2014 West Africa Ebola virus outbreak - Wikipedia, the free ...
Countries with widespread transmission
Ebola outbreak in West Africa – outbreak distribution map as of 17 December 2014
Guinea
Main article: Ebola virus epidemic in Guinea
On 25 March, the World Health Organization
(WHO) reported an outbreak of Ebola virus disease in four southeastern
districts with a total of 86 suspected cases, including 59 deaths. MSF
assisted the Ministry of Health of Guinea by establishing Ebola
treatment centers in the epicenter of the outbreak.[38] On 31 March, the U.S. Centers for Disease Control and Prevention
(CDC) sent a five-person team to assist Guinea's Ministry of Health and
the WHO as they led an international response to the Ebola outbreak.[38]Thinking that the virus was contained, MSF closed its treatment centers in May leaving only a small skeleton staff to handle the Macenta region. However, high numbers of new cases reappeared in the region in late August. According to Marc Poncin, a coordinator for MSF, the new cases were related to persons returning to Guinea from neighbouring Liberia or Sierra Leone.[60]
On 19 October, the WHO reported that although disease transmission remained intense, of the three districts affected, transmission remained the lowest in Guinea.[8] 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.[55] 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 article: Ebola virus epidemic in Liberia
An Ebola treatment unit in Liberia
With only 50 physicians in the entire country—one for every 70,000 Liberians—Liberia already faced a health crisis even before the outbreak.[66] In September the US CDC reported that some hospitals had been abandoned while those which were still functioning lacked basic facilities and supplies.[67] In October, the Liberian ambassador in Washington was reported as saying that he feared that his country may be "close to collapse".[66] By 24 October, all of the 15 Liberian districts had reported Ebola cases.[8][68]
In November the rate of new infections in Liberia appeared to be declining. The drop in cases was believed to be related to an integrated strategy combining isolation and treatment with community behaviour change including safe burial practices, case finding and contact tracing[69][70][71] 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.[72] On 15 December, 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."[73] On December 29, it was reported that dozens of new cases are developing along the border with Sierra Leone.[74]
Sierra Leone
Main article: Ebola virus epidemic in Sierra Leone
Kenema Hospital, Sierra Leone
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.[79] On 4 November, it was reported that thousands violated quarantine in search for food in the town of Kenema.[80] 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."[81] 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.[55] 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.[82]
On 9 December, news reports described the discovery of "a grim scene: piles of bodies, overwhelmed medical personnel and exhausted burial teams in the remote Eastern Kono District.[83] On 15 December, the CDC indicated that their main concern was Sierra Leone where the epidemic had given no evidense of halting and cases continued to rise exponentially; during the second week of December Sierra Leone reported nearly 400 cases, more than three times the number of cases reported by Guinea and Liberia combined. According to the CDC, "the risk we face now [is] that Ebola will simmer along, become endemic and be a problem for Africa and the world, for years to come." [84] On 17 December, President Koroma launched "Operation Western Area Surge" and treatment centers filled as health workers went door-to-door in the capital city looking for possible patients.[85][86] The operation led to a surge in the number of cases, with 403 new cases reported between 14 to 17 December.[87][85] On 25 December, Sierra Leone put the north area of its country on lockdown.[88]
Countries with successfully contained spread
Senegal
In March, the Senegal Ministry of Interior closed the southern border with Guinea,[89] but on 29 August the Senegal health minister announced Senegal's first case, a university student from Guinea who was being treated in a Dakar hospital.[49] 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.[49]On 28 August, authorities in Guinea issued an alert informing medical services in Guinea and neighbouring countries that a person who had been in close contact with an Ebola infected patient had escaped their surveillance system. The alert prompted testing for Ebola at the Dakar laboratory, and the positive result launched an investigation and triggered urgent contact tracing.[49] On 10 September, it was reported that the student had recovered but health officials would continue to monitor his contacts for 21 days.[90] No further cases were reported.[91] and on 17 October, the WHO officially declared that the outbreak in Senegal had ended.[8]
The WHO have officially commended the Senegalese government, and in particular the President Macky Sall and the Minister of Health Dr Awa Coll-Seck, for their 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.[92]
Nigeria
Nigerian states with Ebola cases (Lagos, Port Harcourt)
Nigerian health care workers at a training event, August 2014
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.[96] 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".[48]
On 9 October, the European Centre for Disease Prevention and Control (ECDC) acknowledged Nigeria's positive role in controlling the effort to contain the Ebola outbreak. "We wish to thank the Federal Ministry of Health, Abuja, Nigeria, and the staff of the Ebola Emergency Centre who coordinated the management of cases, containment of outbreaks and treatment protocols in Nigeria." Nigeria's quick responses, including intense and rapid contact tracing, surveillance of potential contacts, and isolation of all contacts were of particular importance in controlling and limiting the outbreak, according to the ECDC.[97] Complimenting Nigeria's successful efforts to control the outbreak, "the usually measured WHO declared the feat 'a piece of world-class epidemiological detective work'."[98]
Spain
Main article: Ebola virus disease cases in Spain
On 5 August 2014, the Brothers Hospitallers of St. John of God
confirmed that Brother Miguel Pajares, who had been volunteering in
Liberia, had become infected. He was evacuated to Spain on 6 August, and
died on 12 August.[99] On 21 September it was announced that Brother Manuel García Viejo, another Spanish citizen who was medical director at the San Juan de Dios Hospital in Lunsar, had been evacuated to Spain from Sierra Leone after being infected with the virus. His death was announced on 25 September.[100]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.[101] A second test confirmed the diagnosis,[102] 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.[51]
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.[103]
United States
Main article: Ebola virus cases in the United States
See also: § Travel restrictions and quarantines
On 30 September, the United States Centers for Disease Control and Prevention (CDC) declared its first case of Ebola virus disease. The CDC disclosed that Thomas Eric Duncan became infected in Liberia and traveled to Texas
on 20 September. On 26 September he fell ill and sought medical
treatment but was sent home with antibiotics. He returned to the
hospital by ambulance on 28 September and was placed in isolation and
tested for Ebola.[104][105] Thomas Duncan died on 8 October.[106]
Two additional cases stemmed from Thomas Eric Duncan, when Nina Pham
and Amber Vinson tested positive for Ebola on October 10 and 14[107][108] and ended when they were declared Ebola free on October 24 and 22, respectively.[109][110]A fourth case of Ebola was identified October 23, 2014 when Dr. Craig Spencer, a physician who had treated Ebola patients in West Africa, himself tested positive for Ebola.[111] This case had no relation to the cases originating from Thomas Eric Duncan. He was declared Ebola free on November 7, 2014.[112] Spencer was released from the hospital on November 11. He was cheered and applauded by medical staff members, and hugged by the Mayor of New York, Bill de Blasio as he walked out of the hospital. The Mayor also declared: “New York City is Ebola free".[113] On January 4, a U.S. health care worker in Sierra Leone, with a high risk of exposure, was sent to Nebraska Medicine in Omaha.[114]
Countries with limited local cases
Mali
Mali regions with Ebola cases (Kayes, Bamako)
Main article: Ebola virus disease in Mali
On 23 October, the first case of Ebola disease in Mali was confirmed in the city of Kayes;
a two year-old girl who had arrived with a family group from Guinea.
Her father had worked for the Red Cross in Guinea and had also worked in
a private health clinic; he died earlier in the month, likely from an
Ebola infection which he had contracted in the private clinic. It was
later established that a number of family members had also died of
Ebola. A family group returned to Mali after the father's funeral via
public bus and taxi, a journey of more than 1,200 kilometres (750 mi).
On 23 October, the girl tested positive for Ebola but died the next day.[115][116] All contacts were followed for 21 days, with no further spread of the disease reported.[117]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 imam who had fallen ill on 17 October in Guinea and was transferred to the Pasteur Clinic in Mali's capital city Bamako for treatment. He was treated for kidney failure but was not tested for Ebola; he died on 27 October and his body was returned to Guinea for burial.[118] A nurse and a doctor who had treated the imam subsequently fell ill with Ebola and died.[119][120] 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.[121] 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.[122] On 16 December, Mali released the final 13 individuals who were being quarantined, and the country is expected to be declared free of the virus on 18 January.[9][123]
United Kingdom
Main article: Ebola virus disease in the United Kingdom
On 29 December 2014, Pauline Cafferkey, a British aid worker who had just returned from Sierra Leone via Casablanca Airport and London Heathrow Airport was diagnosed with Ebola at Glasgow's Gartnavel General Hospital.[124][125] After initial treatment in Glasgow, she was transferred by air to RAF Northolt, to the specialist high-level isolation unit at the Royal Free Hospital in London for longer-term treatment.[124][126]
A Scottish government spokesman described the risk to the general
public as "extremely low to the point of negligible" due to the very
early stage of the infection at the time of detection.[124] Contact tracing is being done on 70 other passengers who travelled on the flight from London to Glasgow with her.[126] She is being treated with blood plasma, from Ebola survivors.[127] On 3 January 2015 the Royal Free Hospital confirmed that her condition had deteriorated to critical.[128]On 30 December 2014 Paul Cosford of Public Health England said approximately 150 people had been tested for Ebola in the UK, of which only two had tested positive. The first person to test positive was William Pooley, a medically evacuated case.[126]
Countries with medically evacuated cases
A number of people who had become infected with Ebola virus disease have been medically evacuated to treatment in isolation wards in Europe or the US. These are mostly health workers with one of the NGOs in the area. With the exception of a single isolated case in Spain, no secondary infections have occurred as a result of these medical evacuations.France
A French volunteer health worker, working for MSF in Liberia, contracted Ebola and was flown to France on 18 September. After successful treatment at Bégin Military Teaching Hospital near Paris, she was discharged on 4 October.[129]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.[130]
Germany
On 27 August, a Senegalese epidemiologist working for the WHO in Sierra Leone became the first patient. On 4 October he was discharged after being declared noninfectious.[131]On 4 October, a Ugandan pediatrician, Dr. Michael Mawanda working in Sierra Leone, was flown to Germany for treatment at the University Hospital in Frankfurt.[132][133] The doctor was released on 19 November after seven weeks of intensive treatment. The doctor suffered multiple organ failure and received intensive treatment[134] including the use of Aethlon's Hemopurifier. During his 6.5 hour treatment his viral load dropped from 400,000 copies/ml blood to about 1,000 copies/ml. The filter was sent to a biosafety level 4 laboratory at the University of Marburg where it was determined that the filter trapped 242 million copies of the Ebola virus.[135]
On 9 October, a Sudanese doctor working with the United Nations UNMIL peacekeeping force in Liberia[136] was transported to the St Georg Hospital in Leipzig for treatment.[137] He died on 14 October, becoming the first person on German soil to die of Ebola.[138] On January 3, a South Korean health worker was flown to Germany after a needle-sticking injury.[139]
Italy
On 24 November the Italian Health Ministry announced that an Italian doctor working for Emergency in Lakka, Sierra Leone, contracted Ebola.[140] On 25 November a military plane carrying the 50-year-old doctor landed at Pratica di Mare military airport, from which he was transferred to the Lazzaro Spallanzani National Institute for Infectious Diseases in Rome. The doctor was reportedly still not showing symptoms and in good health on arrival.[141] On November 29, it was reported the condition of the doctor had worsened, according to Lazzaro Spallanzani hospital. The hospital has "declined" to indicate which experimental drug it has given the patient.[142] 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.[143] On January 2, 2015, he left the hospital and his identity, Fabrizio Pulvirenti, was revealed.[144][145]Netherlands
A United Nations UNMIL Peacekeeper who contracted the disease in Liberia arrived in the Netherlands on 6 December according to the Health Ministry.[146] The Nigerian soldier was treated at the University Medical Centre in Utrecht. This is the third peacekeeper who contracted the disease. The first two cases were fatal.[147] On December 19, it was reported that the Nigerian UN peacekeeper was cured of Ebola; he was to 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.[148] On December 23, the peacekeeper was released and returned to Liberia.[149]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 Oslo University Hospital.[150][151] 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.[152]Switzerland
On 18 November a Cuban doctor, Felix Baez, tested positive for Ebola in Sierra Leone. He arrived in Geneva on Friday 21 Nov for treatment at the Geneva University Hospital. Dr Baez was able to step off the plane unaided.[153] On November 25, it was reported, Dr. Baez was being treated with ZMab, an experimental drug related to ZMapp.[154] On December 6 it was announced that he had recovered and left the country.[155]United Kingdom
An isolation unit at the Royal Free Hospital, London, received its first case on 24 August. William Pooley, a British nurse, was evacuated from Sierra Leone by the Royal Air Force on a specially-equipped C-17 aircraft. He was released from hospital on 3 September.[156][157] Pooley delivered the Channel 4 Alternative Christmas message in 2014.[158]United States
A number of people who contracted Ebola virus disease while working in the affected areas have been medically evacuated to the United States for treatment; most recovered, but one has died.[159] On 17 November 2014 Dr. Martin Salia, evacuated from Sierra Leone to the US, died of the Ebola virus, aged 44 years.[160]Separate outbreak in the Democratic Republic of the Congo
In August 2014, the WHO reported an outbreak of Ebola virus in the Boende District, Democratic Republic of the Congo (DRC).[161] They confirmed that the virus is of the Zaire Ebola species, which is common in the DRC ("Zaire" 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.[162][163]In August, 13 people were reported to have died of Ebola-like symptoms in the remote northern Équateur province.[163] 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.[163] However, more recent findings suggest that there may have been several previous cases, and an investigation is ongoing.[164] According to the WHO, as of 28 October 2014, 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.[165] The government of Congo declared the outbreak over on 15 November 2014, after 42 days without any new cases.[166] This was confirmed by WHO on 21 November.[167]
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