN0HU03Q20141005|publisher=Reuters|accessdate=5 October 2014}}</ref> In October, the ] reported that in a leaked preliminary draft report the WHO admitted to mistakes saying that they had missed chances to stop the spread of Ebola "thanks to incompetent staff, a lack of information, and bureaucracy due to 'politically motivated appointments'." Peter Piot, co-discoverer of the Ebola virus, has called the WHO staff "really not competent.”<ref name="The Guardian">{{cite web | url=http://www.theguardian.com/world/2014/oct/18/oxfam-call-for-troops-ebola--west-africa-world-health-organisation-accused | title=Oxfam calls for troops in Africa as criticism of 'inadequate' Ebola response mounts | publisher=The Guardian | date=18 October 2014 | accessdate=24 October 2014 | author=McVeigh, Tracy}}</ref> | |||
| In September, the ] 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 will be a minimum of $1 billion.<ref>{{cite news|url=http://www.bbc.com/news/world-africa-29262968|title=Ebola 'threat to world security'- UN Security Council|date=18 September 2014|publisher=BBC News|accessdate=18 September 2014}}</ref><ref>{{cite news|url=http://thehill.com/policy/healthcare/217853-who-warns-ebola-to-cost-to-1-billion |title=WHO warns Ebola response could cost $1B|work=The Hill |date=16 September 2014 |accessdate=16 September 2014}}</ref> | |||
| During October, WHO and UNMEER announced a comprehensive 90-day plan to control and reverse the Ebola epidemic. The immediate objective is to isolate at least 70% of Ebola cases and safely bury at least 70% of patients who die from Ebola by 1 December 2014 (the 60-day target) - this has become known as the 70:70:60 program. The ultimate goal is 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).<ref>{{cite web|title=WHO: Ebola Response Roadmap Situation Report 15 October 2014|url=http://apps.who.int/iris/bitstream/10665/136508/1/roadmapsitrep15Oct2014.pdf?ua=1|publisher=World Health Organization|accessdate=29 October 2014|page=5}}</ref> Many nations and charitable organizations are cooperating to realise this plan.<ref>{{cite web|title=Global Response|url=http://www.un.org/ebolaresponse/response.shtml|publisher=United Nations Mission for Ebola Emergency Response|accessdate=29 October 2014}}</ref> A WHO situation report in mid-December indicated that the international community was on track to meet the 90-day target.<ref>{{cite web|title=Ebola response roadmap - Situation report 17 December 2014|url=http://www.who.int/csr/disease/ebola/situation-reports/en/?m=20141217|publisher=WHO|accessdate=19 December 2014}}</ref> | |||
| ==Timeline of reported cases and deaths== | |||
| {{main|2014 Ebola virus disease epidemic timeline}} | |||
| ===Data sources=== | |||
| Data comes from reports by the World Health Organization Global Alert and Response Unit<ref group="Resource">{{cite web | url=http://who.int/csr/don/en/ | title=Disease Outbreak News (DONs) | website=Global Alert and Response (GAR) | publisher=] | deadurl=no<!--present in archive.org--> }}{{Fastdelta}}</ref> and the Organization's Regional Office for Africa.<ref group="Resource" name="autogenerated2">{{cite web | url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news.html | title=Disease Outbreak News | website=Regional Office for Africa | publisher=] | deadurl=no<!--present in archive.org--> }}{{Fastdelta}}</ref> All numbers are correlated with United Nations Office for the Coordination of Humanitarian Affairs (OCHA) if available.<ref group="Resource">{{cite web | url=https://wca.humanitarianresponse.info/en | title=West and Central Africa | website=HumanitarianResponse.info | publisher=] | deadurl=no<!--present in archive.org--> }}</ref> 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.<ref name="CDC Estimating future number of cases" /><ref name="WHO 2014-08-22" /><ref name="Reuters">{{cite news | url=http://www.reuters.com/article/2014/10/22/us-health-ebola-who-idUSKCN0IB23220141022 | title=Official WHO Ebola toll near 5,000 with true number nearer 15,000 | agency=] | date=22 October 2014 | author=Miles, Tom | deadurl=no<!--present in archive.org; title of piece changed between initial staff authored item to item with byline--> }}</ref> As an example, Sierra Leone has grown cases at a much faster rate, while simultaneously at an insoluble lower reported death rate versus those in Guinea and Liberia.<ref>{{cite web | url=http://www.statslife.org.uk/significance/health-medicine/1897-the-ebola-epidemic-is-not-subsiding-any-time-soon | title=The Ebola epidemic is not subsiding any time soon | author=Mehta, Salil | website=] | publisher=] | date=10 November 2014 | deadurl=no<!--present in archive.org--> }}</ref> And 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."<ref name="Ebola_Outbreak_total_WHO_8_Oct" /> | |||
| ===Characterizations of rate of growth=== | |||
| On October 23 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).<ref name=WHOvirtualpress>{{cite web|url=http://www.who.int/mediacentre/multimedia/vpc-23-october-2014.pdf?ua=1|title=WHO Virtual Press Conference on the third meeting of the International Health Regulations Emergency Committee regarding the 2014 Ebola outbreak in West Africa|publisher=WHO|accessdate=5 November 2014}}</ref> A study estimated during the first 9 months of the outbreak the disease was transmitted onwards to approximately 1.7-2 people for each case.<ref name=":1" /> | |||
| ===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: | |||
| * Each data source or report may or may not include suspected cases that have not yet been confirmed. | |||
| * Each source or report may or may not include probable cases. | |||
| * Case numbers may be revised downward if a probable or suspected case is later found to be negative. <small>(Numbers may differ from reports as per respective Government reports. See notes at the bottom for stated source file.)</small> | |||
| * The reports usually refer to cumulative data totals since the start of the 2014 epidemic. When new data becomes available or old data is revised the correction could apply either to the past or the present. | |||
| * The number of deaths may revise downwards if it is later found from testing those deaths were not from Ebola. | |||
| * There are variable delays in gathering, correcting and reporting the data from multiple sources. | |||
| 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=== | |||
| <gallery mode="packed" perrow="3" heights="200px"> | |||
| File:Diseased Ebola 2014.png|Cumulative totals of cases and deaths over time | |||
| File:Evolution of the 2014 Ebola outbreak in semiLog plot..png| Cumulative totals in log scale | |||
| File:West Africa Ebola 2014 5 cum case by country lin.png|Cumulative number of cases by country, using a linear scale | |||
| File:West Africa Ebola 2014 cum case by country log.png|Cumulative number of cases by country, using a logarithmic scale | |||
| File:West Africa Ebola 2014 7 cum case rate by country lin.png|Cases based on population, using a linear scale | |||
| File:West Africa Ebola 2014 8 cum case rate by country log.png|Cases based on population, using a logarithmic scale | |||
| File:West Africa Ebola 2014 13 Reported Cases per Week.png|Weekly cases, total and per country | |||
| </gallery> | |||
| {{clear}} | |||
| ===Tables=== | |||
| <!-- This table is recording WHO reports ONLY. Don't add data from other sources to this table. --> | |||
| {| style="text-align: right;white-space:nowrap;" class="wikitable" width="100%" | |||
| |+Major Ebola virus outbreaks by country and by date – 17 October to most recent WHO / Gov update<br/> | |||
| '''''Note'': These reflect official confirmations only. The actual numbers are estimated to be higher.'''<ref name="CDC Estimating future number of cases" /><ref name="WHO 2014-08-22">{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4260-ebola-virus-disease-west-africa-22-august-2014.html|title=Ebola virus disease, West Africa – update 22 August 2014|publisher=WHO|accessdate=18 September 2014}}</ref><ref name="Reuters" /> | |||
| ! rowspan=2 |Date ||colspan=2 | Total || colspan=2 | Guinea || colspan=2 | Liberia || colspan=2 | Sierra Leone || rowspan=2 width="180px"| Sources | |||
| |- | |||
| ! style="color: red;" | Cases || Deaths || style="color: red;" | Cases || Deaths || style="color: red;" | Cases || Deaths || style="color: red;" | Cases || Deaths | |||
| |- | |||
| | 14 Dec 2014 || 18,590|| 7,288 || 2,415 || 1,525 || 7,819 || 3,346|| 8,356 || 2,417 ||{{efn|group=note|14 December: Guinea as per WHO.Sierra Leone and Liberia as per government report.}}<section begin=caserefs /><ref name="WHO2014_12_17a">{{cite web |url=http://apps.who.int/iris/bitstream/10665/145679/1/roadmapsitrep_17Dec2014_eng.pdf?ua=1 |title=EBOLA RESPONSE ROADMAP | |||
| SITUATION REPORT-17 DECEMBER 2014 |publisher=World Health organization|date=17 December 2014|accessdate =18 December 2014}}</ref><ref name="Ebola_Outbreak_total_sl_14_Dec">{{cite web|url=http://health.gov.sl/wp-content/uploads/2014/12/Ebola-Situation-Report_Vol-201.pdf|title= Sierra Leone: EBOLA VIRUS DISEASE - SITUATION REPORT (Sit-Rep) 15 December, 2014 | accessdate=15 December 2014| date=15 December 2014}}</ref><ref name="Ebola_Outbreak_total_lr_14_Dec">{{cite web|url=http://www.mohsw.gov.lr/documents/SITRep%20213%20Dec%2014th%20%202014.pdf|title=Liberia Ebola SitRep no. 213 |accessdate=18 December 2014| date= 18 December 2014}}</ref><section end=caserefs /> | |||
| |- | |||
| | 9 Dec 2014 || 18,150|| 6,933 || 2,339 || 1,454 || 7,797 || 3,290|| 8,014 || 2,189 ||{{efn|group=note|9 December: All governments as per WHO.Sierra Leone deaths as per Government report.}}<ref name="WHO2014_12_15">{{cite web |url=http://apps.who.int/gho/data/view.ebola-sitrep.ebola-summary-20141215?lang=en |title=Situation Summary Data published on 15 December 2014|publisher=World Health organization|date=15 December 2014|accessdate =16 December 2014}}</ref><ref name="Ebola_Outbreak_total_sl_9_Dec">{{cite web|url=http://health.gov.sl/wp-content/uploads/2014/12/Ebola-Situation-Report_Vol-196.pdf|title= Sierra Leone: EBOLA OUTBREAK UPDATES---December 10, 2014 | accessdate=15 December 2014| date=9 December 2014}}</ref><ref name="WHO2014_12_11">{{cite web |url=http://apps.who.int/gho/data/view.ebola-sitrep.ebola-summary-20141211?lang=en |title=Situation Summary Data published on 11 December 2014|publisher=World Health organization|date=11 December 2014|accessdate =16 December 2014}}</ref> | |||
| |- | |||
| | 7 Dec 2014 || 17,954|| 6,776 || 2,292 || 1,428 || 7,765 || 3,222|| 7,897 || 2,100 ||{{efn|group=note|7 December: All governments as per WHO.Sierra Leone deaths as per Government report.}}<ref name="WHO2014_12_10">{{cite web |url=http://apps.who.int/iris/bitstream/10665/145198/1/roadmapsitrep_10Dec2014_eng.pdf?ua=1 |title=Ebola response roadmap - Situation report|publisher=World Health organization|date=10 December 2014|accessdate =11 December 2014}}</ref><ref name="Ebola_Outbreak_total_sl_7_Dec">{{cite web|url=http://health.gov.sl/wp-content/uploads/2014/12/Ebola-Situation-Report_Vol-194.pdf|title= Sierra Leone: EBOLA OUTBREAK UPDATES---December 08, 2014 | accessdate=11 December 2014| date=9 December 2014}}</ref><ref name=WHO2014_12_11 /> | |||
| |- | |||
| | 30 Nov 2014 || 17,129|| 6,397 || 2,164 || 1,325 || 7,653 || 3,157|| 7,312 || 1,915 ||{{efn|group=note|28 November: Guinea governments as per WHO. Sierra Leone and Liberia as per Government report. }}<ref name="WHO2014_11_30">{{cite web |url=http://apps.who.int/iris/bitstream/10665/144806/1/roadmapsitrep_3Dec2014_eng.pdf?ua=1 |title=Ebola response roadmap - Situation report|publisher=World Health organization|date=1 December 2014|accessdate =2 December 2014}}</ref><ref name="Ebola_Outbreak_total_sl_30_Nov">{{cite web|url=http://health.gov.sl/wp-content/uploads/2014/12/Ebola-Situation-Report_Vol-187.pdf|title= Sierra Leone: EBOLA OUTBREAK UPDATES---December 01, 2014 | accessdate=6 December 2014| date=1 December 2014}}</ref><ref name="Ebola_Outbreak_total_lr_30_Nov">{{cite web|url=http://www.mohsw.gov.lr/documents/SITRep%20199%20Nov%2030th%202014.pdf|title=Liberia Ebola SitRep no. 199 |accessdate=6 December 2014| date= 5 December 2014}}</ref> | |||
| |- | |||
| | 28 Nov 2014 || 16,869|| 6,319 || 2,155 || 1,312 || 7,635 || 3,145|| 7,109 || 1,862 ||{{efn|group=note|28 November: All governments as per WHO. Sierra Leone deaths as per Government report. }}<ref name="WHO2014_11_28">{{cite web |url=http://apps.who.int/gho/data/view.ebola-sitrep.ebola-summary-20141201?lang=en |title=Situation summary Data published on 1 December 2014|publisher=World Health organization|date=1 December 2014|accessdate =2 December 2014}}</ref><ref name="Ebola_Outbreak_total_sl_28_Nov">{{cite web|url=http://health.gov.sl/wp-content/uploads/2014/11/Ebola-Situation-Report_Vol-185.pdf|title= Sierra Leone: EBOLA OUTBREAK UPDATES---November 28, 2014 | accessdate=2 December 2014| date=29 November 2014}}</ref> | |||
| |- | |||
| | 23 Nov 2014 || 15,929|| 5,988 || 2,134 || 1,260 || 7,196 || 3,029 || 6,599 || 1,699 ||{{efn|group=note|23 November: All governments as per WHO except Sierra Leone deaths as per Government report and Liberia as per Gov (WHO report only till 22 Nov for Lib.)}}<ref name="WHO2014_11_23">{{cite web |url=http://apps.who.int/iris/bitstream/10665/144498/1/roadmapsitrep_26Nov2014_eng.pdf?ua=1 |title=EBOLA RESPONSE ROADMAP SITUATION REPORT | |||
| |publisher=World Health organization|date=26 November 2014 |accessdate =27 November 2014}}</ref><ref name="Ebola_Outbreak_total_sl_23_Nov">{{cite web|url=http://health.gov.sl/wp-content/uploads/2014/11/Ebola-Update-November-23-2014.pdf|title= Sierra Leone: EBOLA OUTBREAK UPDATES---November 23, 2014 | accessdate=27 November 2014| date=24 November 2014}}</ref><ref name="Ebola_Outbreak_total_lr_23_Nov">{{cite web|url=http://www.mohsw.gov.lr/documents/SITRep%20192%20Nov%2023th%202014.pdf|title=Liberia Ebola SitRep no. 192 |accessdate=28 November 2014| date= 24 November 2014}}</ref> | |||
| |- | |||
| | 18 Nov 2014 || 15,319|| 5,775 || 2,047 || 1,214 || 7,082 || 2,963 || 6,190 || 1,598 ||{{efn|group=note|18 November: All governments as per WHO. Sierra Leone deaths as per Government report. Liberia dated 17 November}}<ref name="WHO2014_11_18">{{cite web |url=http://apps.who.int/iris/bitstream/10665/144117/1/roadmapsitrep_21Nov2014_eng.pdf |title=EBOLA RESPONSE ROADMAP SITUATION REPORT | |||
| |publisher=World Health organization|date=21 November 2014 |accessdate =24 November 2014}}</ref><ref name="Ebola_Outbreak_total_sl_18_Nov">{{cite web|url=http://health.gov.sl/wp-content/uploads/2014/11/Ebola-Update-November-18-2014.pdf|title= Sierra Leone: EBOLA OUTBREAK UPDATES---November 18, 2014 | accessdate=24 November 2014| date=18 November 2014}}</ref> | |||
| |- | |||
| | 16 Nov 2014 || 15,113|| 5,727 || 1,971 || 1,192 || 7,069 || 2,964 || 6,073 || 1,571 ||{{efn|group=note|16 November: All governments as per WHO. Sierra Leone deaths as per Government report. Liberia dated 15 November}}<ref name="WHO2014_11_19">{{cite web |url=http://apps.who.int/iris/bitstream/10665/144032/1/roadmapsitrep_19Nov14_eng.pdf?ua=1 |title=EBOLA RESPONSE ROADMAP SITUATION REPORT | |||
| |publisher=World Health organization|date=19 November 2014 |accessdate =20 November 2014}}</ref><ref name="Ebola_Outbreak_total_sl_16_Nov">{{cite web|url=http://health.gov.sl/wp-content/uploads/2014/11/Ebola-Update-November-16-2014.pdf|title= Sierra Leone: EBOLA OUTBREAK UPDATES---November 16, 2014 | accessdate=20 November 2014| date=17 November 2014}}</ref> | |||
| |- | |||
| | 11 Nov 2014 || 14,383|| 5,492 || 1,919 || 1,166 || 6,878 || 2,812 || 5,586 || 1,514 ||{{efn|group=note|Guinea and Sierra Leone up to the end of 11 November, and the Ministry of Health of Liberia up to the end of 10 November. Sierra Leone deaths as per Government report}}<ref name="WHO2014_11_14">{{cite web |url=http://www.who.int/csr/disease/ebola/situation-reports/en/?m=20141114 |title=EBOLA RESPONSE ROADMAP SITUATION REPORT UPDATE |publisher=World Health organization|date=14 November 2014 |accessdate =15 November 2014}}</ref><ref name="Ebola_Outbreak_total_sl_11_Nov">{{cite web|url=http://health.gov.sl/wp-content/uploads/2014/11/Ebola-Update-November-11-2014.pdf|title= Sierra Leone: EBOLA OUTBREAK UPDATES---November 11, 2014 | accessdate=15 November 2014| date=14 November 2014}}</ref> | |||
| |- | |||
| | 9 Nov 2014 || 14,068 || 5,476 || 1,878 || 1,142 || 6,822 || 2,836 || 5,368 || 1,498 ||{{efn|group=note|All totals as per WHO report for 9 Nov except Sierra Leone deaths as per Government report}}<ref name="WHO2014_11_12">{{cite web |url=http://www.who.int/csr/disease/ebola/situation-reports/en/?m=20141112&file=sitreps/20141112/20141112.html |title=EBOLA RESPONSE ROADMAP SITUATION REPORT UPDATE |publisher=World Health organization|date=12 November 2014 |accessdate =12 November 2014}}</ref><ref name="Ebola-Update-November-4-2014">{{cite web|url=http://health.gov.sl/wp-content/uploads/2014/11/Ebola-Update-November-4-2014.pdf|title= Sierra Leone: EBOLA OUTBREAK UPDATES---November 9, 2014 | accessdate=12 November 2014| date=9 November 2014}}</ref> | |||
| |- | |||
| | 4 Nov 2014 || 13,200 || 5,275 || 1,760 || 1,054 || 6,619 || 2,766 || 4,821 || 1,455 ||{{efn|group=note|All totals as per WHO report for 4 Nov except Guinea, dated 3 Nov 2014 and Sierra Leone as per Government report}}<ref name=sitrep_7Nov2014 /><ref name="Ebola-Update-November-4-2014" /> | |||
| |- | |||
| | 2 Nov 2014 || 13,014 || 5,191 || 1,731 || 1,041 || 6,524 || 2,700 || 4,759 || 1,450 ||{{efn|group=note|2 November Liberian and Sierra Leone as per Gov. Guinea as per OCHA.}}<ref name="Ebola_Outbreak_total_sl_2_Nov">{{cite web|url=http://health.gov.sl/wp-content/uploads/2014/11/Ebola-Situation-Report_Vol-159.pdf|title=Sierra Leone: EBOLA VIRUS DISEASE - SITUATION REPORT (Sit-Rep) – 2 November , 2014 |accessdate=8 November 2014| date= 3 November 2014}}</ref><ref name="Ebola_Outbreak_total_lr_2_Nov">{{cite web|url=http://www.mohsw.gov.lr/documents/SITRep%20171%20Nov%202nd%202014.pdf|title=Liberia Ebola SitRep no. 171 |accessdate=8 November 2014| date= 2 November 2014}}</ref><ref name="Ebola_Outbreak_total_gn_2_Nov">{{cite web|url=http://www.humanitarianresponse.info/system/files/documents/files/GUINEA_EBOLA_SITREP%20N%20201%20DU%2002%20NOVEMBRE_2014%20VF.pdf|title= Guinea: Ebola Virus Disease(EVD) Outbreak | accessdate=8 November 2014| date=2 November 2014}}</ref> | |||
| |- | |||
| | 30 Oct 2014 || 12,647 || 5,087 || 1,675 || 1,022 || 6,485 || 2,636 || 4,487 || 1,429 ||{{efn|group=note|30 October Liberian and Sierra Leone as per Gov. Guinea as per OCHA.}}<ref name="Ebola_Outbreak_total_sl_30_Oct">{{cite web|url=http://health.gov.sl/wp-content/uploads/2014/10/Ebola-Situation-Report_Vol-156.pdf|title=Sierra Leone: EBOLA VIRUS DISEASE - SITUATION REPORT (Sit-Rep) – 31 October, 2014 |accessdate=8 November 2014| date= 31 October 2014}}</ref><ref name="Ebola_Outbreak_total_lr_30_Oct">{{cite web|url=http://www.mohsw.gov.lr/documents/SITRep%20168%20Oct%2030th%202014.pdf|title=Liberia Ebola SitRep no. 168 |accessdate=8 November 2014| date= 31 October 2014}}</ref><ref name="Ebola_Outbreak_total_gn_30_Oct">{{cite web|url=http://www.humanitarianresponse.info/system/files/documents/files/GUINEA_EBOLA_SITREP%20N%20198%20DU%2030OCTOBRE_2014%20VF.pdf|title= Guinea: Ebola Virus Disease(EVD) Outbreak | accessdate=8 November 2014| date=30 October 2014}}</ref> | |||
| |- | |||
| | 24 Oct 2014 || 11,868 || 5,026 || 1,598 || 981 || 6,253 || ≥2,704 || 4,017 || 1,341 ||{{efn|group=note|Liberia and Sierra Leone countries date as per governments. Guinea as per OCHA. All cases dates 24 October. Death toll for Liberia as per latest WHO report.}}<ref name=Ebola_Outbreak_total_lr_24_Oct /><ref name="Ebola_Outbreak_total_sl_24_Oct">{{cite web|url=http://health.gov.sl/wp-content/uploads/2014/10/Ebola-Situation-Report_Vol-150.pdf|title= Sierra Leone: EBOLA VIRUS DISEASE - SITUATION REPORT (Sit-Rep) – 25 October, 2014 | accessdate=25 October 2014| date=24 October 2014}}</ref><ref name="Ebola_Outbreak_total_gn_24_Oct">{{cite web|url=http://www.humanitarianresponse.info/system/files/documents/files/GUINEA_EBOLA_SITREP%20N%20192%20DU%2024OCTOBRE_2014%20VF.pdf|title=Guinée - Epidémie de la Maladie à virus Ebola |accessdate=25 October 2014| date= 25 October 2014}}</ref> | |||
| |- | |||
| | 19 Oct 2014 || 9,911 || 4,890 || 1,540 || 926 || ≥4,665 || ≥2,705 || 3,706 || 1,259 ||{{efn|group=note|19 October as per WHO for all except Liberia 18 October.}}<ref name=WHO20141022/> | |||
| |- | |||
| | 17 Oct 2014 || 9,668 || 4,802 || 1,501 || 886 || ≥4,607 || ≥2,689 || 3,560 || 1,227 ||{{efn|group=note|17 October data are based on official information reported by Ministries of Health up to the end of 17 October for all governments. Liberian and Sierra Leone as per Gov. Guinea as per OCHA. Rest stat as per WHO 17 Oct report}}<ref name="Ebola_Outbreak_total_WHO_17_Oct"></ref><ref name="Ebola_Outbreak_total_sl_17_Oct">{{cite web|url=http://health.gov.sl/wp-content/uploads/2014/10/Ebola-Situation-Report_Vol-143.pdf|title=Sierra Leone: EBOLA VIRUS DISEASE - SITUATION REPORT (Sit-Rep) – 18 October, 2014 |accessdate=20 October 2014| date= 17 October 2014}}</ref><ref name="Ebola_Outbreak_total_lr_17_Oct">{{cite web|url=http://www.mohsw.gov.lr/documents/SITRep%20155%20Oct%2017th,%202014.pdf|title=Liberia Ebola SitRep no. 155 |accessdate=20 October 2014| date= 17 October 2014}}</ref><ref name="Ebola_Outbreak_total_gn_17_Oct">{{cite web|url=http://www.humanitarianresponse.info/system/files/documents/files/Dashboard-Guinea%20as%20of%2020%20Oct%2014.pdf|title= Guinea: Ebola Virus Disease(EVD) Outbreak | accessdate=20 October 2014| date=17 October 2014}}</ref> | |||
| |} | |||
| {| style="text-align: right;white-space:nowrap;" class="wikitable collapsible collapsed" width="100%" | |||
| |+Minor Ebola virus outbreaks by country and by date – 5 October to most recent WHO / Gov update | |||
| |- | |||
| ! rowspan=2 |Date ||colspan=2 | Total || colspan=2 | Nigeria || colspan=2 | Senegal || colspan=2 | United States || colspan=2 | Spain || colspan=2 | Mali|| rowspan=2 width="180px" |Refs | |||
| |- | |||
| ! style="color: red;" | Cases || Deaths || style="color: red;" | Cases || Deaths || style="color: red;" | Cases || Deaths || style="color: red;" | Cases || Deaths || style="color: red;" | Cases || Deaths|| style="color: red;" | Cases || Deaths | |||
| |- | |||
| | 7 Dec 2014 || 34 || 15 || 20|| 8 || 1 || 0 || 4 || 1 || 1 || 0 || 8 || 6 ||<ref name=WHO2014_12_10 /> | |||
| |- | |||
| | 30 Nov 2014 || 34 || 15 || 20|| 8 || 1 || 0 || 4 || 1 || 1 || 0 || 8 || 6 ||<ref name=WHO2014_11_30 /> | |||
| |- | |||
| | 23 Nov 2014 || 34 || 15 || 20|| 8 || 1 || 0 || 4 || 1 || 1 || 0 || 8 || 6 ||<ref name=WHO2014_11_23 /> | |||
| |- | |||
| | 18 Nov 2014 || 32 || 15 || 20|| 8 || 1 || 0 || 4 || 1 || 1 || 0 || 6 || 6 ||<ref name=WHO2014_11_18 /> | |||
| |- | |||
| | 16 Nov 2014 || 32 || 14 || 20|| 8 || 1 || 0 || 4 || 1 || 1 || 0 || 6 || 5 ||<ref name=WHO2014_11_19 /> | |||
| |- | |||
| | 11 Nov 2014 || 30 || 12 || 20|| 8 || 1 || 0 || 4 || 1 || 1 || 0 || 4 || 3 ||<ref name=WHO2014_11_14 /> | |||
| |- | |||
| | 9 Nov 2014 || 30 || 13 || 20|| 8 || 1 || 0 || 4 || 1 || 1 || 0 || 4 || 4 ||<ref name=WHO2014_11_12 /> | |||
| |- | |||
| | 4 Nov 2014 || 27 || 10 || 20|| 8 || 1 || 0 || 4 || 1 || 1 || 0 || 1 || 1 ||<ref name=sitrep_7Nov2014 /> | |||
| |- | |||
| | 2 Nov 2014 || 27 || 10|| 20|| 8 || 1 || 0 || 4 || 1 || 1 || 0 || 1 || 1 ||<ref name="WHO2014115">{{cite web |url=http://apps.who.int/iris/bitstream/10665/137510/1/roadmapsitrep_5Nov14_eng.pdf?ua=1 |title=EBOLA RESPONSE ROADMAP SITUATION REPORT UPDATE |publisher=World Health organization|date=5 November 2014 |accessdate =5 November 2014}}</ref> | |||
| |- | |||
| | 29 Oct 2014 || 27 || 10|| 20|| 8 || 1 || 0 || 4 || 1 || 1 || 0 || 1 || 1 ||<ref name=WHO20141031>{{cite web |url= http://apps.who.int/iris/bitstream/10665/137424/1/roadmapsitrep_31Oct2014_eng.pdf?ua=1 |title=EBOLA RESPONSE ROADMAP SITUATION REPORT UPDATE |publisher=World Health organization|date=31 October 2014 |accessdate =1 November 2014}}</ref> | |||
| |- | |||
| | 23 Oct 2014 || 27 || 10|| 20|| 8 || 1|| 0|| 4|| 1|| 1|| 0|| 1|| 1||<ref name=WHO20141022 /> | |||
| |- | |||
| | 19 Oct 2014 || 25 || 9|| 20 || 8 || 1|| 0|| 3|| 1|| 1|| 0 || - || -||<ref name=WHO20141022/> | |||
| |- | |||
| | 5 Oct 2014 || 23 || 9|| 20|| 8|| 1|| 0|| 1|| 1|| 1|| 0|| - || -||<ref name="Ebola_Outbreak_total_WHO_10_Oct">{{cite web|url=http://apps.who.int/iris/bitstream/10665/136161/1/roadmapupdate10Oct14_eng.pdf?ua=1|title=WHO: Ebola Outbreak Situation Report |accessdate=15 October 2014| date= 10 October 2014}}</ref> | |||
| |} | |||
| {| style="text-align: right;" class="wikitable collapsible collapsed" width="100%" | |||
| |+Archived Ebola cases and deaths by country – 22 March to 12 Oct | |||
| |- | |||
| ! rowspan=2 |Date ||colspan=2 | Total || colspan=2 | Guinea || colspan=2 | Liberia || colspan=2 | Sierra Leone || colspan=2 | Nigeria ||colspan=2 | Senegal||colspan=2 | United States||colspan=2 | Spain|| rowspan=2 width="180px" |Refs | |||
| |- | |||
| ! style="color: red;" | Cases || Deaths || style="color: red;" | Cases || Deaths || style="color: red;" | Cases || Deaths || style="color: red;" | Cases || Deaths || style="color: red;" | Cases || Deaths || style="color: red;" | Cases || Deaths|| style="color: red;" | Cases || Deaths|| style="color: red;" | Cases || Deaths | |||
| |- | |||
| | 12 Oct 2014 || 8,973 || 4,484 || 1,472 || 843 || 4,249 || 2,458|| 3,252 || 1,183 ||20|| 8|| 1|| 0|| 1|| 0|| 1|| 0||{{efn|group=note|12 October as per WHO Spain and US as per news reports}}<ref name="Ebola_Outbreak_total_WHO_15_Oct"></ref> | |||
| |- | |||
| | 28 Sep 2014 || 7,191 || 3,286 || 1,157 || 710 || 3,696 || 1,998 || 2,317 || 570 ||20|| 8|| 1|| 0|| 1|| 0||- || - ||<ref name="Ebola_Outbreak_total_WHO_28_Sept"></ref><ref name="Ebola_Outbreak_total_sl_28_Sept"></ref> | |||
| |- | |||
| | 14 Sep 2014 || 5,349 || 2,585 || 942 || 601 || 2,720 || 1,461 || 1,655 || 516 ||21|| 7|| 1 || 0 ||- || - ||- || - ||<ref name="roadmapsitrep4_eng"/><ref name="Ebola_Outbreak_total_lr_14_Sept"></ref><ref name="Ebola_Outbreak_total_sl_14_Sept"></ref> | |||
| |- | |||
| | 31 Aug 2014 || 3,685|| 1,801 || 771 || 494 || 1,698 || 871|| 1,216 || 436 ||21|| 7|| 1 || 0 || - || - ||- || - ||<ref name="WHO_31Aug">{{cite web|url=http://who.int/csr/don/2014_09_04_ebola/en/|title=WHO: Ebola Response Roadmap Situation Report 2, 5 September 2014|publisher=WHO|accessdate=18 September 2014}}</ref><ref name="SL_31Aug"></ref> | |||
| |- | |||
| | 16 Aug 2014 || 2,240|| 1,229 ||543 || 394 || 834 || 466 || 848 || 365 || 15 || 4 || - || - ||- || - ||- || - ||<ref name="WHO 2014-08-19">{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4258-ebola-virus-disease-west-africa-19-august-2014.html|title=Ebola virus disease, West Africa – update 19 August 2014|publisher=WHO|accessdate=18 September 2014}}</ref> | |||
| |- | |||
| | 9 Aug 2014 || 1,848|| 1,013 ||506 || 373 || 599 || 323 || 730 || 315 || 13 || 2 || - || - ||- || - ||- || - || <ref name="WHO 2014-08-11">{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4242-ebola-virus-disease-west-africa-11-august-2014.html|title=Ebola virus disease, West Africa – update 11 August 2014|publisher=WHO|accessdate=18 September 2014}}</ref> | |||
| |- | |||
| | 30 Jul 2014 || 1,440 || 826 || 472 || 346 || 391 || 227 || 574 || 252 || 3 || 1 || - || - ||- || - ||- || - ||<ref name="WHO 2014-07-31">{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4238-ebola-virus-disease-west-africa-31-july-2014.html|title=Ebola virus disease, West Africa – update 31 July 2014|publisher=WHO|accessdate=18 September 2014}}</ref> | |||
| |- | |||
| | 23 Jul 2014 || 1,201 || 672 || 427 || 319 || 249 || 129 || 525 || 224 || - || - ||- || - ||- || - ||- || - ||<ref name="WHO 2014-07-25">{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4233-ebola-virus-disease-west-africa-25-july-2014.html|title=Ebola virus disease, West Africa – update 25 July 2014|publisher=WHO|accessdate=18 September 2014}}</ref> | |||
| |- | |||
| | 14 Jul 2014 || 982 || 613 || 411 || 310 || 174 || 106 || 397 || 197 || - || - || - || - ||- || - ||- || - ||<ref name="WHO 2014-07-17">{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4224-ebola-virus-disease-west-africa-17-july-2014.html|title=Ebola virus disease, West Africa – update 17 July 2014|publisher=WHO|accessdate=18 September 2014}}</ref> | |||
| |- | |||
| | 2 Jul 2014 || 779 || 481 || 412 || 305 || 115 || 75 || 252 || 101 || - || - || - || - ||- || - ||- || - ||<ref name="WHO 2014-07-03">{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4216-ebola-virus-disease-west-africa-3-july-2014.html|title=Ebola virus disease, West Africa – update 3 July 2014 |publisher=WHO|accessdate=18 September 2014}}</ref> | |||
| |- | |||
| | 17 Jun 2014 || 528 || 337 || 398 || 264 || 33|| 24 || 97 || 49 || - || - || - || - ||- || - ||- || - ||<ref name="DON 17JUN14">{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4166-ebola-virus-disease-west-africa-17-june-2014.html|title=Ebola virus disease, West Africa (Situation as of 17 June 2014)|publisher=WHO|accessdate=18 September 2014}}</ref> | |||
| |- | |||
| | 27 May 2014 || 309 || 202 || 281 || 186 || 12 || 11 || 16 || 5 || - ||- ||- || - ||- || - ||- || - ||<ref>{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4150-ebola-virus-disease-west-africa-27-may-2014.html|title=Ebola virus disease, West Africa (Situation as of 27 May 2014)|publisher=WHO|accessdate=18 September 2014}}</ref><ref>, WHO</ref> | |||
| |- | |||
| | 12 May 2014 || 260 || 182 || 248 || 171 || 12 || 11 || - || - || - || - || - || - ||- || - ||- || - ||<ref>{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4136-ebola-virus-disease-west-africa-situation-as-of-15-may-2014.html|title=Ebola virus disease, West Africa (Situation as of 15 May 2014)|publisher=WHO|accessdate=18 September 2014}}</ref><ref>{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4135-ebola-virus-disease-west-africa-situation-as-of-10-may-2014.html|title=Ebola virus disease, West Africa (Situation as of 10 May 2014)|publisher=WHO|accessdate=18 September 2014}}</ref> | |||
| |- | |||
| | 1 May 2014 || 239 || 160 || 226 || 149 || 13 || 11 ||- || -|| - || - || - || - ||- || - ||- || - ||<ref name="DON 02MAY14">{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4130-ebola-virus-disease-west-africa-2-may-2014.html|title=Ebola virus disease, West Africa (Situation as of 2 May 2014)|publisher=WHO|accessdate=18 September 2014}}</ref> | |||
| |- | |||
| | 14 Apr 2014 || 194 || 121 || 168 || 108 || 8 || 2 || - || - || - || - || - || - ||- || - ||- || - ||<ref name="DON 14APR14">{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4095-ebola-virus-disease-west-africa-14-april-2014.html|title=''Ebola virus disease, West Africa (Situation as of 14 April 2014)''|publisher=|accessdate=18 September 2014}}</ref> | |||
| |- | |||
| | 31 Mar 2014 || 130 || 82 || 122 || 80 || 8 || 2 || - || - || - || - || - || - ||- || - ||- || - ||<ref>{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4073-ebola-virus-disease-west-africa-1-april-2014.html|title=Ebola virus disease, West Africa (Situation as of 1 April 2014)|publisher=WHO|accessdate=18 September 2014}}</ref> | |||
| |- | |||
| | 22 Mar 2014 || 49 || 29 || 49 || 29 || - || - || - || - || - || - || - || - ||- || - ||- || - ||<ref>{{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4063-ebola-virus-disease-in-guinea.html|title=Ebola virus disease in Guinea|publisher=WHO|accessdate=18 September 2014}}</ref> | |||
| |} | |||
| ===Notes=== | |||
| :: ''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. | |||
| {{reflist|group=note}} | |||
| {{clear right}} | |||
| ==References== | |||
| {{Reflist |30em |refs= | |||
| * <ref name="CDC Estimating future number of cases">{{cite journal | url=http://www.cdc.gov/mmwr/preview/mmwrhtml/su63e0923a1.htm | title=Estimating the Future Number of Cases in the Ebola Epidemic — Liberia and Sierra Leone, 2014–2015 | journal=] | publisher=] | location=United States | date=26 September 2014 | author=Meltzer, Martin I. | author2=Atkins, Charisma Y. | author3=Santibanez, Scott | author4=Knust, Barbara | author5=Petersen, Brett W. | author6=Ervin, Elizabeth D. | author7=Nichol, Stuart T. | author8=Damon, Inger K. | author9=Washington, Michael L. | display-authors=3 }}</ref> | |||
| * <ref name="Tracing Ebola's Breakout to an African 2-Year-Old">{{cite news | author=Grady, Denise | author2=Fink, Sheri | author2-link=Sheri Fink | title=Tracing Ebola's Breakout to an African 2-Year-Old | work=] | date=9 August 2014 | url=http://www.nytimes.com/2014/08/10/world/africa/tracing-ebolas-breakout-to-an-african-2-year-old.html | deadurl=no<!--present in archive.org; this is common for NYT articles--> }}</ref> | |||
| }} | |||
| ==External links== | |||
| {{Sister project links | 1= | display=Ebola virus epidemic in West Africa | author= | wikt=no | commons=Category:2014 West Africa Ebola outbreak | n=no | q=Ebola virus epidemic in West Africa | s=no | b=no | voy=no | v=no | d=Q15989108 | species=no | species_author=no | m=no | mw=no }} | |||
| * {{cite web | url = http://who.int/csr/disease/ebola/situation-reports/ | title = Ebola response roadmap - Situation reports | publisher = ] }} | |||
| * {{cite web|url=http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news.html|publisher=World Health Organization (WHO)|title=Outbreak Updates}} | |||
| * {{cite web|url=http://www.cdc.gov/vhf/ebola/|publisher=US Centers for Disease Control and Prevention (CDC)|title=Outbreak Updates}} | |||
| * {{cite web|url=http://www.fao.org/emergencies/crisis/ebola/en/|title=Ebola Outbreak in West Africa Updates|publisher=Food and Agriculture Organization of the UN (FAO)}} | |||
| * {{cite web|url=http://healthmap.org/ebola/|title=2014 Ebola Outbreak - detail timeline and projection|publisher=healthmap.org}} | |||
| * {{cite web|url=http://ebolacommunicationnetwork.org/|publisher=Ebola Communication Network|title=Platform to share communication materials regarding the Ebola epidemic}} | |||
| * {{cite web|url=http://www.ebolagrandchallenge.net/|title=Fighting Ebola: A Grand Challenge for Development - Platform to collect and distribute ideas to stop the Ebola epidemic|publisher=USAID}} | |||
| * {{cite web|url=http://www.ecdc.europa.eu/en/healthtopics/ebola_marburg_fevers/Pages/ebola-outbreak-west-africa.aspx|publisher=European Centre for Disease Prevention and Control (ECDC)|title=Ebola outbreak in West Africa}} | |||
| * {{cite web|url=http://ebolafacts.com/|title=Ebolafacts - a simple FAQ in English & French}} | |||
| ===Resources=== | |||
| {{reflist|group="Resource"}} | |||
| {{Ebola}} | |||
| {{Navboxes | |||
| |title = Topics of most severely affected countries | |||
| |titlestyle = | |||
| |state =autocollapse | |||
| |list = | |||
| {{Guinea topics}} | |||
| {{Liberia topics}} | |||
| {{Mali topics}} | |||
| {{Nigeria topics}} | |||
| {{Sierra Leone topics}} | |||
| }} | |||
| {{Portal bar|Africa|Current events|Medicine|Viruses}} | |||
| {{Use DMY dates|date=August 2014}} | |||
| ] | |||
| ] | |||
| ] | |||
| ] | |||
| ] | |||
| ] | |||
| ] | |||
Revision as of 21:59, 22 December 2014
Blood will come out of your eyes, your pores, and your anal cavity. Also your ears mouth, and any other orifices.