Ebola outbreak of 2014–16

outbreak of Ebola virus disease that ravaged countries in western Africa in 2014–16 and was noted for its unprecedented magnitude. By January 2016, suspected and confirmed cases had totaled more than 28,600, and reported deaths numbered about 11,300, making the outbreak significantly larger than all previous Ebola outbreaks combined. The actual numbers of cases and deaths, however, were suspected to be far greater than reported figures. The causative virus was a type of Zaire ebolavirus known as Ebola virus (EBOV)—the deadliest of the ebolaviruses, which originally was discovered in the 1970s in central Africa. EBOV was descended from ebolaviruses harboured by fruit bats.

For detailed information on species of ebolavirus, other outbreaks of the disease, and the course of infection, see the articles Ebola and ebolavirus.

The first cases

Retrospective investigation revealed that EBOV first began to sicken people in western Africa in December 2013. The first victim, the suspected index case, was a two-year-old child who died early that month in the village of Méliandou in Guéckédou prefecture in southern Guinea. The child’s illness was characterized by fever, diarrhea, and vomiting. A similar illness claimed the lives of others in Méliandou in subsequent weeks.

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The chain of transmission expanded in early February 2014, when a health care worker at a hospital in Guéckédou fell ill and was taken to a hospital in nearby Macenta for treatment but later died there. A doctor at the Macenta hospital who had treated the individual contracted the disease and died in late February. About the same time, family members and others who had been in contact with the doctor became sick; some of those individuals were in Macenta, but others were in Kissidougou (where the doctor’s funeral was held) and N’zérékoré.

About the middle of March, samples exported for laboratory analysis tested positive for ebolavirus, prompting Guinea health officials to notify the World Health Organization (WHO) of an Ebola outbreak. Cases were also suspected in Liberia and Sierra Leone.

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Escalation of the outbreak

Following notification of WHO, officials with Guinea’s Ministry of Health and aid workers for Doctors Without Borders set up isolation units in Guéckédou and Macenta prefectures. WHO deployed health experts to the region to assist with disease surveillance and control, which included efforts to train community workers in disease detection and the safe burial of deceased victims. Control activities were organized in late March in Liberia, following reports of suspected infections and laboratory confirmation of two cases in Lofa county, at the border of southern Guinea.

Despite the implementation of control measures, concern grew among aid coordinators about the scale of the outbreak in Guinea and particularly the distribution of cases across multiple areas. Through April and into May, the situation stabilized in Liberia, and Sierra Leone appeared to be unaffected. In Guinea, however, the outbreak grew gradually, reaching the country’s capital, Conakry, as well as prefectures in central and western regions.

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By the end of May the situation had escalated noticeably. In Sierra Leone, health officials reported the country’s first laboratory-confirmed cases; the vast majority were from the Kailahun district, which bordered Guéckédou. Liberia also began to experience a rise in cases, with spread to Montserrado, Margibi, and Nimba counties. In response, WHO and partner agencies deployed additional experts and equipment to the region. As the outbreak progressed, however, community resistance began to emerge. Through June and July, containment efforts were increasingly hindered by local resistance and hostility toward doctors, the fleeing of persons suspected to have the disease, the multiple locations involved, and the cross-border movement of infected individuals. In some communities, aid workers were physically threatened, and barriers erected across roads prevented workers from reaching villages with suspected cases. Travel warnings for symptomatic persons leaving affected parts of Africa went unheeded. In late July an infected government official traveled by airplane from Liberia to Lagos, Nigeria, where he later died. Health workers who had come into direct contact with him in Lagos later contracted the illness.

On August 8 WHO Director General Margaret Chan pronounced the outbreak a Public Health Emergency of International Concern—only the third time that such a declaration had been made by WHO since its adoption of new International Health Regulations in 2005. The following day Guinea tightened border control with Liberia and Sierra Leone. The total number of cases in each of those two countries had surpassed the number in Guinea. In mid-August, aid staff at outbreak sites across the region noted that reported numbers of cases and deaths were gross underestimates. At the end of the month, Senegal reported a case of Ebola; the infected individual had fled from Guinea.

In September, with the outbreak continuing to increase in intensity, foreign aid efforts expanded. U.S. Pres. Barack Obama committed an estimated 3,000 troops (about 2,800 ultimately were deployed) and millions of dollars in additional aid resources to a humanitarian response aimed at bringing Ebola under control primarily in Liberia, which had suffered the highest cumulative numbers of cases and deaths among countries affected by the outbreak. Cuban health officials planned to send dozens of doctors, nurses, and infectious-disease specialists to Sierra Leone. Likewise, other countries, including China, France, and the United Kingdom, announced plans to send health workers, supplies, and other forms of aid to augment existing relief efforts in West Africa. At that time the United Nations estimated that $1 billion was needed to combat the outbreak, the severity of which was described as unparalleled.

At the end of September, fears that the outbreak would spread beyond Africa were realized when the U.S. Centers for Disease Control (CDC) confirmed the first diagnosis of Ebola made on U.S. soil. The patient, a man who had been living in Liberia, fell ill about a week after arriving in Dallas, Texas, where he was visiting family. Just days before taking the flight to the United States, he had been in direct contact with a sick woman in Monrovia. Dozens of people in the Dallas community were directly or indirectly exposed to the disease as a result of the man’s illness. He later died. About that time, Spanish health officials confirmed that a nurse at a Madrid hospital had contracted Ebola while caring for a missionary who had been flown back to Spain from western Africa after becoming infected. It was the first documented transmission of the disease to occur beyond the outbreak zone in western Africa.