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Ebola: The Evolving Catastrophe

2.00 Contact Hours:
A score of 80% correct answers on a test is required to successfully complete any course and attain a certificate of completion.
Author:    Pamela Downey (MSN, ARNP)

Purpose/Goals

This educational program will review the current Ebola outbreak, discuss epidemiology pathophysiology, signs and symptoms, patient assessment, prevention, and supportive care for Ebola victims. We will concentrate specifically on the 2014 Ebola virus (EBOV) (Zaire Ebolavirus) epidemic currently raging in the West African countries of Guinea, Liberia, Nigeria, Senegal and Sierra Leone.

Objectives

After completing this course, the learner will be able to meet the following 30 objectives:

  1. Define Ebola virus disease (EVD) or Ebola Hemorrhagic Fever (Ebola HF).
  2. Discuss the evolving catastrophe of the current ebola outbreak
  3. Relate the "hypothesized" modes of transmission of the Ebola virus from bats to various animal populations to humans.
  4. List five ways EVD is transmitted from human-to-human.
  5. State the signs and symptoms of EVD including time from exposure to the ebola virus and onset of symptomology.
  6. Describe the pathophysiology underlying EVD.
  7. Relate a minimum of three key questions which should be asked during the medical history which would lead the healthcare worker to suspect EVD.
  8. Discuss prevention.
  9. Describe the supportive care which should be provided to every individual with EVD.
  10. Discuss the overall mortality rate and its meaning to the countries and the entire world.
  11. List some long-term problems which may persist after surviving EVD.
  12. Discuss the economic effects on the Ebola ravaged countries and the global implications of these effects.

Introduction

As of August 2014, the World Health Organization (WHO) also reported an outbreak of Ebola Virus Disease in the Democratic Republic of the Congo (DRC) which lies in Central Africa. The WHO confirmed that the current strain of the virus is the Zaire Ebola species, which is common in the DRC. The virology results and epidemiological findings indicate no connection to the current epidemic in West Africa (i.e. the index case and her contacts had no history of travel to the Ebola ravaged countries in Western Africa or history of contact with individuals from the affected areas). This is the DRC's seventh Ebola outbreak since 1976.

Ebola virus disease (EVD) or Ebola hemorrhagic fever (Ebola HF) is the human disease caused by the Ebola virus-one of numerous Viral Hemorrhagic Fevers. It is a severe, often fatal disease in humans and nonhuman primates such as monkeys, gorillas, and chimpanzees.

Basic understanding of these countries may help to facilitate understanding of the roadblocks faced in undertaking the eradication of these Ebola outbreaks.

Table 1: Characteristics of the African Countries Affected by EVD
Countries Religion Ethnic Groups Official Language Main Industries GDP Population
West Africa
Guinea 85% Islamic,

8% Christian,

7%
Animist
24 French but 24 Indigenous languages Petroleum, fishing, sawmilling, natural gas $10.41 million 10.5 million
Liberia 85.5% Christian,
12.2% Islamic,
 0.5% Indigenous religions
16 English but 30 indigenous languages Rubber processing, palm oil processing, timber, diamonds $2.719 billion 4 million
Nigeria 50% Islamic,
50% Christian
500 English Crude oil, coal, tin, columbite, uranium; palm oil, peanuts, cotton, rubber, wood; hides and skins, textiles, cement and other construction materials, food products, footwear, chemicals, fertilizer, printing, ceramics, steel, small commercial ship construction and repair, entertainment, machinery, car assembly $522 billion 174 million
Senegal 97% Islamic,
5% Christian
7 French but 24 Indigenous languages Food processing, mining, cement, artificial fertilizer, chemicals, textiles, refining imported petroleum, tourism. Fishing, chemicals, cotton, fabrics, groundnuts, and calcium phosphate. $13.864 billion 13.5 million
Sierra Leone Islamic, Christian 16 English
(Krio language generally spoken)
Diamond mining, small-scale manufacturing (cigarettes, beverages, textiles, footwear), petroleum refining, commercial ship repair $8.412 billion 6 million
Central Africa
Demographic Republic of Congo (DRC) 1.5-10% Islamic, 80% Christian, 1.8-10% Indigenous beliefs 200 French but 242 Indigenous languages Mining (copper, cobalt, gold, diamonds, coltan, zinc, tin, tungsten), mineral processing, consumer products (including textiles, plastics, footwear, cigarettes, processed foods, beverages), metal products, lumber, cement, commercial $55 billion 75 million

In general, there are inherent problems with containing and controlling the Ebola epidemics in the affected countries.

  • Lack of an adequate infrastructural base such as running water, plumbing, schools, hospitals, clinics, roads etc.
  • Culture of corruption limiting development of the countries resources.
  • Maldistribution of wealth resulting in many of the affected areas being extremely poor with limited access to running water or soap.
  • Low literacy rates due to lack of schools or poor school attendance.
  • Poor economic conditions resulting in a "bushmeat" problem, which is a major environmental, as well as, socio-economic crisis. (Bushmeat is typically obtained by trapping wild animals, usually with wire snares, or otherwise with shotguns, poisoned arrows or arms). The "bushmeat crisis" has emerged as a result of poor living conditions and a lack of education about the dangers of eating it. Deplorable economic conditions force many families to become dependent on bushmeat, either as a means of acquiring income (hunting the meat and selling it), or becoming dependent on it for food. Unemployment and urbanization have exacerbated the problem further by turning cities with their urban sprawl into a prime market for commercial bushmeat.
  • In some areas, people have become suspicious of both the government and hospitals. Some hospitals have been attacked by angry protestors who believe that the disease is a hoax or that the hospitals are responsible for the disease.
  • Distrust of western countries due to past history of colonialism.
  • History of political disruptions in the forms of military coups, civil wars etc. which left death and destruction in their wake. This caused recovery to be slow and, in some cases, elusive.
  • Multilingual, multicultural ethnic groups in any given country.
  • Belief in traditional folk remedies.
  • Cultural practices that predispose people to physical contact with the deceased, especially death customs such as washing the body of the deceased.
  • Some hospitals lack basic supplies and are understaffed which has increased the chance of staff catching the virus themselves. In August, the WHO reported that ten percent of the dead were health care workers.

Geographic Locations And Casualty Rates of The 2014 Ebola Epidemic

West Africa, also called Western Africa and the West of Africa, is the westernmost subregion of the African continent. West Africa is inhabited by West Africans, and in line with the current membership of the Economic Community of West African States (ECOWAS), established in May 1975, West Africa has been defined in Africa as including fifteen states Benin, Burkina Faso, Island of Cape Verde, Gambia, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone, and Togo. (Diagram 1).

Diagram 1: EBOLA VIRUS EPIDEMIC IN WEST AFRICA 2014
Ebola Situation Map of the Outbreak 2014
Situation map of the outbreak
Date December 2013 – present

Location Liberia, Sierra Leone, Guinea, Nigeria, Senegal
Casualties
Reported Cases / Deaths (as of 25 September 2014)

Total: 6,808 / 3,159
Liberia: 3,564 / 1,922
Sierra Leone: 2,120 / 564
Guinea: 1,103 / 668
Nigeria: 20 / 8
Senegal: 1 / 0

The Democratic Republic of the Congo, also known as DR Congo, DRC, Congo, Congo-Kinshasa, DROC, or RDC, is a country located in Central Africa. (Diagram 2)

Diagram 2: EBOLA VIRUS EPIDEMIC in the DEMOCRATIC REPUBLIC OF THE CONGO-2014
DRC Ebola area
DRC Ebola area as of 6 September 2014
Casualties
Cases / Deaths (as of 23 September 2014)
DR Congo: 70 / 42
 

Causes

Ebola virus disease (EVD) or Ebola hemorrhagic fever (Ebola HF) is caused by four of five identified subspecies of Ebolavirus classified in the genus Ebolavirus, family Filoviridae, order Mononegavirales. The four identified subspecies of the Ebolavirus that have caused disease in humans are:

  • Bundibugyo virus (BDBV) (Bundibugyo ebolavirus) (Ebola-Bundibugyo)
  • Ebola virus (EBOV) (Zaire ebolavirus)
  • Sudan virus (SUDV) (Sudan ebolavirus)
  • Taï Forest virus (TAFV) (Taï Forest ebolavirus formerly Cote d'Ivoire ebolavirus)

The fifth virus, Reston virus (RESTV) (Reston ebolavirus), has caused disease in nonhuman primates such as monkeys, gorillas and chimpanzees but is not thought to cause disease in humans. A host of similar species are probably associated with Reston virus, which was isolated from infected cynomolgous monkeys that were imported to the United States and Italy from the Philippines. Several workers in the Philippines and in US holding facilities became infected with the virus, but did not become ill.

The International Committee on Taxonomy of Viruses currently recognizes four subspecies of the Ebolavirus: Zaire ebolavirus (EBOV), Sudan ebolavirus (SUDV), Reston ebolavirus (RESTV), and Taï Forest ebolavirus (TAFV). The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) added an additional subspecies of Ebola, the Bundibugyo ebolavirus (BDBV) or Ebola-Bundibugyo, following an outbreak in Uganda in 2007.

Historic Perspective On Ebola Outbreaks

Ebola outbreaks have been restricted to Africa with the exception of the Reston ebolavirus. (Table 2)

The first Ebolavirus subspecies was discovered in 1976 in what is now the Democratic Republic of the Congo (DRC), formerly Zaire, near the Ebola River. Since then, outbreaks have appeared sporadically.

Table 2: LIST OF EBOLA OUTBREAKS
Reported Human Virulence
Date Country Species Cases Deaths Fatality
1976 Aug. DRC EBOV 318 280 88%
Comments: First recognition of EVD. Disease was spread by close personal contact and by use of contaminated needles and syringes in hospitals/clinics.
1976 Sudan SUDV 284 151 53%
Comments: EVD was spread mainly through close personal contact within hospitals. Many medical care personnel were infected.
1977 DRC EBOV 1 1 n/a
Comments: Noted retroactively in the village of Tandala.
1979 Sudan SUDV 34 22 65%
Comments: Occurred in Nzara, Maridi. Recurrent outbreak at the same site as the 1976 Sudan epidemic.
1989 USA RESTV 0 0 n/a
Comments: RESTV was introduced into quarantine facilities in Virginia and Pennsylvania by monkeys. The monkeys were imported from the Philippines.
1990 USA RESTV 4 0 n/a
RESTV was introduced once again into quarantine facilities in Virginia and Texas by monkeys imported from the Philippines. Four humans developed antibodies but remained asymptomatic.
1989–1990 Philippines RESTV 3 0 n/a
Comments: High mortality among crab-eating macaques in a primate facility responsible for exporting animals in the USA. Three workers in the animal facility developed antibodies but remained asymptomatic.
1992 Italy RESTV 0 0 n/a
Comments: RESTV was introduced into quarantine facilities in Siena by monkeys imported from the same export facility in the Philippines that was involved in the episodes in the United States. No humans were infected.
1994 Gabon EBOV 52 31 60%
Comments: Occurred in gold-mining camps deep in the rain forest. Initially thought to be yellow fever; identified as EVD in 1995.
1994 Ivory Coast TAFV 1 0 n/a
Comments: First and thus far only recognition of TAFV. Approximately one week after conducting necropsies on infected western chimpanzees in Taï National Park, a scientist contracted the virus and developed symptoms similar to those of dengue fever. She was discharged from a Swiss hospital two weeks later, and fully recovered after six weeks.
1995 DRC EBOV 315 250 79%
Comments: Occurred in Kikwit and surrounding area. Traced to index case-patient who worked in forest adjoining the city. Epidemic spread through families and hospitals.
1996 Jan-Apr Gabon EBOV 37 21 57%
Comments: Occurred in Mayibout area. A chimpanzee found dead in the forest was eaten by people hunting for food. Nineteen people involved in the butchery of the animal became ill; other cases occurred in family members.
1996 South Africa EBOV 2 1 n/a
Comments: A medical professional traveled from Gabon to Johannesburg, South Africa, and was exposed to the virus after having treated Ebola virus-infected patients. He was hospitalized, and a nurse who took care of him became infected and died.
1996 Mar. Philippines, USA RESTV 0 0 n/a
Comments: RESTV was introduced into a quarantine facility in Texas by crab-eating macaques from a monkey export facility in the Philippines. No human infections were identified.
1996–1997 Jul.-Jan. Gabon EBOV 60 45 75%
Comments: Occurred in Booué area with transport of patients to Libreville. Index case-patient was a hunter who lived in a forest camp. Disease was spread by close contact with infected persons. A dead chimpanzee found in the forest at the time was determined to be infected.
2000–2001 Uganda SUDV 425 224 53%
Comments: Occurred in Gulu, Masindi, and Mbarara districts of Uganda. The three greatest risks associated with EVD were attending funerals of EVD case-patients, having contact with case-patients in one's family, and providing medical care to EVD case-patients without using adequate personal protective measures.
2001–2002 Oct.-Jul. Gabon, DRC EBOV 122 96 79%
Comments: Occurred over the border of Gabon and the Republic of the Congo. This was the first time that EVD was reported in the Republic of the Congo.
2002–2003 Dec.-Apr. DRC EBOV 143 128 90%
Comments: Occurred in the districts of Mbomo and Kéllé in Cuvette Ouest Département.
2003 Nov.-Dec. DRC EBOV 35 29 83%
Comments: Occurred in Mbomo and Mbandza villages located in Mbomo district, Cuvette Ouest Département.
2004 Sudan SUDV 17 7 41%
Comments: Occurred in Yambio County in Western Equatoria of Southern Sudan. This outbreak was concurrent with an outbreak of measles in the same area, and several suspected EVD cases were later reclassified as measles cases.
2007 DRC EBOV 264 187 71%
Comments: Occurred in Kasai-Occidental Province. The outbreak was declared over on November 20. Last confirmed case was on October 4 and last death on October 10.
2007–2008 Dec.-Jan. Uganda BDBV 149 37 25%
Comments: First recognition of BDBV. Occurred in Bundibugyo District in Western Uganda.
2008 Nov. Philippines RESTV 6 0 n/a
Comments: First recognition of RESTV in pigs. Strain closely similar to earlier strains. Six workers from the pig farm and slaughterhouse developed antibodies but did not become sick.
2008–2009 Dec.-Feb. DRC EBOV 32 14 45%
Comments: Occurred in the Mweka and Luebo health zones of the Province of Kasai-Occidental.
2012 Jun.-Aug. Uganda SUDV 24 17 71%
Comments: Occurred in the Kibaale District.
2012 Jun.-Nov. DRC BDBV 77 36 47%
Comments: Occurred in Province Orientale.
2013–2014 Dec.-present Guinea, Liberia, Sierra Leone, Nigeria, Senegal, DRC EBOV 2,127 1,145 64%
Comments: An outbreak of Ebola virus disease (EVD) began in Guinea in December 2013, leading to an epidemic in West Africa. The outbreak was not detected until March 2014. It then spread to Sierra Leone, Liberia, Nigeria and Senegal. The outbreak is caused by the Zaire ebolavirus, known simply as the Ebola virus (EBOV). It is the most severe outbreak of Ebola in terms of the number of human cases and fatalities since the discovery of the virus in 1976.

Epidemiology: 2014 West Africa Ebola Virus Outbreak

Initial Outbreak

December 2013: Researchers believe that a 2-year-old boy was the index case of the current EVD outbreak. He died on 28 December 2013 in the village of Meliandou, Guéckédou Prefecture, Guinea. His mother, sister, and grandmother then became ill with similar symptoms. All died. People infected by those victims spread the disease to other villages. 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 diseases more common to the area. Thus, the disease had several months to spread before it was recognized as Ebola.

Guinea

March 2014

  • The Guinean Ministry of Health acknowledged a local outbreak of an undetermined viral hemorrhagic fever that had sickened at least 35 people and killed 23. "We thought it was Lassa fever or another form of cholera but this disease seems to strike like lightning. We are looking at all possibilities, including Ebola, because bushmeat is consumed in that region and Guinea is in the Ebola belt."
  • The World Health Organization (WHO) reported that Guinea's Ministry of Health had reported an outbreak of EVD in four southeastern districts, with suspected cases in the neighboring countries of Liberia and Sierra Leone being investigated. In Guinea, a total of 86 suspected cases, including 59 deaths (case fatality ratio: 68.5%), had been reported as of 24 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 to lead an international response to the Ebola outbreak. The WHO reported 112 suspected and confirmed cases including 70 deaths. Two cases were reported from Liberia of people who had recently traveled to Guinea, and suspected cases in Liberia and Sierra Leone were being investigated.

April 2014

  • Guinea's Ministry of Health reported 221 suspected and confirmed cases including 146 deaths. The cases included 25 health care workers with 16 deaths.

May 2014

  • The outbreak had spread to Conakry, Guinea's capital, a city of about two million inhabitants. The total cases reported had reached 281 with 186 deaths.
  • Thinking that the virus was contained, Médecins Sans Frontières (MSF) closed its treatment centers leaving only a small skeleton staff to handle the Macenta region.

August 2014

  • High numbers of new cases reappeared in the Macenta region. According to Marc Poncin, a coordinator for MSF, the new cases were related to people returning to Guinea from neighboring Liberia or Sierra Leone.
  • Guinea closed its borders with both Sierra Leone and Liberia to help contain EVD since more new cases were being reported in those countries than in Guinea.

September 2014

  • The bodies of a team of Guinean health and government officials, accompanied by journalists, who had been distributing Ebola information and doing disinfection work were found in a latrine in the town of Womey near Nzérékoré. The workers had been murdered by residents of the village after they initially went missing after a riot against the presence of the health education team. Government officials said, "the bodies showed signs of being attacked with machetes and clubs" and "three of them had their throats slit." It has been reported that some people in this area believe that health workers have been purposely spreading the disease to the people, while others believe that the disease does not exist. Riots recently broke out in the regional capital, Nzérékoré, when rumors were spread that people were being contaminated when health workers were spraying a market area to decontaminate it."
  • WHO estimated that Guinea's capacity to treat EVD cases fell short by the equivalent of 400 beds. Subsequent Spread

Liberia

March 2014

  • EVD was reported in Lofa and Nimba counties.

April 2014

  • The Ministry of Health and Social Welfare recorded possible cases in Margibi and Montserrado counties.

June 2014

  • The first cases in Liberia's capital Monrovia were reported.

July 2014

  • The health ministry implemented measures to improve the country's response.
  • Ellen Johnson Sirleaf, the Liberian president, announced that Liberia would close its borders, with the exception of a few crossing points, such as the airport, where screening centers would be established, and the worst-affected areas in the country would be placed under quarantine. Football events were banned, because large gatherings and the nature of the sport increased transmission risks. Three days after the borders were closed, Sirleaf announced the closure of all schools nationwide, including the University of Liberia, and a few communities were to be quarantined.

August 2014

  • Sirleaf declared a state of emergency partly because the disease's weakening of the health care system had the potential to reduce the system's ability to treat routine diseases such as malaria; she noted that the state of emergency might require the "suspensions of certain rights and privileges".
  • The National Elections Commission announced that it would be unable to conduct the scheduled October 2014 senatorial election and requested postponement, one week after the leaders of various opposition parties had publicly taken different sides on the question.
  • Liberia's Port Authority cancelled all "shore passes" for sailors from ships coming into the country's four seaports.
  • A mob of residents from West Point, an impoverished area of Monrovia, descended upon a local Ebola clinic to protest its presence. The protesters turned violent, threatened the caretakers, removed the infected patients, and looted the clinic of its supplies, including blood-stained bed sheets and mattresses. Police and aid workers expressed fear that this would lead to mass infections of Ebola in West Point.
  • The Liberian government quarantined the entirety of West Point and issued a curfew state-wide.
  • Violence again broke out after the military fired on protesting crowds.
  • The quarantine blockade of the West Point area was lifted. The Information Minister, Lewis Brown, said that this step was taken to ease efforts to screen, test, and treat residents.

September 2014

  • Liberia opened a new 150 bed treatment unit clinic in Monrovia. At the opening ceremony of the Old Island Clinic on Bushrod Island six ambulances were already waiting with potential patients. In addition, the patients were already waiting by the clinic after making their way on foot with the help of relatives. Two days later, 112 beds were already filled with 46 patients testing positive for Ebola, while the rest were admitted for observation.
  • WHO estimated that Liberia's capacity to treat EVD cases fell short by the equivalent of 1,550 beds.

Sierra Leone

March 2014

  • Sierra Leone declared a state of emergency and instituted measures to screen travelers from Guinea and Liberia.

May 2014

  • The first individual reported infected in the spread of EVD was a tribal healer. She had treated an infected person(s) 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 neighboring towns.
  • The first cases in the Kailahun District, near the border with Guéckédou in Guinea, were reported. A study of the virus genomes determined that twelve residents, when attending a funeral in Guinea, became infected. They then carried the virus back home.

June 2014

  • There were 158 suspected cases, mainly in Kailahun and the adjacent district of Kenema. Others were reported in the Kambia, Port Loko, and Western districts in the northwest of the country.

July 2014

  • The total number of suspected cases in the country stood at 442, and had overtaken those in Guinea and Liberia. By 20 July, cases of the disease had additionally been reported in the Bo District. The first case in Freetown, Sierra Leone's capital, was reported in late July.
  • The government began to deploy troops to implement quarantines.
  • Well-known physician Sheik Umar Khan, Sierra Leone's only expert on hemorrhagic fever, died after contracting Ebola at his clinic in Kenema. Khan had long worked with Lassa fever, a disease that kills over 5,000 a year in Africa. He had expanded his clinic to accept Ebola patients. Sierra Leone's President, Ernest Bai Koroma, celebrated Khan as a "national hero".

August 2014

  • Awareness campaigns in Freetown, Sierra Leone's capital, were delivered over the radio and through loudspeakers.
  • Sierra Leone passed a law that subjected anyone hiding someone believed to be infected to two years in jail. At the time the law was enacted, a top parliamentarian was critical of failures by neighboring countries to stop the outbreak.

September 2014

  • In an attempt to control the disease, Sierra Leone imposed a three-day lockdown on its population from 19 to 21 September. During this period 28,500 trained community workers and volunteers went door-to-door providing information on how to prevent infection, as well as setting up community Ebola surveillance teams.
  • Government officials said that the three day lockdown had obtained its objective and would not be extended. Eighty percent of targeted households were reached in the operation. A total of around 150 new cases were uncovered, although reports from remote locations had not yet been received.
  • The government added three more districts under "isolation," in an effort to contain the spread. The districts include Port Loko, Bombali, and Moyamba. This brings the total areas under isolation to five, including the outbreak "hot spots" Kenema and Kailahun which were already in isolation. Only deliveries and essential services were to be allowed in and out. A sharp rise in cases in these areas was noted by the WHO.
  • WHO estimated that Sierra Leone's capacity to treat EVD cases falls short by the equivalent of 532 beds.

Nigeria

July 2014

  • The first case in Nigeria was a Liberian-American, Patrick Sawyer, who flew from Liberia to Nigeria's former capital Lagos. Sawyer became violently ill upon arriving at the airport and died five days later. In response, the Nigerian government as part of the containment efforts, monitored 353 possible contacts in Lagos and 451 in Port Harcourt.
  • The Nigerian government increased surveillance at all entry points to the country.
  • Health officials were placed at entry points to conduct tests on people arriving in the country.
  • Arik Air, Nigeria's main airline, stopped flights to Liberia and Sierra Leone.

August 2014

  • 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 [newly confirmed] cases are being treated at an isolation ward."
  • There were 11 confirmed cases of EVD reported in Nigeria.
  • The Nigerian National Health Research Ethics Committee issued a statement waiving the regular administrative requirements that limit the international shipment of any biological samples out of Nigeria and supporting the use of non-validated treatments without prior review and approval by a health research ethics committee. Other than increased surveillance at the country's borders, the Nigerian government stated that they have also made attempts to control the spread of disease through an improvement in tracking, providing education to avert disinformation and increase accurate information, and the teaching of appropriate hygiene measures.
  • The doctor who treated Sawyer, Ameyo Adadevoh, 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.
  • The Commissioner of Health in Lagos announced that Nigeria had seen twelve confirmed cases; four died (including the index case) while another five, including two doctors and a nurse, were declared disease-free and released.

September 2014

  • 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."
  • The WHO stated that Nigeria had not reported any new cases since 8 September and if no further cases are reported, Nigeria will be declared Ebola-free on 20 October.
  • The WHO reported a total of 20 cases with 8 deaths. They continue to monitor a few contacts, but the disease appears to now be contained in Nigeria.

Senegal

March 2014

  • The Senegal Ministry of Interior closed the southern border with Guinea.

August 2014

  • The Senegalese Health Minister Awa Marie Coll Seck announced Senegal's first case, a university student from Guinea who was being treated in Dakar. The student 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. He sought medical care for symptoms including fever, diarrhea, and vomiting. He received treatment for malaria, but did not improve and left the facility. Still experiencing the same symptoms, he was referred to a specialized facility for infectious diseases, and was subsequently hospitalized.

September 2014

  • The university student from Guinea subsequently recovered and the WHO announced that all contacts had completed a 21-day follow-up with no further cases of Ebola in Senegal.

Countries with Imported Cases

The following countries have reported imported cases since the 2014 Ebola outbreak in West Africa:

  • France - One French volunteer health worker in Liberia: survived.
  • Germany - One Senegalese epidemiologist working for the WHO in Sierra Leone
  • Spain - Spanish Brother volunteering in Liberia: died.
  • India - 821 people were being monitored for the Ebola virus derived from 112 Indian citizens and 4 Nepalese citizens who had landed in Mumbai and Delhi from Liberia.
  • United Kingdom-British citizen evacuated from Sierra Leone: survived.
  • United States

American aid worker Kent Brantly, a physician, became infected with Ebola while working in a Monrovia treatment center as medical director for the aid group Samaritan's Purse; Nancy Writebol, one of Brantly's missionary co-workers, became infected at the same time. Both were flown to the United States at the beginning of August for further treatment in Atlanta's Emory University Hospital, near the headquarters of the Centers for Disease Control. Both survived. Both survived.

A Boston physician, Rick Sacra, was airlifted from Liberia to be treated in the United States. He is the third US missionary, working for Serving in Mission (SIM), who had tested positive for the disease. Sacra was being treated in Omaha at the Nebraska Medical Center. The doctor did not get infected while treating Ebola patients, but was exposed to the virus while delivering babies at a hospital in Liberia. On 9 September, it was reported that Sacra had received an experimental therapy (not ZMapp) and it was later announced that he had received a blood transfusion from Kent Brantly, the American physician who had recovered from the disease. It has been theorized that transfusing blood products from former Ebola patients may assist a diseased person's immune system to fight the disease. He survived a fourth U.S. citizen who contracted the Ebola virus arrived at Emory University Hospital in Atlanta for treatment. The patient was airlifted from Sierra Leone and landed at Dobbins Air Reserve Base. The identity of the patient, a male doctor working for the WHO in Sierra Leone, has not been released. According to doctors at the hospital, he will not be receiving any experimental treatment and will only receive supportive care to boost his immune system. The patient exited the ambulance and was assisted into the hospital while walking on his own.

Thomas Eric Duncan, a Liberian national, flew to Dallas, Texas to visit family. He left Liberia on September 19, 2014 and arrived in Dallas on September 20th. On September 24th he developed symptoms and sought medical care at Texas Health Presbyterian Hospital and was discharged from the Emergency Department on antibiotics. He returned to the same hospital via EMS on September 28th and was admitted. On September 30th the CDC confirmed Ebola. Ashoka Makpo, an NBC cameraman, tested positive for Ebola in Liberia. He began feeling achy and tired on October 1, 2014. He will be flown back to the USA on October 10, 2014. Medical institution unknown.

2014 Ebola Virus Epidemic In The Democratic Republic Of The Congo

August 2014

  • An outbreak of Ebola Virus in the Democratic Republic of Congo (DRC) was reported. The index case and the 80 contacts had no history of travel to the Ebola-affected countries or history of contact with individuals from the affected areas. It is believed that the outbreak in the DRC is unrelated to the ongoing outbreak in West Africa.
  • Several people, including four health care workers, were reported to have died of Ebola-like symptoms in the remote northern Équateur province, a province that lies about 750 miles north of the capital Kinshasa.
  • 13 people were reported to have died with similar symptoms.
  • The Équateur Province Ministry of Health confirmed an outbreak of Ebola to the WHO. The initial case was a woman from Ikanamongo Village who became ill with symptoms of Ebola after she had butchered a bush animal that her husband had killed. She was treated in a private clinic, but on 11 August she died of a then-unidentified hemorrhagic fever. The following week, relatives of the woman, several health-care workers who had treated the woman, and individuals with whom they had been in contact came down with similar symptoms. Five health care workers subsequently died.

September 2014

  • The WHO said that there were currently 31 deaths in the Northern Boende area in the province of Équateur and 53 confirmed, suspected or likely cases. The WHO confirmed that the current strain of the virus in the Boende District is the Zaire Ebola species. This strain is common in the country and similar to the 1995 Kikwit outbreak in the DRC. The virology results and epidemiological findings indicated no connection to the current epidemic in West Africa.
  • The WHO raised the number of cases to 62 and the death toll to 35 from possible or confirmed Ebola cases. Included in this number are 9 health-care workers with 7 deaths among them. In total 386 contacts have been listed and 239 contacts are being followed up. The outbreak is still contained in Jeera County in the Boende region.
  • The WHO raised the number of cases to 71 and the death toll to 40 from possible or confirmed Ebola cases.

Natural Reservoir Hosts

The natural reservoir host of ebolaviruses remains unknown. However, on the basis of available evidence and the nature of similar viruses, researchers believe that the virus is animal-borne with bats, particularly fruit bats, being considered the most likely natural reservoir of the Ebola virus (EBOV).

In the 1976 and 1979 outbreaks in the cotton factory where the first cases of EBOV were employed, bats were known to roost. Only bats became infected when 24 plant species and 19 vertebrate species were experimentally inoculated with EBOV. The absence of clinical signs in these bats is characteristic of a reservoir species. In a 2002–2003 survey of 1,030 animals including 679 bats from Gabon and the Republic of the Congo, 13 fruit bats were found to contain EBOV RNA fragments. As of 2005, three types of fruit bats (Hypsignathus monstrosus, Epomops franqueti, and Myonycteris torquata) have been identified as being in contact with EBOV. They are now suspected to represent the EBOV reservoir hosts. Antibodies against Ebola Zaire and Reston viruses have been found in fruit bats in Bangladesh, thus identifying potential virus hosts and signs of the filoviruses in Asia.

Between 1976 and 1998, in 30,000 mammals, birds, reptiles, amphibians, and arthropods sampled from outbreak regions, no ebolavirus was detected apart from some genetic traces found in six rodents (Mus setulosus and Praomys) and one shrew (Sylvisorex ollula) collected from the Central African Republic. Traces of EBOV were detected in the carcasses of gorillas and chimpanzees during outbreaks in 2001 and 2003, which later became the source of human infections. However, the high lethality from infection in these species makes them unlikely as a natural reservoir.

Bushmeat
Bushmeat Ebola
Bushmeat being prepared for cooking. Human consumption of equatorial animals in Africa in the form of bushmeat has been linked to the transmission of diseases to people, including Ebola.

Transmission

Because the natural reservoir of ebolaviruses has not yet been proven, the manner in which the virus first appears in humans at the start of an outbreak remains unknown. EVD outbreaks are usually traceable to a single individual who has handled an infected animals body fluids while skinning the carcass of a gorilla, chimpanzee, or duiker.

Bats drop partially eaten fruits and pulp onto the ground then land mammals such as gorillas and duikers feed on these fallen fruits. This chain of events forms a possible indirect means of transmission from the natural host to animal populations, which has led to research towards viral shedding in the saliva of bats. Fruit bats are also eaten by people in parts of West Africa where they are smoked, grilled or made into a spicy soup. (Diagram 3).

Fruit production, animal behavior, and other factors vary at different times and places that may trigger outbreaks among animal populations.

Diagram 3: LIFE CYCLES OF THE EBOLA VIRUS
Ebola Life Cycle

Human-to-human transmission of EVD infections is considered low as the disease is only spread by direct contact with the secretions from an individual who is showing the signs and symptoms of infection. EVD is spread by:

  • Direct contact with blood or bodily fluids (urine, feces, vomit, semen) from an infected person (including embalming of an infected dead person).
  • Through broken skin or mucus membranes.
  • Contact with contaminated medical equipment, particularly needles and syringes
  • Sexual intercourse with a male since semen is infectious in survivors for up to 7 weeks.
  • Oral exposure and exposure to conjunctival secretions since these have been confirmed in non-human primates.

The quick onset of symptoms makes it easier to identify sick individuals and limits an infected individual's ability to spread the disease by traveling. Because dead bodies are still infectious, some doctors dispose of them by cremation, despite local traditional burial rituals.

Healthcare workers have also contracted EVD. In these cases, transmission has occurred because:

  • Appropriate protective clothing including masks, goggles, face shields, gowns and gloves have not been worn
  • Needles and syringes have been reused without being appropriately sterilized
  • Improper sterilization of instruments before being used again occurred
  • There is a lack of use of universal precautions

Airborne transmission has not been documented during previous EVD outbreaks. The Ebola virus is, however, infectious as breathable 0.8–1.2 micrometre laboratory generated droplets. Because of this potential route of infection, ebolaviruses have been classified as Category A biological weapons.

Healthcare workers, family and friends in close contact with Ebola patients are at the highest risk of contracting EVD because they may come in contact with infected blood or body fluids.

Signs And Symptoms

The average time between exposure to the Ebola virus thus contracting EVD and the onset of symptoms may range anywhere from 2 to 21 days, although 8-10 days is most common.

Signs and symptoms of EVD usually begin suddenly with a flu-like stage characterized by (Diagram 4):

  • fatigue
  • fever (greater than 38.6°C or 101.5°F)
  • headaches
  • joint and muscle pain
  • abdominal (stomach) pain
  • vomiting
  • diarrhea
  • loss of appetite

Less common symptoms include the following: sore throat

  • chest pain
  • hiccups
  • shortness of breath
  • trouble swallowing
  • decreased functioning of the liver and kidneys

Skin manifestations may include a maculopapular rash (in about 50% of cases). Not all infected individuals show hemorrhagic symptoms.

All infected individuals show some symptoms of circulatory system involvement, including impaired blood clotting. In 40–50% of cases, bleeding from puncture sites and mucous membranes (e.g. gastrointestinal tract, nose, vagina and gums) have been reported.

In the bleeding phase, which typically starts 5 to 7 days after first symptoms:

  • internal and subcutaneous bleeding may present itself through reddening of the eyes and bloody vomit
  • bleeding into the skin may create petechiae, purpura, ecchymoses, and hematomas (especially around needle injection sites)
  • types of bleeding known to occur with EVD include: vomiting blood, coughing up blood, bloody stools
  • Heavy bleeding is rare and is usually confined to the gastrointestinal tract

In general, the development of bleeding symptoms often indicates a worse prognosis and this blood loss can result in death. If the infected individual does not recover, death due to multiple organ dysfunction syndrome occurs within 7 to 16 days (usually between days 8 and 9) after the onset of first symptoms.

Some who become sick with EVD recover. Why this occurs is unknown. However, individuals who die usually have not developed a significant immune response to the virus at the time of death.

Diagram 4: SYMPTOMS OF EBOLA
Diagram-4

Pathophysiology

Endothelial cells, mononuclear phagocytes, and hepatocytes are the main targets of the Ebola virus. After infection, a secreted glycoprotein (sGP) known as the Ebola virus glycoprotein (GP) is synthesized. Ebola replication overwhelms protein synthesis of infected cells and host immune defenses. The GP forms a trimeric complex, which binds the virus to the endothelial cells lining the interior surface of blood vessels. The sGP forms a dimeric protein that interferes with the signaling of neutrophils, a type of white blood cell, which allows the virus to evade the immune system by inhibiting early steps of neutrophil activation. These white blood cells also serve as carriers to transport the virus throughout the entire body to places such as the lymph nodes, liver, lungs, and spleen.

The presence of viral particles and cell damage resulting from budding causes the release of cytokines (to be specific, TNF-a, IL-6, IL-8, etc.), which are the signaling molecules for fever and inflammation. The cytopathic effect, from infection in the endothelial cells, results in a loss of vascular integrity. This loss in vascular integrity is furthered with synthesis of GP, which reduces specific integrins responsible for cell adhesion to the inter-cellular structure, and damage to the liver, which leads to coagulopathy. (Diagram 5).

Diagram 5: PATHOGENESIS SCHEMATIC
Diagram-5

Medical History/Laboratory And Diagnostic

Tests

The medical history including travel (country, dates of travel), work history and exposure to wildlife are clues which should lead the healthcare worker to suspect the diagnosis of EVD.

The diagnosis is confirmed by isolating the virus itself, detecting its RNA or proteins, or detecting antibodies against the virus in a person's blood. Isolating the virus by cell culture, detecting the viral RNA by polymerase chain reaction (PCR) and detecting proteins by enzyme-linked immunosorbent assay (ELISA) is effective early and in those who have died from the disease. Detecting antibodies against the virus is effective late in the disease and in those who recover.

During an outbreak, virus isolation is often not feasible. The most common diagnostic tests are therefore real time PCR and ELISA detection of proteins, which can be performed in field or mobile hospitals. Filovirions can be seen and identified in cell culture by electron microscopy due to their unique filamentous shapes, but electron microscopy cannot tell the difference between the various filoviruses despite there being some length differences.

Timeline of Infection Diagnostic Tests Available
Within a few days after symptoms begin
  • Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing
  • IgM ELISA
  • Polymerase chain reaction (PCR)
  • Virus isolation
Later in disease course or after recovery
  • IgM and IgG antibodies
Retrospectively in deceased patients
  • Immunohistochemistry testing
  • PCR
  • Virus isolation

Differential Diagnosis

Early symptoms of EVD may be similar to those of dengue fever, Marburg virus disease, viral hemorrhagic fever, falciparum malaria, typhoid fever, shigellosis, rickettsial diseases such as typhus, cholera, gram-negative septicemia, borreliosis such as relapsing fever or EHEC enteritis.

Other infectious diseases that should be included in the differential diagnosis include: leptospirosis, scrub typhus, plague, Q fever, candidiasis, histoplasmosis, measles, trypanosomiasis, visceral leishmaniasis, hemorrhagic smallpox, and fulminant viral hepatitis.

Non-infectious diseases that can be confused with EVD include: acute promyelocytic leukemia, hemolytic uremic syndrome, snake envenomation, clotting factor deficiencies/platelet disorders, thrombotic thrombocytopenic purpura, hereditary hemorrhagic telangiectasia, Kawasaki disease, and even warfarin poisoning.

Prevention/Education

Behavioral Changes

Ebola viruses are contagious after the onset of symptoms so preventing the spread of EVD is paramount. Healthcare providers caring for individuals with EVD, as well as, family and friends in close contact with individuals with EVD are at the highest risk of contracting the disease. Behavioral changes include:

  • Frequent hand washing before and after patient contact, contact with potentially infectious material and before putting on and after removing personal protective equipment (PPE) including gloves. This simple action can be difficult in areas where there is not even enough water for drinking.
  • Avoiding contact with blood and bodily secretions of any individual especially one who is already sick including items that may have come in contact with an ill individuals blood or body secretions.
  • Wearing full body personal protective equipment (PPE) including gowns, gloves, masks and goggles and/or face shield.        Using infection-control measures such as complete sterilization of equipment and routine use of disinfectant.
  • Avoiding touching the body of a deceased individual who has died of Ebola.
  • Discouraging or modifying traditional burial rituals, especially those requiring embalming of bodies.
  • Avoiding touching bats and nonhuman primates or their blood or body secretions and especially touching or eating raw meat prepared from these animals.
  • Using standard precautions for all patients in the healthcare setting.
  • Isolating all patients with suspected or confirmed EVD when caring for them.
  • Immediately seeking healthcare should an individual begin to feel ill especially if they have been exposed to anyone who has been diagnosed with EVD. 

Due to lack of proper equipment and hygienic practices, large-scale epidemics have occurred mostly in poor, isolated areas without modern hospitals or well-educated medical staff. Airline crews who fly to these areas of the world are taught to identify potential Ebola victims and isolate anyone who has symptoms.

Quarantine

Quarantine, also known as enforced isolation, is usually effective in decreasing the spread of EVD. Governments often quarantine areas where the disease is occurring or individuals who may be infected. In the United States the law allows quarantine of those infected with Ebola. The lack of roads and transportation may help slow the disease in Africa.

Vaccine

No vaccine is currently available for humans. The most promising candidates are DNA vaccines or vaccines derived from adenoviruses, vesicular stomatitis Indiana virus (VSIV) or filovirus-like particles (VLPs) because these candidates could protect nonhuman primates from ebolavirus-induced disease. DNA vaccines, adenovirus-based vaccines, and VSIV-based vaccines have entered clinical trials.

Vaccines have protected nonhuman primates such as crab-eating macaques and mice but the development and rigorous testing and trials on humans remains a long way off.

Treatment

No proven ebolavirus-specific treatment exists. Treatment is primarily supportive in nature and includes:

  • either oral rehydration therapy (slightly sweet and salty water to drink) or intravenous fluids
  • balancing fluids and electrolytes to counter dehydration
  • minimizing invasive procedures
  • administration of anticoagulants early in infection to prevent or control disseminated intravascular coagulation        administration of procoagulants late in infection to control bleeding
  • maintaining oxygen levels
  • pain management
  • the use of medications to treat bacterial or fungal secondary infections

Early treatment may increase the chance of survival. Timely treatment of EVD is important but challenging because the disease is difficult to diagnose clinically in the early stages of infection. Because early symptoms, such as headache and fever, are nonspecific to Ebola viruses, cases of EVD may be initially misdiagnosed.

Experimental Treatments

The lack of treatments in the most-affected regions has spurred controversy. Some individuals are demanding that experimental drugs be made more widely available in Africa on a humanitarian basis. Other individuals warn that making unproven drugs widely available would be unethical, especially in light of past experimentation conducted in developing countries by Western drug companies. As a result of the controversy, on August 12, 2014 an expert panel of the WHO endorsed the use of interventions with as-yet-unknown effects for both treatment and prevention of EVD. The WHO expert panel also stated that deciding which treatments should be used and how to distribute them equitably were matters that needed further discussion.

Subsequently the WHO Assistant Director-General for Health Systems and Innovation said on September 5, 2014 that transfusion of whole blood or purified serum from Ebola survivors is the therapy with the greatest potential to be implemented immediately on a large scale in West Africa, although there is little information on the efficacy of such treatment.

In mid-September the sale of black market blood from survivors of the disease had become a new trend in the Ebola-affected regions. Serum derived blood from surviving victims has been used under strict control in certain cases. This trend in an uncontrolled manner could potentially lead to other infectious diseases. This treatment must be properly implemented as a medical treatment under strict control and screening of possible donors. Margaret Chan of the WHO has criticized the use of this practice in a black market environment, noting concerns over "storage and collection methods".

A number of experimental treatments are being studied or will undergo trials:

  • ZMapp, being developed by Mapp Biopharmaceuticals, Inc., is a monoclonal antibody vaccine. It is still in the experimental stage and randomized controlled clinical trials still need to be conducted. The limited supply of the drug has been used to treat a small number of individuals infected with the Ebola virus. Although some of these have recovered the outcome is not considered statistically significant. ZMapp has proved highly effective in a trial involving rhesus macaque monkeys.
  • TKM-Ebola, an RNA interference drug.
  • Favipiravir, a drug approved in Japan for stockpiling against influenza pandemics. The drug appears to be useful in a mouse model of the disease. Japan has offered to supply the drug if requested by the WHO.
  • In September, an experimental vaccine, currently known as the NIAID/GSK vaccine, commenced simultaneous Phase 1 trials in Oxford and Bethesda. The vaccine was developed jointly by GlaxoSmithKline and the NIH. If this phase is completed successfully, the vaccine will be fast tracked for use in West Africa. In preparation for this, GSK is preparing a stockpile of 10,000 doses.

It is important to remember that vaccines are usually given to individuals before they are exposed to a virus that causes a disease. A vaccine stimulates the immune system to generate antibodies and cellular immunity that can fight off an infection should it occur. Typically, therapeutics are provided to individuals who are already infected with a virus. As can be seen, prevention of EVD is the best route to take while waiting for the development and rigorous testing of vaccines and other therapeutic treatments.

Prognosis

The disease has a high mortality rate: often between 50 percent and 90 percent. April 2014 information from the WHO across all occurrences to date puts the overall fatality rate at 60%-65%. There are indications based on variations in death rate between countries that early and effective treatment of symptoms (e.g., supportive care to prevent dehydration) may reduce the fatality rate significantly.

If an infected individual survives, recovery may be quick and complete. Prolonged cases are often complicated by the occurrence of long-term problems, such as:

  • inflammation of the testicles
  • joint pains
  • muscle pains
  • skin peeling
  • hair loss
  • eye symptoms may include: light sensitivity, excess tearing, iritis, iridocyclitis, choroiditis and blindness

EBOV and SUDV may be able to persist in the semen of some survivors for up to seven weeks, which could give rise to infections and disease via sexual intercourse.

Projections

The basic reproduction number is a statistical measure of the 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 and if the rate is greater than 1 the infection will continue to spread in a population.

Using data supplied by the WHO, several studies have estimated the reproduction number of the EVD epidemic in West Africa between 1.2 and 2.5, with variations between countries and time during the outbreak. The basic reproduction number of EVD together with its generation time, which is the time between initial infection and transmission to others, cause the cumulative number of infected cases to double every two to three weeks in some affected areas.

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. 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. The WHO acknowledges that the aggregate case load of EVD 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 3 months." It does not provide details of how it made this total casualty estimate or a more detailed projection of how Ebola casualty statistics might evolve over time. It includes an assumption that some country or countries will pay the required cost of their plan, estimated at half a billion dollars.

A number of epidemiologists have highlighted that the WHO projection of a total of 20,000 cases might be an underestimate. On August 31, the journal Science quoted Christian Althaus, a mathematical epidemiologist at the University of Bern in Switzerland, as saying that if the epidemic were to continue in this way until December, the cumulative number of cases would exceed 100,000 in Liberia alone.

According to a research paper released in early September, in the hypothetical worst-case scenario, if a reproduction number of over 1.0 continues for the remainder of the year we would expect to observe a total of 77,181 to 277,124 additional cases within 2014.

Writing in the NYT on 12 September, Bryan Lewis, an epidemiologist at the Virginia Bioinformatics Institute at Virginia Tech, said that researchers at various universities who have been using computer models to track the growth rate say that at the virus's present rate of growth, there could easily be close to 20,000 cases in one month, not in nine.

On 3 September, Thomas Kenyon, Director of the U.S. CDC's Center for Global Health said, "The highly virulent disease, which has claimed more than 1,900 lives so far, is spreading faster than health workers in Guinea, Liberia, Nigeria and Sierra Leone can manage".

Similar comments were made by Anthony Fauci, Director of the US NIH's National Institute of Allergy and Infectious Diseases, who said that 42 percent of the cases have occurred in the last month and that the outbreak is "completely out of control". He further noted that the rate of infection is exponential: "The number of cases per unit time is dramatically increasing."

On 8 September, the WHO warned that the number of new cases in Liberia was increasing exponentially, and would increase by "many thousands" in the following 3 weeks.

On 9 September, Jonas Schmidt-Chanasit of the Bernhard Nocht Institute for Tropical Medicine controversially announced that the containment fight in Sierra Leone and Liberia had already been "lost" and that the disease will "burn itself out" after eventually infecting nearly the entire population, with half of them,  around five million, dying.

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, cordon sanitaire (fear of human contact), leading to loss of income for producers and traders.
  • Movement of people away from affected areas has disturbed agricultural activities. The U.N. Food and Agriculture Organization (FAO) have warned that the outbreak could endanger harvest and food security in West Africa.
  • Tourism is directly impacted in affected countries. Other countries in Africa which are not directly affected by the virus have also reported adverse effects on tourism.
  • Foreign mining companies have withdrawn non-essential personnel, deferred new investment, and cut back operations.
  • Many airlines have experienced reduced traffic. Some airlines have suspended flights to the area.
  • Forecasts of economic growth have been reduced. A 4 August World Bank-IMF assessment for Guinea projected a full percentage point fall in GDP growth from 4.5 percent to 3.5 percent and on 17 September, they reported that if the epidemic continues to grow, the affected countries could see the economic impact grow eight-fold, "dealing a potentially catastrophic blow to the already fragile states."
  • The outbreak is straining the finances of governments, with Sierra Leone using Treasury bills to fund the fight against the virus.
  • The IMF is considering expanding assistance to Guinea, Sierra Leone, and Liberia as their national deficits balloon and their economies contract sharply.

Global Responses

International Organizations which have responded to the Ebola Epidemic in West Africa and the Democratic Republic of the Congo include the:

  • World Health Organization
  • US Centers for Disease Control
  • Médecins Sans Frontières
  • Economic Community of West African States (ECOWAS)
  • European Union
  • World Bank Group
  • World Food Program
  • United Nations Security Council
  • US NIH's National Institute of Allergy and Infectious Diseases

Charitable Organizations, Foundations and Individuals include:

  • Bill and Melinda Gates Foundation
  • Paul G. Allen Family Foundation
  • Samaritan's Purse
  • Red Cross
  • Aiko Dangote

It would be fair to say that most countries circling the globe have responded with:

  • Money
  • Health care supplies including medical protective clothing, disinfectants, thermodetectors and medicines
  • Health Care Teams including Infectious Disease Specialists and research teams
  • Initiated stepped up surveillance of all travelers entering or leaving the country by air or sea from Ebola-affected regions
  • Issued travel advisories
  • Food and water donations
  • Sent healthcare personnel or other personnel i.e. military personnel to assist in the construction of hospitals/clinics to aid the volumes of ill individuals

Conclusion

Anxiety and fear now has struck the United States and other countries of the world since EVD is no longer being viewed as "just an African problem". Despite all the best intentions and best efforts the Ebola epidemic in West Africa continues to spread exponentially. The Ebola epidemic in the DRC is just beginning to pick up speed. Now the whole world feels threatened, so much so, that most average everyday people feel at risk.

Instead of feeling afraid and becoming paranoid use common sense: wash your hands, pay attention to those who seem to "have the flu", ask questions about recent travel, to what country, exposure to bushmeat etc. Remember, despite what you may think, African "bushmeat" is illegally sold here in America.

The Centers for Disease Control and Prevention offer protocols for diagnosis/testing, transportation/monitoring/movement, protecting healthcare workers, EVD information for clinicians in U.S. healthcare settings and other very valuable information for caring for the Ebola patient and keeping all others safe.

Literature Review/Resources/References

References

Books/Journals

Alazard-Dany N, Ottmann Terrangle M, Volchkov V (2006). "[Ebola and Marburg viruses: the humans strike back]". Med Sci (Paris) (in French) 22 (4): 405–10.

Althaus, Christian L. "Estimating the Reproduction Number of Ebola Virus (EBOV) During the 2014 Outbreak in West Africa". PLoS Currents.

Baize, Sylvain; Pannetier, Delphine; Oestereich, Lisa; Rieger, Toni (16 April 2014). "Emergence of Zaire Ebola Virus Disease in Guinea — Preliminary Report". New England Journal of Medicine.

Bogomolov BP (1998). "Differential diagnosis of infectious diseases with hemorrhagic syndrome". Terapevticheskii arkhiv 70 (4): 63–68.

Barrette, R.; Metwally, S.; Rowland, J.; Xu, L.; Zaki, S.; Nichol, S.; Rollin, P.; Towner, J.; Shieh, W.; Batten, B.; Sealy, T. K.; Carrillo, C.; Moran, K. E.; Bracht, A. J.; Mayr, G. A.; Sirios-Cruz, M.; Catbagan, D. P.; Lautner, E. A.; Ksiazek, T. G.; White, W. R.; McIntosh, M. T. (2009). "Discovery of swine as a host for the Reston ebolavirus". Science 325 (5937): 204–206.

Bausch DG, Feldmann H, Geisbert TW, Bray M, Sprecher AG, Boumandouki P, Rollin PE, Roth C (2007). "Outbreaks of Filovirus Hemorrhagic Fever: Time to Refocus on the Patient". The Journal of Infectious Diseases 196: S136–S141.

Bush, L (2005). "Crucell and NIH sign Ebola vaccine manufacturing contract". Pharmaceutical Technology 29: 28.

Choi JH, Croyle MA (December 2013). "Emerging targets and novel approaches to Ebola virus prophylaxis and treatment". BioDrugs 27 (6): 565–83.

Fauquet C.M.. (2005). Virus taxonomy classification and nomenclature of viruses; 8th report of the International Committee on Taxonomy of Viruses. Oxford: Elsevier/Academic Press. p. 648.

Fisher-Hoch SP, Platt GS, Neild GH, Southee T, Baskerville A, Raymond RT, Lloyd G, Simpson DI (1985). "Pathophysiology of shock and hemorrhage in a fulminating viral infection (Ebola)". J. Infect. Dis. 152 (5): 887–894.

Fisman, David; Khoo, Edwin; Tuite, Ashleigh. "Early Epidemic Dynamics of the West African 2014 Ebola Outbreak: Estimates Derived with a Simple Two-Parameter Model". PLoS Currents.

Formenty, P.; Libama, F.; Epelboin, A.; Allarangar, Y.; Leroy, E.; Moudzeo, H.; Tarangonia, P.; Molamou, A.; Lenzi, M.; Ait-Ikhlef, K.; Hewlett, B.; Roth, C.; Grein, T. (2003). "Outbreak of Ebola hemorrhagic fever in the Republic of the Congo, 2003: a new strategy?" Medecine tropicale 63 (3): 291–295.

Gatherer D (2014). "The 2014 Ebola virus disease outbreak in West Africa". J. Gen. Virol. 95 (Pt 8): 1619–1624.

Gear JH (1989). "Clinical aspects of African viral hemorrhagic fevers". Reviews of infectious diseases. 11 Suppl 4: S777–S782.

Gear JH, Ryan J, Rossouw E (1978). "A consideration of the diagnosis of dangerous infectious fevers in South Africa". South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 53 (7): 235–237.

Geisbert TW, Jahrling PB (1995). "Differentiation of filoviruses by electron microscopy". Virus research 39 (2–3): 129–150.

Geisbert TW, Daddario-Dicaprio KM, Lewis MG, Geisbert JB, Grolla A, Leung A, Paragas J, Matthias L, Smith MA, Jones SM, Hensley LE, Feldmann H, Jahrling PB (2008). "Vesicular Stomatitis Virus-Based Ebola Vaccine is Well-Tolerated and Protects Immunocompromised Nonhuman Primates". In Kawaoka, Yoshihiro. PLoS Pathogens 4 (11): e1000225.

Geisbert TW, Geisbert JB, Leung A, Daddario-DiCaprio KM, Hensley LE, Grolla A, Feldmann H (2009). "Single-Injection Vaccine Protects Nonhuman Primates against Infection with Marburg Virus and Three Species of Ebola Virus". Journal of Virology 83 (14): 7296–7304.

Geisbert TW, Daddario-Dicaprio KM, Geisbert JB, Reed DS, Feldmann F, Grolla A, Ströher U, Fritz EA, Hensley LE, Jones SM, Feldmann H (2008). "Vesicular stomatitis virus-based vaccines protect nonhuman primates against aerosol challenge with Ebola and Marburg viruses". Vaccine 26 (52): 6894–6900.

Georges, A. J.; Leroy, E. M.; Renaut, A. A.; Benissan, C. T.; Nabias, R. J.; Ngoc, M. T.; Obiang, P. I.; Lepage, J. P. M.; Bertherat, E. J.; Bénoni, D. D.; Wickings, E. J.; Amblard, J. P.; Lansoud-Soukate, J. M.; Milleliri, J. M.; Baize, S.; Georges-Courbot, M. C. (1999). "Ebola Hemorrhagic Fever Outbreaks in Gabon, 1994–1997: Epidemiologic and Health Control Issues". The Journal of Infectious Diseases 179: S65–S75.

Gire, S.; et al (28 August 2014). "Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak". Science.

Gomes, Marcelo F. C.; Pastore y Piontti, Ana; Rossi, Luca; Chao, Dennis; Longini, Ira; Halloran, M. Elizabeth; Vespignani, Alessandro. "Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak". PLoS Currents.

Gonzalez JP, Pourrut X, Leroy E (2007). "Ebolavirus and other filoviruses". Current topics in microbiology and immunology. Current Topics in Microbiology and Immunology 315: 363–387.

Grolla A, Lucht A, Dick D, Strong JE, Feldmann H (2005). "Laboratory diagnosis of Ebola and Marburg hemorrhagic fever". Bull Soc Pathol Exot 98 (3): 205–9.

Hayes, C. G.; Burans, J. P.; Ksiazek, T. G.; Del Rosario, R. A.; Miranda, M. E.; Manaloto, C. R.; Barrientos, A. B.; Robles, C. G.; Dayrit, M. M.; Peters, C. J. (1992). "Outbreak of fatal illness among captive macaques in the Philippines caused by an Ebola-related filovirus". The American journal of tropical medicine and hygiene 46 (6): 664–671.

Heymann, D. L.; Weisfeld, J. S.; Webb, P. A.; Johnson, K. M.; Cairns, T.; Berquist, H. (1980). "Ebola hemorrhagic fever: Tandala, Zaire, 1977-1978". The Journal of infectious diseases 142 (3): 372–376.

Hoenen T, Groseth A, Falzarano D, Feldmann H (May 2006). "Ebola virus: unravelling pathogenesis to combat a deadly disease". Trends in Molecular Medicine 12 (5): 206–215.

Hoenen T, Groseth A, Feldmann H (July 2012). "Current ebola vaccines". Expert Opinion on Biological Therapy 12 (7): 859–72.

Jaax N, Jahrling P, Geisbert T, Geisbert J, Steele K, McKee K, Nagley D, Johnson E, Jaax G, Peters C (Dec 1995). "Transmission of Ebola virus (Zaire strain) to uninfected control monkeys in a biocontainment laboratory". Lancet 346 (8991–8992): 1669–1671.

Jaax NK, Davis KJ, Geisbert TJ, Vogel P, Jaax GP, Topper M, Jahrling PB (Feb 1996). "Timed appearance of lymphocytic choriomeningitis virus after gastric inoculation of mice". Archives of pathology & laboratory medicine 120 (2): 140–155.

Jahrling, P. B.; Geisbert, T. W.; Dalgard, D. W.; Johnson, E. D.; Ksiazek, T. G.; Hall, W. C.; Peters, C. J. (1990). "Preliminary report: isolation of Ebola virus from monkeys imported to USA". Lancet 335 (8688): 502–505.

Jeffs B (2006). "A clinical guide to viral haemorrhagic fevers: Ebola, Marburg and Lassa". Tropical Doctor 36 (1): 1–4.

Johnson E, Jaax N, White J, Jahrling P (Aug 1995). "Lethal experimental infections of rhesus monkeys by aerosolized Ebola virus". International journal of experimental pathology 76 (4): 227–236.

Khan, A. S.; Tshioko, F. K.; Heymann, D. L.; Le Guenno, B.; Nabeth, P.; Kerstiëns, B.; Fleerackers, Y.; Kilmarx, P. H.; Rodier, G. R.; Nkuku, O.; Rollin, P. E.; Sanchez, A.; Zaki, S. R.; Swanepoel, R.; Tomori, O.; Nichol, S. T.; Peters, C. J.; Muyembe-Tamfum, J. J.; Ksiazek, T. G. (1999). "The Reemergence of Ebola Hemorrhagic Fever, Democratic Republic of the Congo, 1995". The Journal of Infectious Diseases 179: S76–S86.

Kupferschmidt, Kai. "Disease modelers project a rapidly rising toll from Ebola". Science Magazine.

Lashley, edited by Felissa R.; Durham, Jerry D. (2007). Emerging infectious diseases trends and issues (2nd ed. ed.). New York: Springer Pub. Co. p. 141.

Leffel EK, Reed DS (2004). "Marburg and Ebola viruses as aerosol threats". Biosecurity and bioterrorism: biodefense strategy, practice, and science 2 (3): 186–191.

Le Guenno, B.; Formenty, P.; Wyers, M.; Gounon, P.; Walker, F.; Boesch, C. (1995). "Isolation and partial characterisation of a new strain of Ebola virus". Lancet 345 (8960): 1271–1274.

Leroy EM, Kumulungui B, Pourrut X, Rouquet P, Hassanin A, Yaba P, Délicat A, Paweska JT, Gonzalez JP, Swanepoel R (2005). "Fruit bats as reservoirs of Ebola virus". Nature 438 (7068): 575–576.

Longo, DL; Kasper, DL; Jameson, JL; Fauci, AS; Hauser, SL; Loscalzo, J, eds. (2012). "Chapter 197". Harrison's Principles of Internal Medicine (18th ed.). McGraw-Hill.

Martin JE, Sullivan NJ, Enama ME, Gordon IJ, Roederer M, Koup RA, Bailer RT, Chakrabarti BK, Bailey MA, Gomez PL, Andrews CA, Moodie Z, Gu L, Stein JA, Nabel GJ, Graham BS (2006). "A DNA Vaccine for Ebola Virus is Safe and Immunogenic in a Phase I Clinical Trial". Clinical and Vaccine Immunology 13 (11): 1267–1277.

Miranda, M. E.; Ksiazek, T. G.; Retuya, T. J.; Khan, A. S.; Sanchez, A.; Fulhorst, C. F.; Rollin, P. E.; Calaor, A. B.; Manalo, D. L.; Roces, M. C.; Dayrit, M. M.; Peters, C. J. (1999). "Epidemiology of Ebola (Subtype Reston) Virus in the Philippines, 1996". The Journal of Infectious Diseases 179: S115–S119.

Morvan JM, Deubel V, Gounon P, Nakouné E, Barrière P, Murri S, Perpète O, Selekon B, Coudrier D, Gautier-Hion A, Colyn M, Volehkov V (1999). "Identification of Ebola virus sequences present as RNA or DNA in organs of terrestrial small mammals of the Central African Republic". Microbes and Infection 1 (14): 1193–1201.

Netesov, SV; Feldmann, H; Jahrling, PB; Kiley, MP; Klenk, H-D; Sanchez, A (2004-04-24). "Filoviridae". International Committee on Taxonomy of Viruses. Retrieved 2009-10-04.

Nishiura, H; Chowell, G (2014 Sep 11). "Early transmission dynamics of Ebola virus disease (EVD), West Africa, March to August 2014.". Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin 19 (36).

Nkoghé D, Formenty P, Nnégué S, Mvé MT, Hypolite I, Léonard P, Leroy E (2004). "Practical guidelines for the management of Ebola infected patients in the field". Medecine tropicale : revue du Corps de sante colonial 64 (2): 199–204.

Oestereich, L.; Lüdtke, A.; Wurr, S.; Rieger, T.; Muñoz-Fontela, C.; Günther, S. (2014). "Successful treatment of advanced Ebola virus infection with T-705 (favipiravir) in a small animal model". Antiviral Research 105: 17–21.

Okware, S. I.; Omaswa, F. G.; Zaramba, S.; Opio, A.; Lutwama, J. J.; Kamugisha, J.; Rwaguma, E. B.; Kagwa, P.; Lamunu, M. (2002). "An outbreak of Ebola in Uganda". Tropical medicine & international health : TM & IH 7 (12): 1068–1075.

Olival KJ, Islam A, Yu M, Anthony SJ, Epstein JH, Khan SA, Khan SU, Crameri G, Wang LF, Lipkin WI, Luby SP, Daszak P (2013). "Ebola virus antibodies in fruit bats, bangladesh". Emerging Infect. Dis. 19 (2): 270–3.

Oplinger, Anne A. (2003-11-18). NIAID Ebola vaccine enters human trial. Bio-Medicine.

Paul R. Masson, Catherine Anne Pattillo, "Monetary union in West Africa (ECOWAS): is it desirable and how could it be achieved?" (Introduction). International Monetary Fund, 2001.

Pourrut X, Kumulungui B, Wittmann T, Moussavou G, Délicat A, Yaba P, Nkoghe D, Gonzalez JP, Leroy EM (2005). "The natural history of Ebola virus in Africa". Microbes and infection / Institut Pasteur 7 (7–8): 1005–1014.

Pourrut X, Délicat A, Rollin PE, Ksiazek TG, Gonzalez JP, Leroy EM (2007). "Spatial and temporal patterns of Zaire ebolavirus antibody prevalence in the possible reservoir bat species". The Journal of infectious diseases. Suppl 2 (s2): S176–S183.

Rollin, P. E.; Williams, R. J.; Bressler, D. S.; Pearson, S.; Cottingham, M.; Pucak, G.; Sanchez, A.; Trappier, S. G.; Peters, R. L.; Greer, P. W.; Zaki, S.; Demarcus, T.; Hendricks, K.; Kelley, M.; Simpson, D.; Geisbert, T. W.; Jahrling, P. B.; Peters, C. J.; Ksiazek, T. G. (1999). "Ebola (Subtype Reston) Virus among Quarantined Nonhuman Primates Recently Imported from the Philippines to the United States". The Journal of Infectious Diseases 179: S108–S114.

Schultz, edited by Kristi Koenig, Carl (2009). Koenig and Schultz's disaster medicine : comprehensive principles and practices. Cambridge: Cambridge University Press. p. 209.

Smith, Tara (2005). Ebola (Deadly Diseases and Epidemics). Chelsea House Publications.

Sompayrac, Lauren (2002). How pathogenic viruses work (3. print. ed.). Boston: Jones and Bartlett Publishers. p. 87.

Sullivan N, Yang ZY, Nabel GJ (2003). "Ebola Virus Pathogenesis: Implications for Vaccines and Therapies" (Free full text). Journal of Virology 77 (18): 9733–9737.

Sullivan NJ, Geisbert TW, Geisbert JB, Xu L, Yang ZY, Roederer M, Koup RA, Jahrling PB, Nabel GJ (2003). "Accelerated vaccination for Ebola virus haemorrhagic fever in non-human primates". Nature 424 (6949): 681–684.

Swanepoel R, Leman PA, Burt FJ, Zachariades NA, Braack LE, Ksiazek TG, Rollin PE, Zaki SR, Peters CJ (Oct 1996). "Experimental inoculation of plants and animals with Ebola virus". Emerging Infectious Diseases 2 (4): 321–325.

Towers, Sherry; Patterson-Lomba, Oscar; Castillo-Chavez, Carlos. "Temporal Variations in the Effective Reproduction Number of the 2014 West Africa Ebola Outbreak". PLoS Currents.

Towner, J. S.; Sealy, T. K.; Khristova, M. L.; Albariño, C. S. G.; Conlan, S.; Reeder, S. A.; Quan, P. L.; Lipkin, W. I.; Downing, R.; Tappero, J. W.; Okware, S.; Lutwama, J.; Bakamutumaho, B.; Kayiwa, J.; Comer, J. A.; Rollin, P. E.; Ksiazek, T. G.; Nichol, S. T. (2008). "Newly Discovered Ebola Virus Associated with Hemorrhagic Fever Outbreak in Uganda" (Full free text). In Basler, Christopher F. PLoS Pathogens 4 (11): e1000212.

Warfield KL, Swenson DL, Olinger GG, Kalina WV, Aman MJ, Bavari S (2007). "Ebola Virus-Like Particle–Based Vaccine Protects Nonhuman Primates against Lethal Ebola Virus Challenge". The Journal of Infectious Diseases 196: S430–S437.

Weingartl HM, Embury-Hyatt C, Nfon C, Leung A, Smith G, Kobinger G (2012). "Transmission of Ebola virus from pigs to non-human primates". Sci Rep 2: 811.

Xu L, Sanchez A, Yang Z, Zaki SR, Nabel EG, Nichol ST, Nabel GJ (1998). "Immunization for Ebola virus infection". Nature Medicine 4 (1): 37–42.

CDC

Centers for Disease Control and Prevention and World Health Organization (1998). Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting (PDF). Atlanta, Georgia, US: Centers for Disease Control and Prevention. Retrieved 2013-02-08.

Special Pathogens Branch CDC (2008-01-14). "Known Cases and Outbreaks of Ebola Hemorrhagic Fever". Center for Disease Control and Prevention. Retrieved 2008-08-02.

"Ebola Hemorrhagic Fever Signs and Symptoms". CDC. January 28, 2014. Retrieved 2 August 2014.

"Ebola Hemorrhagic Fever Diagnosis". CDC. January 28, 2014. Retrieved 3 August 2014.

"Outbreak of Ebola in Guinea and Liberia". Centers for Disease Control and Prevention. 24 June 2014. Retrieved 25 June 2014.

"Chronology of Ebola Hemorrhagic Fever Outbreaks". Centers for Disease Control and Prevention. 24 June 2014. Retrieved 25 June 2014 Centers for Disease Control. "Outbreak Postings". Centers for Disease Control. Retrieved 2014-07-11.

"Outbreak of Ebola in Guinea, Liberia, and Sierra Leone". Centers for Disease Control and Prevention. Retrieved 27 July 2014. "CDC Telebriefing on Ebola outbreak in West Africa". CDC. July 28, 2014. Retrieved 3 August 2014.

"Ebola Hemorrhagic Fever Prevention". CDC. July 31, 2014. Retrieved 2 August 2014.

"Ebola Hemorrhagic Fever Risk of Exposure". CDC. August 1, 2014. Retrieved 2 August 2014.

Centers for Disease Control (CDC) (1990). "Update: filovirus infection in animal handlers". MMWR. Morbidity and mortality weekly report 39 (13): 221.

League Of Nations

"Outbreak(s) of Ebola haemorrhagic fever, Congo and Gabon, October 2001-July 2002". Releve epidemiologique hebdomadaire / Section d'hygiene du Secretariat de la Societe des Nations = Weekly epidemiological record / Health Section of the Secretariat of the League of Nations 78 (26): 223–228. 2003.

"Outbreak of Ebola haemorrhagic fever in Yambio, south Sudan, April - June 2004". Releve epidemiologique hebdomadaire / Section d'hygiene du Secretariat de la Societe des Nations = Weekly epidemiological record / Health Section of the Secretariat of the League of Nations 80 (43): 370–375. 2005.

"Outbreak news. Ebola virus haemorrhagic fever, Democratic Republic of the Congo--update". Releve epidemiologique hebdomadaire / Section d'hygiene du Secretariat de la Societe des Nations = Weekly epidemiological record / Health Section of the Secretariat of the League of Nations 82 (40): 345–346. 2007.

"Outbreak news. Ebola Reston in pigs and humans, Philippines". Releve epidemiologique hebdomadaire / Section d'hygiene du Secretariat de la Societe des Nations = Weekly epidemiological record / Health Section of the Secretariat of the League of Nations 84 (7): 49–50. 2009.

Médecins Sans Frontières

"Ebola: the failures of the international outbreak response". Médecins Sans Frontières. 29 August 2014. Retrieved 7 September 2014. - See more at: http://www.ceufast.com/course/ebola/#Initial_Outbreak

WHO:

"Ebola haemorrhagic fever in Zaire, 1976". Bulletin of the World Health Organization 56 (2): 271–293. 1978.

"Ebola haemorrhagic fever in Sudan, 1976". Bulletin of the World Health Organization 56 (2): 247–270. 1978.

Simpson DIH (1977). "Marburg and Ebola virus infections: a guide for their diagnosis, management, and control" (PDF). WHO Offset Publication No. 36. p. 10f.

Baron, R. C.; McCormick, J. B.; Zubeir, O. A. (1983). "Ebola virus disease in southern Sudan: hospital dissemination and intrafamilial spread". Bulletin of the World Health Organization 61 (6): 997–1003.

"Ebola haemorrhagic fever - South Africa" (PDF). Weekly Epidemiological Record (Geneva: World Health Organization) 71 (47): 353–360. 22 November 1996.

"Ebola haemorrhagic fever in the Republic of the Congo - Update 6". World Health Organization. 6 January 2004.

Global Alert and Response (2009-02-17). "End of Ebola outbreak in the Democratic Republic of the Congo". Disease Outbreak News. Geneva, Switzerland: World Health Organization. Retrieved 2011-02-27.

World Health Organization (2012-10-04). "End of Ebola outbreak in Uganda". Geneva, Switzerland: World Health Organization. Retrieved 2014-03-25.

"End of Ebola outbreak in Uganda" (Press release). World Health Organization. 2008-02-20. Retrieved 2009-11-29.

"Ebola virus disease". World Health Organization. March 2014. Retrieved 12 April 2014.

"Ebola virus disease – Senegal". World Health Organization. 29 March 2014. Retrieved 1 September 2014.

"Ebola Haemorrhagic Fever, West Africa (Situation)". WHO. 16 April 2014. Retrieved 16 April 2014.

"2014 Ebola Virus Disease (EVD) outbreak in West Africa". WHO. Apr 21 2014. Retrieved 3 August 2014.

"Ebola virus disease, West Africa (Update of 26 May 2014)". WHO: Outbreak news. 26 May 2014. Retrieved 28 July 2014.

"Ebola virus disease, West Africa – update 23 June 2014". WHO: Outbreak news. 23 June 2014. Retrieved 28 July 2014.

"Ebola virus disease, West Africa – update 18 July 2014". WHO: Outbreak news. 18 July 2014. Retrieved 27 July 2014.

"Ebola virus disease, West Africa – update 23 July 2014". WHO: Outbreak news. 23 July 2014. Retrieved 27 July 2014.

"Ebola virus disease, West Africa – update 25 July 2014". WHO: Outbreak news. 25 July 2014. Retrieved 27 July 2014.

"Ebola virus disease, West Africa – update 31 July 2014 - WHO | Regional Office for Africa". Afro.who.int. Retrieved 8 August 2014.

WHO (August 4, 2014). "Ebola virus disease, West Africa – update 4 August 2014"

"Ebola virus disease – Democratic Republic of Congo". World Health Organization. 26 August 2014. Retrieved 27 August 2014.

"Disease Outbreak News". Disease Outbreak News. WHO. 28 August 2014. Retrieved 29 August 2014.

"Ebola virus disease update Senegal 30 August 2014". World Health Organization. Retrieved 17 September 2014.

"WHO issues roadmap for scaled-up response to the Ebola outbreak". Retrieved 18 September 2014. news release (3 September 2014). "UN senior leaders outline needs for global Ebola response". WHO. Retrieved 7 September 2014.

"Virological analysis: no link between Ebola outbreaks in west Africa and Democratic Republic of Congo". WHO. 2 September 2014. Retrieved 7 September 2014.

"Ebola virus disease – Democratic Republic of Congo". WHO. 10 September 2014. Retrieved 11 September 2014.

"WHO: Ebola Response Roadmap Situation Report - 18 September 2014". WHO. 18 September 2014. Retrieved 19 September 2014.

News Agencies

"Fruit bats may carry Ebola virus". BBC News. 2005-12-11. Retrieved 2008-02-25.

"Uganda: Deadly Ebola Outbreak Confirmed - UN". UN News Service. 2007-11-30. Retrieved 2009-11-29.

"Ebola/Marburg Vaccine Development" (Press release). National Institute of Allergy and Infectious Diseases. 2008-09-15.

"Mystery hemorrhagic fever kills 23 in Guinea". Reuters. 2014-03-19. Retrieved 9 August 2014.

"Ebola Death Toll in Guinea Rises to 70 as Senegal Closes Border". Bloomberg News. 29 March 2014. Retrieved 31 March 2014.

"2 of 5 Test Positive for Ebola in Liberia", Liberian Observer, 31 March 2014, retrieved 6 July 2014.

Cham, Kemo (1 April 2014). "Sierra Leone restricts movement across borders over Ebola fears". Africa Review. Retrieved 1 April 2014.

Starkey, Jerome (5 April 2014) 90 killed as fruit bats spread Ebola virus across West Africa The Times (subscription may be needed), Retrieved 5 April 2014.

Ebola Virus Disease Epidemic in Liberia: Situation Report 11 (PDF), LR: Ministry of Health and Social Welfare, 13 April 2014, retrieved 6 July 2014.

"BBC News - UK employees leave Sierra Leone over Ebola threat". Bbc.co.uk. 2014-06-03. Retrieved 2014-08-25.

"Sierra Leone Is Epicenter of Ebola as Guinea Clinic Shut". 8 June 2014. Retrieved 30 July 2014.

"Seven die in Monrovia Ebola outbreak". BBC News. 17 June 2014. Retrieved 28 July 2014.

"Ebola Wreaks Economic Woe In West Africa". NPR. 2014-07-17. Retrieved 2014-08-25.

"Sierra Leone hunts Ebola patient kidnapped in Freetown". British Broadcasting Corporation. 25 July 2014.

"Nigeria 'on red alert' over Ebola death in Lagos". BBC News. 26 July 2014. Retrieved 27 July 2014.

"Ebola outbreak: Sierra Leone escaped patient dies". BBC News. 27 July 2014. Retrieved 27 July 2014.

"Ebola outbreak: Liberia shuts most border points". BBC News. 28 July 2014. Retrieved 28 July 2014.

Cocks, Tim (28 July 2014). "Nigeria isolates Lagos hospital where Ebola victim died". Reuters. Retrieved 1 August 2014.

"Ebola outbreak: Asky bans flights in West Africa". BBC News. 29 July 2014. Retrieved 29 July 2014.

"Liberia shuts schools, quarantines communities in bid to halt Ebola". Reuters. 30 July 2014. Retrieved 30 July 2014.

Lewis1, David (Jul 30, 2014). "Liberia shuts schools, considers quarantine to curb Ebola". Reuters. Retrieved 3 August 2014.

"Sierra Leone declares state of emergency over Ebola". Reuters. 31 July 2014. Retrieved 31 July 2014.

Daygbor, E.J. Nathaniel (31 July 2014). "Senatorial Election Faces Postponement as Political Leaders Debate". The New Dawn. Retrieved 7 August 2014.

Kwanue, C.Y. (1 August 2014). "In Compliance with Sirleaf's Mandate, UL Closed". Liberian Observer. Retrieved 2 August 2014.

Wesee, Ben P. (4 August 2014). "I'm ok - Nigerian Ambassador Assures Public". The New Dawn, Monrovia. Retrieved 7 August 2014.

"Ebola: World Bank Group Mobilizes Emergency Funding to Fight Epidemic in West Africa". Worldbank.org. 2014-08-04. Retrieved 2014-08-20.

Reuters (4 August 2014). "Lagos records second Ebola case in doctor who treated victim: Nigerian health minister".

Mark, Monica (6 August 2014). "Ebola Outbreak: Nurse who Treated First Victim in Nigeria Dies". The Guardian. Retrieved 7 August 2014.

"Ellen Declares State of Emergency". Executive Mansion via Heritage. 6 August 2014. Retrieved 7 August 2014.

Ofeibea Quist-Arcton (6 August 2014). "Skeptics In Sierra Leone Doubt Ebola Virus Exists". WVXU.

Mark, Monica (6 August 2014). "Ebola Outbreak: Nurse who Treated First Victim in Nigeria Dies". The Guardian. Retrieved 7 August 2014.

"Ebola Drug From Japan May Emerge Among Key Candidates". Bloomberg.com. 7 August 2014.

Briggs, Helen (7 August 2014) Ebola: Experimental drugs and vaccines BBC News, Health, Retrieved 8 August 2014.

Pollack, Andrew (7 August 2014) Second Drug Is Allowed for Treatment of Ebola The New York Times, Retrieved 8 August 2014.

"NEC Recommends Postponement of Senatorial Election", Heritage, 7 August 2014. Accessed 7 August 2014.

"Guinea closes border as Ebola ravages Sierra Leone and Liberia". The Africa News.Net. Retrieved 8 August 2014.

Grady, Denise; Fink, Sheri (9 August 2014). "Tracing Ebola's Breakout to an African 2-Year-Old". The New York Times. Retrieved 14 August 2014.

"Tracing Ebola's Breakout to an African 2-Year-Old". New York Times. 9 August 2014. Retrieved 10 August 2014.

"Who, What, Why: How many people infected with ebola die?" BBC News. 2014-08-09.

"NHREC Statement on Ebola Care". Nigerian National Health Research Ethics Committee. 9 August 2014. Retrieved 12 August 2014.

"Liberian Soldiers Seal Slum to Halt Ebola". NBC News. 2014-08-09. Retrieved 2014-08-23.

"West Africa Ebola outbreak forces miners to lock down operations, delay projects". MINING.com. 2014-08-10. Retrieved 2014-08-25.

McNeil, Donald G., Jr. (13 August 2014). "Using a Tactic Unseen in a Century, Countries Cordon Off Ebola-Racked Areas". The New York Times. Retrieved 14 August 2014.

Kay, Chris (2014-08-14). "Ebola Threatens West Africa GDP as Companies Slow Production". Bloomberg. Retrieved 2014-08-25.

"Nigeria reports one more Ebola case, 11 in total; Reuters". In.reuters.com. Retrieved 14 August 2014.

"First WHO worker infected by Ebola, DR Congo reports cases". Rappler.com. 2014-08-15. Retrieved 2014-08-25.

19 August 2014. "Ebola Latest: 3 new cases as 4 more victims are discharged - Vanguard News". Vanguardngr.com. Retrieved 2014-08-20.

Johnathan Paye-Layleh, Associated Press (2014-08-17). "Ebola fears heightened in Liberia as clinic looted". Usatoday.com. Retrieved 2014-08-23.

"Dr Ameyo Adadevoh dies from Ebola virus infection". YNaija.com The Internet Newspaper for Young Nigerians. Retrieved 2014-08-20.

"Ebola crisis: Illness With Ebola-Like Symptoms Kills Several In Congo". The Huffington Post. 20 August 2014. Retrieved 21 August 2014.

Lomax, Selma (2014-08-20). "Liberia: Ebola Outbreak Affects Agriculture in Lofa County". allAfrica.com. Retrieved 2014-08-25.

Chris Kay (2014-08-20). "Africa nations sell debt for Ebola fight | African Business". BDlive. Retrieved 2014-08-25.

"Ebola Virus Eats Into West Africa's Economic Growth". AFKInsider. 2014-08-21. Retrieved 2014-08-25.

"Ebola strikes at the heart of Nigeria: Ameyo, daughter of Kwaku Adadevoh, grand daughter of Herbert Macaulay dies". Thisday. Retrieved 22 August 2014.

"Tribute to Herbert Macaulay's Great-Granddaughter who died in service to Nigeria". The Cable. Retrieved 22 August 2014.

"Ebola kills doctor related to first African Anglican Bishop". Anglican News. Retrieved 22 August 2014.

"Two year jail terms for hiding Ebola victims in Sierra Leone". IBNLIVE. 22 August 2014. Retrieved 23 August 2014.

"Liberian mob attacks Ebola clinic; dozens of patients missing | The Rundown | PBS NewsHour". Pbs.org. Retrieved 2014-08-23.

By Clair MacDougall and James Harding Giahyue. "Liberia police fire on protesters as West Africa's Ebola toll hits 1,350". Reuters. Retrieved 2014-08-23.

"Last Ebola-free region of Liberia falls to virus". News 24. 23 August 2014. Retrieved 23 August 2014.

"Sierra Leone 'hero' doctor's death exposes slow Ebola response". Sierra Leone 'hero' doctor's death exposes slow Ebola response. Fox News. 25 August 2014. Retrieved 25 August 2014.

"Ebola outbreak: Japan offers anti-influenza drug for treatment". CBC News Health. 25 August 2014.

Brock, Joe. "Ebola fears slowing tourist flow to Africa | Reuters". Uk.reuters.com. Retrieved 2014-08-25.

Mark Anderson and agencies. "Ebola: airlines cancel more flights to affected countries | Society". The Guardian. Retrieved 2014-08-25.

"WHO pulls staff after worker infected with Ebola in Sierra Leone". Reuters. 26 August 2014. Retrieved 26 August 2014.

"Ebola Patient Arrives in Germany for Treatment". NBC News. 27 August 2014. Retrieved 28 August 2014.

"Breaking: Nigeria Records New Ebola Death In Port Harcourt". SAHARA REPORTERS. 27 August 2014. Retrieved 27 August 2014.

"Ebola spreads to Nigeria oil hub Port Harcourt". BBC News. 28 August 2014. Retrieved 28 August 2014.

"Rivers official confirms suspected Ebola Death in Port Harcourt". Premium Times. 28 August 2014. Retrieved 28 August 2014.

"Over 1,500 people have died due to Ebola virus, says WHO". Africa Leader. 28 August 2014. Retrieved 30 August 2014.

"Senegalese minister of health confirms 1st case of Ebola virus in the West African country". Washington Post. 29 August 2014. Retrieved 29 August 2014.

"First case of Ebola virus is confirmed in Senegal". ITV. 29 August 2014. Retrieved 29 August 2014.

"Senegal Confirms Its 1st Case of Ebola". ABC News. 29 August 2014. Retrieved 31 August 2014.

"Liberian Ebola survivor calls for quick production of experimental drug". Global News. 30 August 2014. Retrieved 30 August 2014.

"Ebola-hit Liberia bans sailors from disembarking". Yahoo News. 31 August 2014. Retrieved 30 August 2014.

"Ebola threatens food security in West Africa: FAO". Retrieved 3 September 2014.

Roy-Macaulay, Clarence (6 September 2014). "Sierra Leone orders lockdown in Ebola crisis". Sierra Leone orders lockdown in Ebola crisis. The Washington Post. Retrieved 19 September 2014.

"Liberian government accepts offer of U.S. military support to combat Ebola". Liberia News.Net. 8 September 2014. Retrieved 9 September 2014.

"Obama says military will help fight Ebola outbreak in West Africa". Fox News. 8 September 2014. Retrieved 8 September 2014.

"Ebola virus is surging in places where it was beaten back: experts". CTV News. 8 September 2014. Retrieved 8 September 2014.

"How Will We Know If The Ebola Drugs Worked?". Forbes. Retrieved 10 September 2014.

"No Single Case of Ebola in Nigeria, Says Chukwu". Thisday. Retrieved 12 September 2014.

"No single Ebola case' in Nigeria". thecable.ng. Retrieved 12 September 2014.

Grady, Denise. (12 September 2014). "U.S. Scientists See Long Fight Against Ebola". New York Times. Retrieved 13 September 2014. 

"Worst-ever Ebola outbreak, by the numbers". CBC News. Retrieved 16 September 2014.

"Ebola: Economic Impact Already Serious; Could Be "Catastrophic" Without Swift Response". press release. The World Bank. 17 September 2014. Retrieved 19 September 2014.

"First British volunteer injected with trial Ebola vaccine in Oxford". Guardian. Retrieved 17 September 2014.

"An Ebola vaccine was given to 10 volunteers, and there are 'no red flags' yet". Washington Post. Retrieved 17 September 2014.

"Ebola Outbreak Still Not Under Control: Officials". US News & World Report. Retrieved 18 September 2014.

Phillip, Abby (18 September 2014). "Eight dead in attack on Ebola team in Guinea. 'Killed in cold blood.". Eight dead in attack on Ebola team in Guinea. 'Killed in cold blood.'. The Washington Post. Retrieved 19 September 2014.

"Guinea Outbreak: Guinea Health Team Killed". BBC News. 19 September 2014. Retrieved 19 September 2014.

"ZMapp drug fully protects monkeys against Ebola virus". Science News. Retrieved 10 September 2014.

"Blood transfusion named as priority treatment for Ebola". Nature. Retrieved 11 September 2014.

Payne, Ed (12 September 2014). "West African health centers can't keep up with Ebola outbreak, WHO says". CNN Health. Retrieved 15 September 2014.

Liberia: Liberia Ebola Sit Rep no. 122, 14 September 2014.

Sierra Leone: EBOLA VIRUS DISEASE - SITUATION REPORT (Sit-Rep) – 15 September, 2014.

Sun, Lena H.; Eilperin, Juliet (16 September 2014). "U.S. military will lead $750 million fight against Ebola in West Africa". The Washington Post. Retrieved 16 September 2014.

"Case Fatality Rate for ebolavirus". epidemic. Retrieved 16 September 2014.

"NIH: Ebola Outbreak is 'Completely Out of Control". Retrieved 18 September 2014.


This course is applicable for the following professions:

Advanced Registered Nurse Practitioner (ARNP), Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Registered Nurse (RN)

Topics:

CPD: Practice Effectively, Infection Control/Disease, Medical Surgical


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