As of the end of March 2016, the West Africa epidemic of Ebola virus disease (Ebola) had resulted in a total of 28,646 cases, 11,323 of them fatal, reported to the World Health Organization. Guinea, Liberia, and Sierra Leone were most heavily affected, but Ebola cases were exported to several other African and European countries as well as the United States, with limited further transmission, including to healthcare workers. We review the descriptive epidemiology of the outbreak, novel aspects and insights concerning the unprecedented response, scientific observations, and public health implications. The large number of Ebola survivors has highlighted the frequency of persistent symptoms and the possibility of virus persistence in sanctuary sites, sometimes leading to delayed transmission. Although transmission appears to have ceased in 2016, the West Africa Ebola epidemic has profoundly influenced discussions and practice concerning global health security.


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Literature Cited

  1. 1. World Health Organization 2014. Ebola virus disease in Guinea http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4063-ebola-hemorrhagic-fever-in-guinea.html
  2. 2. World Health Organization 2016. Latest Ebola outbreak over in Liberia; West Africa is at zero, but new flare-ups are likely to occur http://www.who.int/mediacentre/news/releases/2016/ebola-zero-liberia/en/
  3. 3. World Health Organization 2016. WHO declares the end of the most recent Ebola virus disease outbreak in Liberia http://www.afro.who.int/en/media-centre/pressreleases/item/8699-who-declares-the-end-of-the-most-recent-ebola-virus-disease-outbreak-in-liberia.html
  4. Arwady MA, Bawo L, Hunter J. 4.  et al. 2015. Evolution of Ebola Virus Disease from exotic infection to global health priority, Liberia, Mid-2014. Emerg. Infect. Dis. 21:578–84 [Google Scholar]
  5. 5. World Health Organization 2016. Ebola situation report, 30 March, 2016 http://apps.who.int/iris/bitstream/10665/204714/1/ebolasitrep_30mar2016_eng.pdf?ua=1&ua=1
  6. 6. World Health Organization 2014. Ebola virus disease in Liberia http://www.who.int/csr/don/2014_03_30_ebola_lbr/en/
  7. 7. WHO 2014. Ground zero in Guinea: the Ebola outbreak smoulders—undetected—for more than 3 months. A retrospective on the first cases of the outbreak. http://www.who.int/csr/disease/ebola/ebola-6-months/guinea/en/
  8. 8. TDR 2016. TDR scientist Andy Ramsay recognized for 2014 Ebola response http://www.who.int/tdr/news/2016/ramsay-recognized-for-2014-ebola-response/en/
  9. 9. WHO 2016. Situation report. Ebola virus disease, 10 June, 2016. http://apps.who.int/iris/bitstream/10665/208883/1/ebolasitrep_10Jun2016_eng.pdf?ua=1
  10. Matanock A, Arwady A, Ayscue P. 10.  et al. 2014. Ebola virus disease cases among health care workers not working in Ebola Treatment Units—Liberia, June–August, 2014. Morb. Mortal. Wkly. Rep. 63:1077–81 [Google Scholar]
  11. Forrester JD, Hunter JC, Pillai SK. 11.  et al. 2014. Cluster of Ebola cases among Liberian and U.S. health care workers in an Ebola treatment unit and adjacent hospital—Liberia, 2014. Morb. Mortal. Wkly. Rep. 63:925–29 [Google Scholar]
  12. Lindblade KA, Kateh F, Nagbe TK. 12.  et al. 2015. Decreased Ebola transmission after rapid response to outbreaks in remote areas, Liberia, 2014. Emerg. Infect. Dis. 21:1800–7 [Google Scholar]
  13. Lindblade KA, Nyenswah T, Keita S. 13.  et al. 2016. Secondary infections with Ebola virus in rural communities, Liberia and Guinea, 2014–2015. Emerg. Infect. Dis. 22:1653–55 [Google Scholar]
  14. Formenty P, Hatz C, Le Guenno B. 14.  et al. 1999. Human infection due to Ebola virus, subtype Côte d'Ivoire: clinical and biologic presentation. J. Infect. Dis. 179:Suppl. 1S48–53 [Google Scholar]
  15. Schoepp RJ, Rossi CA, Khan SH. 15.  et al. 2014. Undiagnosed acute viral febrile illnesses, Sierra Leone. Emerg. Infect. Dis. 20:1176–82 [Google Scholar]
  16. Spengler JR, Ervin ED, Towner JS. 16.  et al. 2016. Perspectives on West Africa Ebola virus disease outbreak, 2013–2016. Emerg. Infect. Dis. 22:956–63 [Google Scholar]
  17. Faisal Shuaib F, Gunnala R, Musa EO. 17.  et al. 2014. Ebola virus disease outbreak—Nigeria, July–September 2014. Morb. Mortal. Wkly. Rep. 63:867–72 [Google Scholar]
  18. Chevalier MS, Chung W, Smith J. 18.  et al. 2014. Ebola virus disease cluster in the United States—Dallas County, Texas, 2014. Morb. Mortal. Wkly. Rep 63:1087–88 [Google Scholar]
  19. 19. World Health Organization 2015. Report of the Ebola interim assessment panel http://www.who.int/csr/resources/publications/ebola/report-by-panel.pdf?ua=1
  20. 20. World Health Organization 2014. Statement on the 1st meeting of the IHR Emergency Committee on the 2014 Ebola outbreak in West Africa http://www.who.int/mediacentre/news/statements/2014/ebola-20140808/en/
  21. Kates J, Michaud J, Wexler A. 21.  et al. 2015. The U.S. response to Ebola: status of the FY2015 emergency Ebola appropriation. http://kff.org/global-health-policy/issue-brief/the-u-s-response-to-ebola-status-of-the-fy2015-emergency-ebola-appropriation/
  22. Frieden TR, Damon IK. 22.  2015. Ebola in West Africa—CDC's role in epidemic detection, control, and prevention. Emerg. Infect. Dis. 21:1897–905 [Google Scholar]
  23. Gibbs N. 23.  2014. Person of the year: the choice. Time http://time.com/time-person-of-the-year-ebola-fighters-choice/
  24. Meltzer MI, Atkins CY, Santibanez S. 24.  et al.Centers for Disease Control and Prevention (CDC) 2014. Estimating the future number of cases in the Ebola epidemic—Liberia and Sierra Leone, 2014–2015. Morb. Mortal. Wkly. Rep.Suppl. 63:31–14 [Google Scholar]
  25. Nyenswah TG, Westercamp M, Kamali AA. 25.  et al. 2014. Evidence for declining numbers of Ebola cases—Montserrado County, Liberia, June–October 2014. Morb. Mortal. Wkly. Rep. 63:1072–76 [Google Scholar]
  26. Kateh F, Nagbe T, Kieta A. 26.  et al. 2015. Rapid response to Ebola outbreaks in remote areas—Liberia, July–November 2014. Morb. Mortal. Wkly. Rep. 64:188–92 [Google Scholar]
  27. Dahl BA, Kinzer MH, Raghunathan PL. 27.  et al. 2016. CDC's response to the 2014–2016 Ebola Epidemic—Guinea, Liberia, and Sierra Leone. Morb. Mortal. Wkly. Rep. 65:12–20 [Google Scholar]
  28. Schieffelin JS, Shaffer JG, Goba A. 28.  et al. 2014. Clinical illness and outcomes in patients with Ebola in Sierra Leone. N. Engl. J. Med. 371:2092–100 [Google Scholar]
  29. Ibrahima Bah E, Lamah M-C, Fletcher T. 29.  et al. 2015. Clinical presentation of patients with Ebola virus disease in Conakry, Guinea. N. Engl. J. Med. 372:40–47 [Google Scholar]
  30. Uyeki TM, Mehta AK, Davey RT. 30.  et al. 2016. Clinical management of Ebola virus disease in the United States and Europe. N. Engl. J. Med. 374:636–46 [Google Scholar]
  31. Van Griensven J, Edwards T, de Lamballerie X. 31.  et al. 2016. Evaluation of convalescent plasma for Ebola virus disease in Guinea. N. Engl. J. Med. 374:33–42 [Google Scholar]
  32. Sissoko D, Laouenan C, Folkesson E. 32.  et al. 2016. Experimental treatment with favipiravir for Ebola virus disease (the JIKI Trial): a historically controlled, single-arm proof-of-concept trial in Guinea. PLOS Med 13:e1001967 [Google Scholar]
  33. Davey RT. 33. for the Multi-National PREVAIL II Study Team 2016. PREVAIL II: a randomized controlled trial of ZMappin acute Ebola virus infection Presented at Conf. Retrovir. Opportun. Infect., Feb. 22–25 Boston, MA: Abstr. 77LB [Google Scholar]
  34. Warren TK, Jordan R, Lo MK. 34.  et al. 2016. Therapeutic efficacy of the small molecule GS-5734 against Ebola virus in rhesus monkeys. Nature 531:381–85 [Google Scholar]
  35. Bolay F. 35.  for the Partnership for Research on Ebola Vaccines in Liberia (PREVAIL 1) Team; 2016. A randomized controlled trial of the safety and immunogenicity of two Ebola vaccines Presented at Conf. Retrovir. Opportun. Infect., Feb. 22–25 Boston, MA: Abstr. 76LB [Google Scholar]
  36. Henao-Restrepo AM, Longini IM, Egger E. 36.  et al. 2015. Efficacy and effectiveness of an rVSV-vectored vaccine expressing Ebola surface glycoprotein: interim results from the Guinea ring vaccination cluster-randomised trial. Lancet 386:857–66 [Google Scholar]
  37. Etard J-F, Sow MS, Leroy S. 37.  et al. for the Postebogui study group; 2016. Sequelae of Ebola virus disease in surviving patients in Guinea: Postebogui cohort. Presented at Conf. Retrovir. Opportun. Infect., Feb. 22–25 Boston, MA: Abstr. 73LB [Google Scholar]
  38. Fallah M. 38. for the Prevail III Research Team 2016. A cohort study of survivors of Ebola virus infection in Liberia (PREVAIL III) Presented at Conf. Retrovir. Opportun. Infect., Feb. 22–25 Boston, MA: Abstr. 74LB
  39. Varkey J, Shantha J, Crozier I. 39.  et al. 2015. Persistence of Ebola virus in ocular fluid during convalescence. N. Engl. J. Med. 372:2423–27 [Google Scholar]
  40. Jacobs M, Rodger A, Bell DJ. 40.  et al. 2016. Late Ebola relapse causing meningoencephalitis: a case report. Lancet 388:498–503 [Google Scholar]
  41. Christie A, Davies-Wayne GJ, Cordier-Lasalle T. 41.  et al. 2015. Possible sexual transmission of Ebola virus more than three months after recovery, Liberia 2015. Morb. Mortal. Wkly. Rep. 64:479–81 [Google Scholar]
  42. Mate SE, Kugelman JR, Nyenswah TG. 42.  et al. 2015. Molecular evidence of sexual transmission of Ebola virus. N. Engl. J. Med. 373:2448–54 [Google Scholar]
  43. Deen GF, Knust B, Broutet N. 43.  et al. 2015. Ebola RNA persistence in semen of Ebola virus disease survivors—preliminary report. N. Engl. J. Med. In press. doi: 10.1056/NEJMoa1511410
  44. Blackley DJ, Wiley MR, Ladner JT. 44.  et al. 2016. Reduced evolutionary rate in reemerged Ebola virus transmission chains. Sci. Adv. 2 e1600378
  45. 45. World Health Organization 2015. Interim guidance on the use of rapid Ebola antigen detection tests http://apps.who.int/iris/bitstream/10665/160265/1/WHO_EVD_HIS_EMP_15.1_eng.pdf?ua=1
  46. Nyenswah T, Kateh F, Bawo L. 46.  et al. 2016. Ebola and its control in Liberia, 2014–2015. Emerg. Infect. Dis. 22:169–77 [Google Scholar]
  47. Moon S, Sridhar D, Pate MA. 47.  et al. 2015. Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola. Lancet 386:2204–21 [Google Scholar]
  48. 48. Médecins Sans Frontières 2015. Pushed to the limit and beyond http://www.msf.org/sites/msf.org/files/msf1yearebolareport_en_230315.pdf
  49. De Cock KM, El-Sadr WM. 49.  2015. A tale of two viruses: HIV, Ebola and health systems. AIDS 29:989–91 [Google Scholar]
  50. Heymann DL, Chen L, Takemi K. 50.  et al. 2015. Global health security: the wider lessons from the West African Ebola virus disease epidemic. Lancet 385:1884–901 [Google Scholar]
  51. Takahashi S, Metcalf J, Ferrari M. 51.  et al. 2015. Reduced vaccination and the risk of measles and other childhood infections post-Ebola. Science 347:1240–42 [Google Scholar]
  52. Suk J, Jimenez A, Kourouma M. 52.  et al. 2016. Post-Ebola measles outbreak in Lola, Guinea, January–June 2015. Emerg. Infect. Dis. 22:1106–8 [Google Scholar]
  53. Elston JWT, Moosa AJ, Moses F. 53.  et al. 2015. Impact of the Ebola outbreak on health systems and population health in Sierra Leone. J. Public Health 2015:fdv158 [Google Scholar]
  54. Lori JR, Rominski SD, Perosky JE. 54.  et al. 2015. A case series study on the effect of Ebola on facility-based deliveries in rural Liberia. BMC Pregnancy Childbirth 15:254 [Google Scholar]
  55. Barden-O'Fallon J, Barry MA, Brodish P. 55.  et al. 2015. Rapid assessment of Ebola-related implications for reproductive, maternal, newborn and child health service delivery and utilization in Guinea. PLOS Curr. Outbreaks. Aug. 4 , 1.
  56. Brolin Ribacke KJ, van Duinen AJ, Nordenstedt H. 56.  et al. 2016. The impact of West Africa Ebola outbreak on obstetric health care in Sierra Leone. PLOS ONE 11:2 [Google Scholar]
  57. Plucinski M, Guilavogui T, Sidikiba S. 57.  et al. 2015. Effect of the Ebola-virus-disease epidemic on malaria case management in Guinea, 2014; a cross-sectional survey of health facilities. Lancet Infect. Dis. 15:1017–23 [Google Scholar]
  58. Pagnoni F, Bosman A. 58.  2015. Malaria kills more the Ebola virus disease. Lancet Infect. Dis. 15:988–89 [Google Scholar]
  59. De Cock KM, Simone P, Davison V. 59.  et al. 2013. The new global health. Emerg. Infect. Dis. 19:1192–97 [Google Scholar]
  60. 60. World Health Organization 2005. International Health Regulations. Geneva: WHO, 2nd ed..

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