Chapter 1 : West Africa 2013: Re-examining Ebola

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The outbreak of Ebola virus disease (EVD) that began in Guinea in 2013 and then rapidly spread through Liberia and Sierra Leone lasted over 2 years and resulted in over 28,500 cases and at least 11,000 deaths in West Africa, with 27 imported or medically evacuated cases and 5 deaths in the United States and Europe ( Fig. 1 ) ( ). By comparison, fewer than 3,000 cases of EVD have been registered for previous outbreaks combined ( Table 1 ). The previous largest outbreak on record, which occurred in Gulu, Uganda, in 2000–2001, lasted only three and a half months and consisted of 425 cases with 224 deaths. But the impact of an outbreak of EVD or other emerging viruses cannot be measured simply by tallying cases and deaths. In 2015 the West Africa EVD outbreak resulted in $2.2 billion in lost economic growth in the region, stalling fledging economies that were struggling to recover from civil war. On a personal level, such sterile-sounding statistics translate to extreme personal suffering—upward of 3,000 orphaned children, children’s education and development jeopardized as school is cancelled for a year, job loss, smaller harvests and hungry families, and deep but less easily measurable mental health and socio-cultural impacts. Furthermore, as the region’s resources were funneled to EVD, there were an estimated 10,000 excess deaths due to untreated malaria, HIV/AIDS, and tuberculosis. Reductions in vaccination coverage and a rise in teenage pregnancy were also noted ( ).

Citation: Bausch D, Rojek A. 2016. West Africa 2013: Re-examining Ebola, p 1-37. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0022-2016
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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.

Citation: Bausch D, Rojek A. 2016. West Africa 2013: Re-examining Ebola, p 1-37. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0022-2016
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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.

Citation: Bausch D, Rojek A. 2016. West Africa 2013: Re-examining Ebola, p 1-37. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. 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.

Citation: Bausch D, Rojek A. 2016. West Africa 2013: Re-examining Ebola, p 1-37. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. 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.

Citation: Bausch D, Rojek A. 2016. West Africa 2013: Re-examining Ebola, p 1-37. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. 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 .

Citation: Bausch D, Rojek A. 2016. West Africa 2013: Re-examining Ebola, p 1-37. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. 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.

Citation: Bausch D, Rojek A. 2016. West Africa 2013: Re-examining Ebola, p 1-37. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0022-2016
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