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West Africa 2013: Re-examining Ebola

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  • Authors: Daniel G. Bausch1, Amanda Rojek2
  • Editors: W. Michael Scheld3, James M. Hughes4, Richard J. Whitley5
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112; 2: University of Oxford, Oxford, UK; 3: Department of Infectious Diseases, University of Virginia Health System, Charlottesville, VA; 4: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA; 5: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
  • Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0022-2016
  • Received 28 April 2016 Accepted 28 April 2016 Published 10 June 2016
  • Daniel G. Bausch, bauschd@who.int
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  • Abstract:

    The outbreak of Ebola virus disease (EVD) that occurred from 2013 to 2016 in the West African countries of Guinea, Liberia, and Sierra Leone, with imported cases to three neighboring African countries as well as to the United States and Europe, constituted a major humanitarian disaster. The outbreak numbered over 28,500 cases, more than 10 times the number cumulatively registered from all previous EVD outbreaks combined, with at least 11,000 deaths, and resulted in billions of dollars of lost economic growth to an already impoverished region. The unprecedented scale of West Africa 2013 took the world by surprise and laid bare deficiencies in our response capacity to complex humanitarian disasters of highly infectious and lethal pathogens. However, the magnitude of West Africa 2013 also provided an, albeit unwelcome, unique opportunity and obligation to better understand the biology and epidemiology of EVD and, equally as important, the many scientific, economic, social, political, ethical, and logistical challenges in confronting emerging diseases in the modern era. Here we re-examine EVD, reviewing the unique challenges and scientific advances of West Africa 2013, contrasting them with the prior assumptions and classical teachings, identifying what they have taught us and what we still have to learn.

  • Citation: Bausch D, Rojek A. 2016. West Africa 2013: Re-examining Ebola. Microbiol Spectrum 4(3):EI10-0022-2016. doi:10.1128/microbiolspec.EI10-0022-2016.

Key Concept Ranking

Phase II Clinical Trial
0.43277234
Ebola Virus
0.40646183
0.43277234

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/content/journal/microbiolspec/10.1128/microbiolspec.EI10-0022-2016
2016-06-10
2017-04-28

Abstract:

The outbreak of Ebola virus disease (EVD) that occurred from 2013 to 2016 in the West African countries of Guinea, Liberia, and Sierra Leone, with imported cases to three neighboring African countries as well as to the United States and Europe, constituted a major humanitarian disaster. The outbreak numbered over 28,500 cases, more than 10 times the number cumulatively registered from all previous EVD outbreaks combined, with at least 11,000 deaths, and resulted in billions of dollars of lost economic growth to an already impoverished region. The unprecedented scale of West Africa 2013 took the world by surprise and laid bare deficiencies in our response capacity to complex humanitarian disasters of highly infectious and lethal pathogens. However, the magnitude of West Africa 2013 also provided an, albeit unwelcome, unique opportunity and obligation to better understand the biology and epidemiology of EVD and, equally as important, the many scientific, economic, social, political, ethical, and logistical challenges in confronting emerging diseases in the modern era. Here we re-examine EVD, reviewing the unique challenges and scientific advances of West Africa 2013, contrasting them with the prior assumptions and classical teachings, identifying what they have taught us and what we still have to learn.

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Figures

Image of FIGURE 1
FIGURE 1

Map of West Africa showing the epicenter of the 2013–2016 outbreak of Ebola virus disease (red) and imported cases (orange and arrows). The total number of cases seen in each country is shown in parentheses.

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0022-2016
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Image of FIGURE 2
FIGURE 2

Epidemiologic curve of the West Africa 2013 Ebola virus disease (EVD) outbreak. The dashed vertical lines indicate key events during the outbreak: First suspected case in Meliandou, Guinea. Laboratory confirmation of EVD and disease reported by Guinean Health Authorities. WHO declares public health emergency of international concern. U.S. President Obama announces major initiative to help control EVD in Liberia; creation of the United Nations Mission for Ebola Emergency. Publication of preliminary results from first EVD phase III vaccine efficacy study (rVSV-EBOV). Publication of preliminary results of first EVD phase III therapeutic efficacy trial (convalescent plasma). Adapted from WHO Ebola Response Roadmap Situation Reports with publicly available data. World Health Organization: http://apps.who.int/gho/data/node.ebola-sitrep.main-countries?lang=en.

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0022-2016
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FIGURE 3

Sizes and population densities of Guinea, Liberia, and Sierra Leone combined compared with the Democratic Republic of the Congo. To illustrate the difference in size, the three West African countries are shown superimposed on the Democratic Republic of the Congo.

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0022-2016
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FIGURE 4

“Bush taxis” in Guinea traveling back and forth between remote areas and major cities. Photos by Frederique Jacquerioz.

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0022-2016
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FIGURE 5

Virus persistence after the day of disease onset in various body compartments in survivors of Ebola virus disease as detected by reverse-transcription polymerase chain reaction (RT-PCR, green) and cell culture (blue). Red bars represent the day of the first negative RT-PCR detection in the patient’s blood, when available. Reprinted with permission from reference 66 .

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0022-2016
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FIGURE 6

Examples of various types of personal protective equipment used during the care of patients with Ebola virus disease during the 2013–2016 outbreak in West Africa. The equipment shown is for demonstration only and should not be construed as advocating or confirming the efficacy of any specific equipment. Photos by Thomas Fletcher and Frederique Jacquerioz.

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0022-2016
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Tables

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TABLE 1

Laboratory-confirmed outbreaks of Ebola virus disease since discovery of the virus in 1976 through April 2016. Cases related to laboratory infections are not shown

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0022-2016
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TABLE 2

Bed capacity and bed requirements for patients with Ebola virus disease in West Africa in October, 2014

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0022-2016
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TABLE 3

Registered clinical trials of experimental therapeutics for Ebola virus disease during the West Africa 2013 outbreak

Source: microbiolspec June 2016 vol. 4 no. 3 doi:10.1128/microbiolspec.EI10-0022-2016

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