# Ebola virus epidemic in West Africa

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Ebola virus epidemic in West Africa
Situation map of the outbreak as of 5 September 2014[update][1]
Date | December 2013 – present[2]
Location | Guinea, Liberia, Nigeria, Senegal, Sierra Leone
Casualties

- Cases / Deaths (as of 5 September 2014[update])[1]
- Total: 3,967 / 2,105
- Guinea: 812 / 517
- Liberia: 1,871 / 1,089
- Nigeria: 22 / 8
- Senegal: 1 / 0
- Sierra Leone: 1,261 / 491

As of 2014[update], an epidemic of Ebola virus disease (EVD) is ongoing in West Africa. The outbreak began in Guinea in December 2013, but was not detected until March 2014,[3] after which it spread to Liberia, Sierra Leone, Nigeria and Senegal. The outbreak is caused by Ebola virus (EBOV). It is the most severe outbreak of Ebola in terms of the number of human cases and deaths since the discovery of the virus in 1976,[4] with the number of cases from the current outbreak now outnumbering the combined cases from all known previous outbreaks.[5] Another outbreak in the Democratic Republic of the Congo, which has 53 possible and confirmed cases and 31 deaths as of 2 September 2014, is believed to be unrelated to the West African outbreak.[6]

As of 5 September 2014[update], the World Health Organization (WHO) and the Centers for Disease Control (CDC) reported a total of 3,967 suspected cases and 2,105 deaths (2,383 cases and 1,243 deaths being laboratory confirmed).[7] Many experts believe that the official numbers substantially understate the size of the outbreak because of families' widespread reluctance to report cases.[8] On 28 August, the WHO reported an overall case fatality rate estimate of 52%, considerably lower than an average of rates reported from previous outbreaks.

On 8 August, the outbreak was formally designated as a public health emergency of international concern.[9] This is a legal designation used only twice before (for the 2009 H1N1 (swine flu) pandemic and the 2014 resurgence of polio) and invokes legal measures on disease prevention, surveillance, control, and response, by 194 signatory countries.[10] On 28 August, the WHO reported that it estimated that up to 20,000 individuals could be infected before containment efforts bring the outbreak to a halt.[11]

Affected countries have encountered many difficulties in their attempt to control the spread of Ebola. It is the first Ebola epidemic that West African nations have experienced and many individuals, including medical staff, lack knowledge and experience in dealing with a highly communicable disease. 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. Many of the areas that have been infected are areas of extreme poverty without even running water or soap to help control the spread of disease. Other factors include belief in – and reliance on – traditional folk remedies, magical beliefs, and cultural practices that predispose 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 likelihood of staff catching the virus themselves. In August the WHO reported that ten percent of the dead have been health care workers.[citation needed]

Various aid organisations and international bodies, including the Economic Community of West African States (ECOWAS), US Centers for Disease Control and Prevention (CDC), and the European Commission have donated funds and mobilised personnel to help counter the outbreak; charities including Médecins Sans Frontières, the Red Cross,[12] and Samaritan's Purse are also working in the area. At the end of August the WHO reported that the loss of so many health workers was making it difficult for them to provide sufficient numbers of foreign medical staff, and the African Union launched an urgent initiative to recruit more health care workers from among its members.[13]

## Development of the outbreak

### Initial outbreak in Guinea

Researchers believe that the first human case of the Ebola virus disease leading to the 2014 outbreak was a 2-year-old boy who died 6 December 2013 in the village of Meliandou, Guéckédou Prefecture, Guinea. His mother, 3-year-old sister and grandmother then became ill with symptoms consistent with Ebola infection and died. People infected by those victims spread the disease to other villages.[2][14]

On 19 March, the Ministry of Health acknowledged a local outbreak of an undetermined viral hemorrhagic fever; the outbreak, ongoing since February, had sickened at least 35 people and killed 23. Ebola was suspected, and samples had been sent to Senegal and France for disease identification.[15] On 25 March, the World Health Organization (WHO) reported that the Ministry of Health of Guinea had reported an outbreak of Ebola virus disease in four southeastern districts: Guekedou, Macenta, Nzerekore and Kissidougou with suspected cases in the neighbouring 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.[16]

On 31 March, the US Center for Disease Control and Prevention (CDC) sent a five-person team to assist Guinea Ministry of Health and World Health Organization to lead an international response to the Ebola outbreak. On that date the WHO reported 112 suspected and confirmed cases including 70 deaths. Two cases were reported from Liberia of people who had recently travelled to Guinea, and suspected cases in Liberia and Sierra Leone were being investigated.[16] On 30 April, Guinea's Ministry of Health reported 221 suspected and confirmed cases including 146 deaths. The cases included 25 health care workers with 16 deaths. By late May, the outbreak had spread to Conakry, Guinea's capital, a city of about two million inhabitants.[16] On 28 May, the total cases reported had reached 281 with 186 deaths.[16]

### Subsequent spread

In Liberia, the disease was reported in Lofa and Nimba counties in late March,[17] and by mid-April, the Ministry of Health and Social Welfare had recorded possible cases in Margibi and Montserrado counties.[18] In mid-June the first cases in Liberia's capital Monrovia were reported.[19]

Sierra Leone, Mali, and Ghana identified suspected cases of the disease by mid-April, but all clinical samples of suspected cases at the time tested negative for the Ebola virus.[20] In Guinea, from 23 to 27 May, three previously affected districts (Guéckédou, Macenta and Conakry), and four new districts (Boffa, Télimélé, Boke and Dubréka) reported cases.[21]

The outbreak progressed rapidly in Sierra Leone. The first cases were reported on 25 May in the Kailahun District, near the border with Guéckédou in Guinea.[22] By 20 June, there were 158 suspected cases, mainly in Kailahun and the adjacent district of Kenema, but also in the Kambia, Port Loko and Western districts in the north west of the country.[23] By 17 July, the total number of suspected cases in the country stood at 442, and had overtaken those in Guinea and Liberia.[24] By 20 July, cases of the disease had additionally been reported in the Bo District;[25] the first case in Freetown, Sierra Leone's capital, was reported in late July.[26][27]

Médecins Sans Frontières described the situation as being "totally out of control" in late June. Urging the world to offer aid to the affected regions, the Director-General said, "Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the international community to provide this support on the most urgent basis possible."[28]

The first case in Nigeria was reported by the WHO on 25 July:[29] Patrick Sawyer, a Liberian Ministry of Finance official, flew from Liberia to Nigeria after exposure to the virus, and died at Lagos soon after arrival.[30] In response, the hospital where he was being treated was shut down and quarantined, and the health officials who were treating him were isolated in an attempt to stop the spread of the virus.[31][32][33] However, a doctor and nurse who treated Sawyer both died from Ebola.[34][35]

Situation on Aug 14, 2014.[36]

In August, a cordon sanitaire, a disease fighting practice that forcibly isolates affected regions, was established in the triangular area where Guinea, Liberia, and Sierra Leone are separated only by porous borders and where 70 percent of the known cases had been found.[8]

Disease reports accelerated in August with 40% of the total cases reported in a period of only three weeks. The WHO stated that the acceleration could see the number of cases reported exceed 20,000.[37]

On 29 August, the Senegalese Health minister, Awa Marie Coll Seck, announced the first case of Ebola in the country. The case has been confirmed in Senegal.[38][39]

## Complications in containment efforts

Difficulties faced in attempting to contain the outbreak include the outbreak's multiple locations across country borders,[28] inadequate equipment provided for medical personnel,[40] and lack of soap and water for hand-washing and disinfection.[41] Containment efforts are further hindered because there is reluctance among country people to recognize the danger of infection related to person-to-person spread of disease, such as burial practices which include washing of the body of one that has died.[26][42][43][44] See also Control and Containment.

### Extreme poverty

A condition of dire poverty exists in many of the areas that have experienced a high incidence of infections. According to the director of NGO Plan International in Guinea, "The poor living conditions and lack of water and sanitation in most districts of Conakry pose a serious risk that the epidemic escalates into a crisis. People do not think to wash their hands when they do not have enough water to drink."[45]

### Rumours and denial

Denial in some affected countries has often made containment efforts difficult.[46] Language barriers and the appearance of medical teams in protective suits has sometimes exaggerated fears of the virus.[47] There are reports that some people believe that the disease is caused by sorcery and that doctors are killing patients.[48] In late July, the former Liberian health minister, Peter Coleman, stated that "people don't seem to believe anything the government now says."[49] Acting on a rumor that the virus was invented to conceal "cannibalistic rituals", demonstrations were staged outside of the main hospital treating Ebola patients in Kenema, Sierra Leone. The demonstrations were broken up by the police and resulted in the need to use armed guards at the hospital.[50] In Liberia, a mob attacked an Ebola isolation centre stealing equipment and "freeing" patients while shouting "There's no Ebola".[51] Red Cross staff was forced to suspend operations in southeast Guinea after they were threatened by a group of men armed with knives.[52]

### Healthcare workers

Healthcare providers caring for Ebola patients and family and friends in close contact with Ebola patients are at the highest risk of getting sick because they may come in direct contact with the blood or body fluids of sick patients. In some places affected by the current outbreak, care may be provided in clinics with limited resources (for example, no running water, no climate control, no floors, inadequate medical supplies), and workers could be in those areas for several hours with a number of Ebola infected patients.[53] As of 11 August, healthcare workers have represented nearly 10 percent of the cases and fatalities, significantly impairing the ability to respond to the outbreak in a country which already faces a severe shortage of doctors.[54] On 26 August, the WHO reported that more than 240 health care workers have developed Ebola in Guinea, Liberia, Nigeria, and Sierra Leone, and more than 120 have died. According to the WHO, the high proportion of infected medical staff can be explained by lack of the number of medical staff needed to manage such a large outbreak, shortages of protective equipment or improperly using what is available, and "the compassion that causes medical staff to work in isolation wards far beyond the number of hours recommended as safe.".[13]

Comparing the present Ebola outbreak to some in the past, the WHO notes that many of the most recent districts in which epidemics have occurred were in remote areas where the transmission had been easier to track and break. This outbreak is different in that large cities have been affected as well, where tracking has been difficult and medical staff may not suspect Ebola disease when they make a diagnosis. Several infectious diseases endemic to West Africa, such as malaria and typhoid fever, mimic the symptoms of Ebola disease, and doctors and nurses may see no need to take protective measures.[13] Also, without recent past experience with the disease, people have become intensely fearful and have in some cases attacked medical staff, believing that they cause the disease .[13]

The WHO reports that in the hardest hit areas there have historically been only one or two doctors available to treat 100,000 people, and these doctors are heavily concentrated in urban areas; the loss of so many health workers has made it difficult for the WHO to provide sufficient numbers of medical staff. Among the fatalities is Samuel Brisbane, a former advisor to the Liberian Ministry of Health and Social Welfare, described as "one of Liberia's most high-profile doctors."[55] In July, leading Ebola doctor Sheik Umar Khan from Sierra Leone died in the outbreak. His death was followed by two more deaths in Sierra Leone: Modupe Cole, a senior physician at the country`s main referral facility,[56] and Sahr Rogers, who worked in Kenema.[57] [58][59] [60] The African Union has launched an urgent initiative to recruit more health care workers from among its members.[13]

## Treatment

Researchers looking at slides of cultures of cells that make monoclonal antibodies. These are grown in a lab and the researchers are analyzing the products to select the most promising of them.
See also: Research into the Ebola virus disease and Treatment of the Ebola virus disease

No proven Ebola virus-specific treatment exists as of August 2014.[61] Treatment is primarily supportive in nature and includes minimizing invasive procedures, balancing fluids and electrolytes to counter dehydration, 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, and the use of medications to treat bacterial or fungal secondary infections.[62][63][64] Early treatment may increase the chance of survival.[65]

### Level of care

In late August Médecins Sans Frontières (MSF) called the situation "chaotic" and the medical response "inadequate". They report that they have expanded their operations but have been unable to keep up with the rapidly increasing need for assistance which has forced them to reduce the level of care they are able to offer: "It is not currently possible, for example, to administer intravenous treatments." Calling the situation "an emergency within the emergency", MSF reports that many hospitals have had to shut down due to lack of staff or fears of the virus among patients and staff which has left people with other health problems without any care at all. Speaking from a remote region, a MSF worker said that a shortage of protective equipment was making the medical management of the disease difficult and that they had limited capacity to safely bury bodies.[66]

### Experimental treatments

The unavailability of treatments in the most-affected regions has spurred controversy, with some calling for experimental drugs to be made more widely available in Africa on a humanitarian basis, and others warning that making unproven drugs widely available would be unethical, especially in light of past experimentation conducted in developing countries by Western drug companies.[67][68] As a result of the controversy, an expert panel of the WHO endorsed the use of interventions with as-yet-unknown effects both for treatment and for prevention of Ebola, and also said that deciding which treatments should be used and how to distribute them equitably were matters that needed further discussion.[69]

A number of experimental treatments are being studied or will undergo trials proximately:[70]

- ZMapp, a monoclonal antibody vaccine. The limited supply of the drug has been used to treat a few individuals infected with the Ebola virus: two U.S. aid workers who contracted Ebola in Liberia were successfully treated after repatriation in an Atlanta hospital;[71] a Spanish priest was treated after repatriation but later died; and three infected African doctors, one of whom died in Monrovia on 24 August, also received the experimental drug.[71]
- TKM-Ebola, an RNA interference drug.[72]
- Favipiravir, a drug approved in Japan for stockpiling against influenza pandemics.[73] The drug appears to be useful in a mouse model of the disease[74][75] and Japan has offered to supply the drug if requested by the WHO.[76]

## Fatality rate

See also: Ebola virus disease § Prognosis

According to a website for collaborative analysis and discussion about the Ebola emergence, as of 7 August attempts to create an accurate Case Fatality Rate (CFR) had been unreliable due to differences in testing policies, the inclusion of probable and suspected cases, and primarily the rate of new cases that have not run their course.[77] However, on 28 August, the WHO made their first overall case fatality rate estimate of 52%. It ranges from 42% in Sierra Leone to 66% in Guinea.[78] Compared to previous Zaire strain outbreaks, this number is quite low. The twelve Zaire strain outbreaks since the first one reported in the Democratic Republic of Congo in 1976 have had an average CFR of about 76%. Even the Sudan ebolavirus species, known to be less virulent than the Zaire species of the Ebola virus, has had an average CFR of about 57%.[79]

## 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, or fear of human contact, leading to loss of income for producers and traders.[80]
- Movement of people away from affected areas has disturbed agricultural activities.[81][82]
- Tourism is directly impacted in affected countries.[83] Other countries in Africa which are not directly affected by the virus have also reported adverse effects on tourism[84]
- Foreign mining companies have withdrawn non-essential personnel, deferred new investment, and cut back operations.[82][85][86]
- Many airlines have experienced reduced traffic. Some airlines have suspended flights to the area.[87]
- Forecasts of economic growth have been reduced.[88] An initial World Bank-IMF assessment for Guinea projects a full percentage point fall in GDP growth from 4.5 percent to 3.5 percent[89]
- The outbreak is straining the finances of governments, with Sierra Leone using Treasury bills to fund the fight against the virus[90]
- The U.N. Food and Agriculture Organisation (FAO) has warned that the outbreak could endanger harvest and food security in West Africa .[91]

## Unrelated outbreak in the Democratic Republic of Congo

Democratic Republic of Congo-2014
DRC Ebola area as of 2 September 2014[update][92]
Casualties

- Cases / Deaths (as of 2 September 2014[update])[93]
- DR Congo: 59 / 32

On 20 August, 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.[94] By 21 August, 13 people were reported to have died with similar symptoms. On 22 August, a World Health Organization (WHO) official and Médecins Sans Frontières (MSF) announced that it was too soon to tell whether Ebola had caused the deaths.[95] Blood samples were sent for testing and on 24 August it was reported that the samples were positive for Ebola; one tested positive for the Sudan ebolavirus, which is a different species of ebolavirus than the one responsible for the West African outbreak; the other tested positive for a mixture of the Sudanese and Zaire species, the species that is responsible for the present outbreak in West Africa.[96][97]

On 26 August, the Équateur Province Ministry of Health confirmed an outbreak of Ebola to the WHO.[98] 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 in Isaka Village, 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 that they had been in contact with came down with similar symptoms. Five health care workers subsequently died.[98]

On 26 August, the WHO reported: "Between 28 July and 18 August, a total of 24 suspected cases of Ebola virus, including 13 deaths, have been noted. Samples have been sent to laboratories in Kinshasa and in Gabon for confirmation of EVD and to identify the strain. The index case and the 80 contacts have no history of travel to the EVD-affected countries in West Africa (Guinea, Liberia, Nigeria, or Sierra Leone) or history of contact with individuals from the affected areas. At this time, it is believed that the outbreak in DRC is unrelated to the ongoing outbreak in West Africa."[98]

On Tuesday 2 September the head of communication for the WHO, Eugene Kambambi, told Agence France-Presse (AFP) that there are currently 31 deaths in the Northern Boende area in the province of Équateur. Kambambi also added that there were "53 confirmed, suspected or likely cases". Currently 185 other contacts cases are being monitored for any signs of the disease. MSF have also told AFP on Monday that they are in the process of setting up a clinic in the area to treat Ebola patients.[99]

On 2 September, the World Health Organization 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 samples were tested positive for this strain by Gabon’s Centre International de Recherches Médicales in Franceville. The virology results and epidemiological findings indicates no connection to the current epidemic in West Africa Region or Nigeria. The variant is different from those tested in the epidemic region.[100]

On 6 September the Health Minister, Felix Kabange Numbi, released a press statement raising the death toll to 32 from possible or confirmed Ebola cases. The total possible infected cases was raised to 59 as well. The outbreak is still contained to the Boende region, with 336 contact cases being tracked.[93]

## Response by country

### Countries with active local transmission

Treatment facilities in West Africa
Treatment facilities and responses in the West African Ebola region as of 5 September 2014[update][101]

#### Guinea

The border between Guinea and Liberia remained open in April; Guinea's ambassador in Monrovia noted his government's belief that efforts to fight the disease directly would be more effective than closing the border.[102] In early August 2014, Guinea closed its borders with both Sierra Leone and Liberia to help contain the spreading of the disease, as more new cases were being reported in those countries than in Guinea.[103]

#### Liberia

By 23 July, the Liberian health ministry began to implement a strategic plan in line with the Accra meeting's conclusions to improve the country's response to the outbreak.[104]

On 27 July, Ellen Johnson Sirleaf, the Liberian president, announced that Liberia would close its borders, with the exception of a few crossing points, such as the country's principal airport, where screening centres would be established, and the worst-affected areas in the country would be placed under quarantine.[49] Football events were banned, because large gatherings and the nature of the sport increase transmission risks.[105] Three days after the borders were closed, Sirleaf announced the closure of all schools nationwide, including the University of Liberia,[106] and a few communities were to be quarantined.[107] Sirleaf declared a state of emergency on 6 August, partly because the disease's weakening of the health care system has 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."[108] On the same day, the National Elections Commission announced that it would be unable to conduct the scheduled October 2014 senatorial election and requested postponement,[109] one week after the leaders of various opposition parties had publicly taken different sides on the question.[110]

On 18 August, 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, threatening the caretakers, removing the infected patients, and looting 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.[111][112] The Liberian government has since quarantined the entirety of West Point, despite riots, and issued a curfew state-wide.[113][114] On 22 August it was reported that violence had again broken out after the military fired on protesting crowds.[115]

On 22 August, officials declared that two people in Sinoe province had died from Ebola. This area was the last Ebola free area in Liberia. With 624 deaths recorded to date, the country has seen the highest death toll of all affected areas.[115]

On 26 August, Tom Frieden, director of the U.S. Centers for Disease Control, said at a meeting attended by the Liberian President, Ellen Johnson Sirleaf, “Lots of hard work is happening. Lots of good things are happening, but the virus still has the upper hand.” President Sirleaf's office said in a statement that any top government officials who defied her orders to remain in Liberia or to return from any trips outside the country had been fired; how many or who had been dismissed was unclear.[116]

The quarantine blockade in the West Point area, imposed by the Liberian president was lifted on Saturday 30 August. The Information Minister, Lewis Brown, said that this step was taken to ease efforts to screen, test and treat residents for the disease. He added that this step does not mean the area is Ebola free. The quarantine blockade was in place since 19 August.[117]

On 30 August, Liberia's Port Authority have cancelled all "shore passes" for sailors from ships coming into the country's four seaports. No one will be allowed to disembark from any commercial ships while in port. Three added screening points are in place for persons going on board a ship; these include the port gate, the security desk and the pier.[118]

#### Nigeria

Nigeria Ebola areas-2014
Nigeria Situation Map as of 5 September 2014[update][119]
Date | July 2014 – present[120]
Casualties

- Cases / Deaths (as of 5 September 2014[update])[7]
- Nigeria: 22 / 8

The first reported Ebola case in Nigeria was an imported case of a Liberian-American, Patrick Sawyer, who travelled by air from Liberia and became violently ill upon arriving in the city of Lagos. Sawyer died five days later, on 25 July. In response, the Nigerian government observed all of Sawyer's contacts for signs of infection and 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.[121] On 19 August, it was reported that the doctor who treated Sawyer, Ameyo Adadevoh, had also died of Ebola disease.[34][122] Adadevoh, a descendant of Herbert Macaulay[123][124] and Samuel Ajayi Crowther[125] 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. On 6 August, Nigerian authorities confirmed the Ebola death of a nurse who had also treated Sawyer.[35]

In July, Arik Air, Nigeria's main airline, stopped flights to Liberia and Sierra Leone.[49]

On 9 August, the Nigerian National Health Research Ethics Committee, the organization regulating research ethics in the country, issued a statement waiving the regular administrative requirements that limit the international shipment of any biological samples out of Nigeria.[126] The statement also supports the use of non-validated treatments without prior review and approval by a health research ethics committee.[126]

On 14 August, the Nigerian government said Aliko Dangote had donated 150 million naira to halt the spread of the Ebola virus outbreak.[127]

On 19 August, the Commissioner of health in Lagos announced that Nigeria has seen twelve confirmed cases; four have died (including the index case) while another five, including two doctors and a nurse, have been declared disease-free and released.[128][129] Other than increased surveillance at the country’s borders, the Nigerian government states 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: "Efforts are currently ongoing to scale up and strengthen all aspects of response, including contact tracking, public information and community mobilization, case management and infection prevention and control, and coordination. There is now increased disease surveillance system in a bid to monitor, control, and prevent any occurrence of the disease".[128]

On 22 August, a doctor who treated a Liberian diplomat in an unnamed hotel—who had contact with Patrick Sawyer—died in Port Harcourt from Ebola. The BBC report says the diplomat had escaped from quarantine in Lagos and travelled to the city for medical treatment. He however survived after being treated. At present, the total number of deaths from Ebola in Nigeria has been brought to six.[130] The Good Heart Hospital and the unnamed hotel in Rivers State have been shut down. As a result 70 suspected contacts have been quarantined.[131][132]

#### Sierra Leone

The first person recorded to be infected with Ebola was a tribal healer who had treated an infected person, or persons, in her area and was reported to have died on 26 May. According to tribal tradition, her body was washed for her burial and several women from neighboring towns became infected.[133]

On 1 April, Sierra Leone instituted a temporary measure which includes reactivation of its "Active Surveillance Protocol" that will see all travellers into the country from either Guinea or Liberia subjected to strict screening to ascertain their state of health.[134] The government of Sierra Leone declared a state of emergency on 30 July and deployed troops to quarantine the hot spots of the epidemic.[135]

On 29 July, well-known physician Sheik Umar Khan, Sierra Leone's only expert on hemorrhagic fever, died after contacting Ebola at his clinic in Kenema. Khan had long worked with Lassa fever patients, which kills over 5,000 a year in Sierra Leone, and he expanded his clinic to accept Ebola patients when the disease broke out. At his death, Sierra Leone President Ernest Bai Koroma celebrated Khan as a "national hero".[133]

In August, awareness campaigns in Freetown, Sierra Leone's capital, were delivered over the radio or through car loudspeakers.[136] Also in August, Sierra Leone passed a law that will subject a two-year jail term on anyone found to be hiding a person who is believed to be infected with Ebola disease. The new measure was announced as a top parliamentarian lashed out at neighbouring countries for failing to do more to curtail the outbreak.[137]

On 26 August, the WHO said it had shut down one of its two laboratories in Sierra Leone after a health worker there was infected with Ebola. The laboratory is situated in the Kailahun district, one of the worst affected areas in Sierra Leone. This may disrupt efforts to increase the global response to the outbreak of the disease in the district.[138] "It's a temporary measure to take care of the welfare of our remaining workers," WHO spokesperson Christy Feig announced. He did not specify how long the closure would last, but they will return after the WHO assessment of the situation. The medical worker is one of the first WHO staff infected by the Ebola Virus. The worker was first treated at a government hospital in Kenema and then evacuated to Germany for further treatment.[138][139]

#### Senegal

In March, the Senegal Ministry of Interior ordered all movements of people through the southern border with Guinea to be suspended indefinitely to prevent the spread of the disease, according to a statement published on 29 March by state agency APS.[140]

On 29 August, the Senegalese Health minister, Awa Marie Coll Seck, announced the first case of Ebola in the country. The patient arrived from the neighbouring country Guinea, where the virus was first reported. The case has been confirmed in Senegal.[38][39] The patient, a university student from Guinea, is being treated in Dakar. Samples were sent to the Institut Pasteur, where Ebola was confirmed. The World Health Organization (WHO) was informed of the situation on 30 August [141] and is treating the situation "as a top priority emergency", and it has now dispatched operational personnel to Dakar.[142]

### Countries with suspected or non-transmissive cases

#### Germany

Germany has set up a special isolation ward that will care for up to six patients at the University Medical Center Hamburg-Eppendorf to provide treatment for Ebola patients. On 27 August the first patient arrived, a Senegalese epidemiologist who was working for the World Health Organization in Sierra Leone.[139]

#### India

On Tuesday 27 August a Health Ministry official said that 112 Indian citizens and four Nepalese citizens had landed in Mumbai and Delhi from Liberia.[143] Of the 17 who had arrived in Delhi, one had fever symptoms and had been quarantined at the Airport Health Organisation (APHO), an airport medical facility. Six others were screened for Ebola, and five passengers who arrived on routine flights from affected countries showing fever symptoms had also been quarantined. Earlier, it was reported that an isolation facility with 120 beds was being created in the Hindu Hriday Samrat Jogeshwari trauma care hospital by Brihanmumbai Municipal Corporation (BMC).[144] On 28 August, the Health Ministry reported that 821 people were being monitored and tracked for the Ebola virus.[145]

#### Spain

On 5 August, the Brothers Hospitallers of St. John of God confirmed that the Spanish Brother Miguel Pajares was infected with the Ebola virus while volunteering in Liberia. His repatriation, coordinated by the Spanish Ministry of Defence, occurred on 6 August 2014.[146] Spanish authorities confirmed that the patient would be treated in the 'Carlos III' hospital in Madrid. The decision attracted some controversy, amid questions as to the authorities' ability to guarantee no risk of transmission.[147] Brother Pajares died from the virus on 12 August.[148]

#### United Kingdom

In August, an isolation unit at the Royal Free Hospital in North London was prepared to treat patients with highly infectious diseases. On 24 August, William Pooley, a British citizen, was medically evacuated from Sierra Leone for treatment in the newly created unit. Pooley, a British health worker, is the first British citizen confirmed to have contracted the disease in Sierra Leone.[149] On 3 September, the 29-year old Pooley was discharged from hospital after a making full recovery from the disease. According to his doctors, he no longer poses a risk to the community and is no longer infectious.[150]

#### United States

American aid worker Kent Brantly became infected with Ebola, while working in a Monrovia treatment centre 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.[151][152][153] 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.[154] On 21 August, both Dr. Brantly and Ms. Writebol were discharged from Emory University Hospital, having recovered from the virus. Neither patient is considered contagious.[155]

On Thursday 4 September a Boston physician, Dr 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 tested positive for the disease. Dr Sacra will be treated in Omaha at the Nebraska Medical Center.[156] Dr. Sacra landed on Friday 5 September at the Offutt Air Force Base. A heavy police guard escorted the ambulance to the hospital in Nebraska. The doctor did not get infected while treating Ebola patients, but was exposed to the virus while delivering babies at a hospital in Liberia. [157]

### Other countries and economic regions

#### Economic Community of West African States

On 30 March, during the 44th Summit of the heads of state and government of West Africa, Economic Community of West African States (ECOWAS) disbursed US$250,000 to deal with the outbreak.[158] At the event in July of that year, the Nigerian government donated US$500,000 to the Liberian government to aid the fight against the virus.[159]

In July, the WHO convened an emergency sub-regional meeting with health ministers from eleven countries in Accra, Ghana.[160] On 3 July, the West African states announced collaboration on a new strategy, and the creation of a World Health Organization sub-regional centre in Guinea "to co-ordinate technical support";[161] the centre was inaugurated in Conakry on 24 July.[162]

On 31 July, the WHO and West Africa nations announced $100 million in aid to help contain the disease.[163]

#### European Union

In March, the European Commission (EC) gave €500,000 to help contain the spread of the virus in Guinea and its neighbouring countries. The EC has also sent a health expert to Guinea to help assess the situation and liaise with the local authorities. EU Commissioner for International Cooperation, Humanitarian Aid and Crisis Response Kristalina Georgieva said: "We are deeply concerned about the spread of this virulent disease and our support will help ensure immediate health assistance to those affected by it. It's vital that we act swiftly to prevent the outbreak from spreading, particularly to neighbouring countries."[164]

In April, a mobile laboratory, capable of performing the molecular diagnosis of viral pathogens of risk groups 3 and 4, was deployed in Guinea by the European Mobile Laboratory project (EMLab) as part of the WHO/GOARN outbreak response. Prior samples were analyzed at the Jean Mérieux BSL-4 Laboratory in Lyon.[165]

Germany's Foreign Office issued travel warnings for all affected countries at the end of July,[166] Spain did so on 2 August[167] and the UK did on 20 August.[168]

#### Australia

On 14 August, the Australian ambassador to the People’s Republic of China revealed that the Australian government would donate $US1 million to the World Health Organisation, in addition to its annual support, to assist in combating the Ebola outbreak.[169]

#### Canada

On 12 August, the Public Health Agency of Canada (PHAC) announced that the country would donate between 800 and 1,000 doses of an untested vaccine (VSV-EBOV) to the World Health Organization.[170] The offer was made by the Minister of Health directly to the Director General of the WHO as part of the country's commitment to containment efforts. The Government of Canada holds the intellectual property associated with the vaccine, but has licensed BioProtection Systems of Ames, Iowa to develop the product for use in humans.[171]

As of 12 August, Canada's contribution to address the spread of the Ebola virus in West Africa is estimated at $5,195,000. This includes resources dedicated to humanitarian, security, and public health interventions.[172]

On 26 August, the PHAC said it is preparing to bring home three members from their mobile laboratory in Sierra Leone. The three Canadians were among six workers at the mobile lab. The team is from the National Microbiology Laboratory in Winnipeg. The recall follows the diagnoses of three persons, staying at the same hotel as the team members, with the Ebola virus. The team members had no direct contact with the infected persons and are not showing any signs of the disease. The team members will be monitored as they travel back to Canada and will remain in voluntary isolation until cleared, officials from the PHAC said.[173]

On 6 September, the Public Health Agency of Canada announced that they will be resuming work at the Kailahun mobile laboratory after recalling them in late August for safety reasons. A three person team have been sent to the laboratory in eastern Sierra Leone. The team will rotate on a monthly bases.[174]

#### Chad

The Prime Minister of Chad, Kalzeubet Pahimi Deubet, said it will follow in the footsteps of South Africa and impose travel restrictions to and from the countries currently affected by the Ebola outbreak. Chad will close all its borders to Nigeria to prevent the spread of the disease to the country. He added that this would have an economic impact to Chad and the region, but the restrictions are necessary.[175]

#### China

A Chinese plane carrying supplies worth 30 million yuan (4.9 million US dollars) arrived in Guinea, Sierra Leone and Liberia on 11 August.[176][177] This is their second Ebola relief after the first batch delivered in May to Guinea, Liberia, Sierra Leone and Guinea-Bissau. The supplies include medical protective clothes, disinfectants, thermo-detectors and medicines. China also sent three expert teams composed of epidemiologists and specialists in disinfection and protection as well as medical supplies to Guinea, Liberia and Sierra Leone despite high risk of infection.[178][179] Before their arrival, eight members of a Chinese medical team sent to assist patients in Sierra Leone's hospitals were quarantined after treating Ebola patients.

Some Chinese companies in West Africa also joined the relief efforts. China Kingho Group, a leading exploration and mining company in Sierra Leone, donated 400 million Leones (about $90,000) to the Government and People of Sierra Leone on 15 August.[180]

On 16 August, Chinese President Xi Jinping and UN Secretary-General Ban Ki-moon on Saturday discussed several hot issues, including Ebola, in their fourth meeting this year. The meeting in Nanjing, capital of east China's Jiangsu Province, was held before they attended the opening ceremony of the 2nd Summer Youth Olympic Games.

Xi said China will continue to make joint efforts with the international community to prevent and control the Ebola virus outbreak that has hit West Africa. China has provided emergency medical assistance to Ebola-hit countries and sent expert groups. China's medical teams in the countries are working with local staff, according to Xi.

Xi also spoke highly of the measures taken by the United Nations and World Health Organization its professional institutions, and called for more assistance and input for medical and health services in African countries.[181]

#### Colombia

On 8 August, the Vice Minister of Health and Social Protection of Colombia, Fernando Ruiz, assured the public that the Government is preparing itself to face the virus even though Colombia's given conditions don't give Ebola the chance to natively spread since "the bat species in charge of transmitting the disease nor the practice of eating it aren't present in Colombia."[182] Ruiz also stated that Colombians travelling to the affected parts of West Africa are being warned to take appropriate precautions.[183] Previously, on 5 August, the Ministry of Health and Social Protection issued a press release stating that "since the month of April the National Government has been closely following and monitoring the outbreak of the Ebola virus in West Africa and the State has decided to adopt word by word the contingency plan prepared by the World Health Organization (WHO)."[184]

#### Equatorial Guinea

Equatorial Guinea temporarily stopped issuing visas from neighbouring countries and cancelled regional flights by Ceiba Intercontinental Airlines.[185]

#### Ghana

On 30 August the Ghanaian Presidency released a press statement, announcing the country's willingness to use Accra as a support base to help fight Ebola in the stricken countries. This agreement follows a telephonic meeting with the United Nations chief, Ban Ki-moon and John Dramani Mahama, the President of Ghana. Accra will serve as a base for air lifting medical and other supplies to countries affected by the Ebola outbreak, as well as personnel to curtail the disease.[186]

#### India

On 8 August, India placed all of its airports on high alert and stepped up surveillance of all travellers entering the country from Ebola-affected regions. The Union Health Minister, Harsh Vardhan, issued a statement, "There is no cause for panic. We have put in operation the most advanced surveillance and tracking systems." From 9 August, passengers coming from Ebola-affected countries will have to complete a form before landing; the form has a check-list for symptoms and asks travellers from West Africa for information about places visited, length of stay and other important information.

"The form is ready and will be officially released by Saturday. We will request all airlines to direct their staff to distribute the form in-flight, like immigration forms are given before arrival," said Jagdish Prasad, director general of health services, Union Ministry of Health. In New Delhi, Ram Manohar Lohia Hospital in New Delhi has been designated as a treatment centre for Ebola Virus Disease (EVD) cases. A 24-hour emergency helpline will also be functional from Saturday. Its numbers are (011)-23061469, 3205 and 1302. The estimated 47,000 Indians in the affected countries are being contacted by area diplomatic missions and supplied with educational material about the disease.[187]

#### Ivory Coast

The Ivory Coast on Friday 22 August released a statement on state-owned television announcing the closure of its borders to the neighbouring countries affected by the Ebola outbreak. Attempting to prevent the Ebola outbreak of the virus from spreading to the Ivory Coast the government announced the closure of all its land based borders to the country's West African neighbours Guinea and Liberia.[188]

The Ivory Coast previously placed a ban on all flights to and from Sierra Leone, Liberia and Guinea.[189]

#### Japan

In April, the Government of Japan gave $520,000 through the United Nations Children’s Fund (UNICEF) to support the Ebola outbreak response in Guinea.[190] In August, another $1.5 million in additional support was provided to be disbursed via the WHO, UNICEF and Red Cross, and will be used for measures to prevent Ebola infections and to provide medical supplies.[191]

On 25 August, Japanese authorities announced that they would be willing to provide access to an anti-influenza drug currently under development called favipiravir to try to treat EVD patients.[192] Fujifilm Holdings Corp and MediVector have reportedly approached the U.S. Food and Drug Administration to request approval for this experimental use of favipiravir. Up to 20,000 doses of favipiravir would currently be available.

#### Kenya

The Kenyan government banned people travelling from or through Sierra Leone, Guinea and Liberia for all ports of entry.[193]

#### Morocco

Beginning in April, Morocco reinforced medical surveillance at the Casablanca airport, a regional hub for flights from and to West Africa.[194][195] In early August, Liberian interior minister Morris Dukuly announced the Ebola death of a Liberian man in the country,[196] but the Moroccan Ministry of Health announced that the person died of a heart attack, rather than Ebola.[197]

#### Philippines

The Philippine Department of Foreign Affairs has raised Alert Level 2 in Guinea, Liberia and Sierra Leone and has temporarily halted the sending of Filipino workers to the affected countries since 30 June. Filipino seafarers are also cautioned about potentially contracting Ebola when their ship docks in affected countries.[198] The Department of Health expressed its willingness to send medical workers to Ebola-affected countries to help contain the outbreak.[199] On 23 August, the Philippines announced that it is pulling out its 115 UN peacekeepers stationed in Liberia due to the increasing health risk the troops face due to the outbreak.[200]

#### Qatar

Qatar has banned the import of live animals, food and meat products from Guinea, Liberia, Sierra Leone and Nigeria as a precaution against Ebola.[201]

#### Seychelles

Seychelles introduced a visa requirement for the citizens of Sierra Leone, Liberia, Guinea-Bissau, Guinea Conakry, Nigeria, Cameroon, Chad, Niger, Burkina Faso, Mali, Benin, Ivory Coast, Ghana, Togo, Congo, D.R. Congo, Gambia, Mauritania, and Senegal. Citizens of these countries will require a visa until the Ebola outbreak is declared over.[202] Members of the Sierra Leone national football team were refused visas over the outbreak.[203]

#### Saudi Arabia

On 1 April, Saudi Arabia stopped issuing visas for the Muslim pilgrimage to Mecca to people from Guinea, Liberia, and Sierra Leone.[204]

On 5 August Saudi Arabia announced that it would block issuance of Hajj and Umrah visas to the citizens of Sierra Leone, Guinea and Liberia.[205]

On 6 August, the Saudi Ministry of Health advised citizens and residents of Saudi Arabia to avoid travelling to Liberia, Sierra Leone, and Guinea until further notice.[206]

#### South Africa

On 21 August South Africa announced a ban on all travelers from the three Ebola-hit West African nations. A government spokesman confirmed they are following other countries responses to the disease outbreak. The health ministry of South Africa confirmed that the country's citizens would be asked to limit travel to absolutely essential needs, if going to the countries involved in the current outbreak. All South Africans returning from these countries would only be allowed back after undergoing extensive medical tests, and quarantine, if necessary.[207]

#### Sri Lanka

Sri Lanka cancelled visa on-arrival facility on 21 August for citizens of Guinea, Liberia, Nigeria and Sierra Leone.[208]

#### United Kingdom

The UK government has made £2 million available to partners including the International Federation of the Red Cross (IFRC) and Médecins Sans Frontières that are operating in Sierra Leone and Liberia to tackle the outbreak.[209] Additionally a £6.5 million rapid response research initiative has been announced jointly by the Department for International Development and the Wellcome Trust to better inform the management of Ebola outbreaks. This includes research which could help tackle the current outbreak.[210]

On 26 August, British Airways extended its ban on flights to Liberia and Sierra Leone until 31 December due to the declining public health situation.[211][212]

The Foreign Office issued updated travel advice in the week ending 24 August urging Britons to evaluate the need to travel to Sierra Leone, Guinea and Liberia.[149]

## Response by organisations

### World Health Organization

The World Health Organisation's (WHO) Regional Director for Africa, Luis Sambo, visited the affected countries from 21 to 25 July, meeting with political leaders, ministers of health, NGOs, and other agencies. He stressed the need to "promote behavioural change while respecting cultural practices."[29] On 24 July, WHO's Director General met with agencies and donors in Geneva to facilitate an increase in funding and manpower to respond to the outbreak.[29]

WHO declared the outbreak an international public health emergency on 8 August, after a two-day teleconference of experts.[9] On 11 August, they emphasised lack of supplies and capacity as one of the problems, while local awareness of the disease had increased.[213] Revised guidelines on how to prevent the spread of the disease were released, updating guidelines from 2008.[214]

On 28 August, the WHO said it is seeking $490 million in funding to fight the outbreak.[215] They report that they "are on the ground establishing Ebola treatment centres and strengthening capacity for laboratory testing, contact tracing, social mobilization, safe burials, and non-Ebola health care" and "continue to monitor for reports of rumoured or suspected cases from countries around the world." Other than cases where individuals are suspected or have been confirmed of being infected with Ebola, or have had contact with cases of Ebola, the WHO does not recommend any travel or trade restrictions.[13]

### US Centers for Disease Control

On 31 July, US health officials from the US Centers for Disease Control (CDC) issued a travel advisory for Guinea, Liberia, and Sierra Leone, warning against non-essential travel.[216] By 26 August, the CDC had issued a Level 3 travel warning for Sierra Leone, Guinea, and Liberia and a Level 2 travel warning for Nigeria.[217] The Level 3 warning is the highest that can be issued and will be in place until 27 February 2015. It means that United States residents must avoid nonessential travel to the three countries worst hit by the virus.

By the beginning of August, the US Centers for Disease Control had placed staff in Guinea, Sierra Leone, Liberia, and Nigeria to assist the local Ministries of Health and WHO-led response to the outbreak.[128] On 6 August, the Centers for Disease Control moved its Ebola response to Level 1 (the highest on a scale from 1 to 6) to increase the agency's ability to respond to the outbreak.[218]

On 29 August the CDC issued a Level 2 travel warning for the Democratic Republic of the Congo (DRC), warning against contact with body fluids of people with Ebola.[219]

### Médecins Sans Frontières

The humanitarian aid organisation Médecins Sans Frontières (Doctors Without Borders) started its Ebola intervention in West Africa in March 2014 and is now present in Guinea, Liberia, Nigeria, and Sierra Leone. At the end of August, the organization runs five Ebola case management centers with a total capacity of 415 beds. Since March, MSF has admitted a total of 1,885 patients. 907 of these patients tested positive for Ebola, and 170 have recovered. MSF has deployed 184 international staff to the region and employs 1,800 nationally hired personnel.[66]

On 29 August MSF described the international response as slow and derisory.[220]

### Samaritan's Purse

Samaritan's Purse is also providing direct patient care in multiple locations in Liberia.[221] At a congressional committee hearing on 7 August 2014, the head of Samaritan's Purse stated that "The disease is uncontained and out of control in West Africa."[222]

### World Food Program

On 18 August, World Food Program announced plans to mobilise food assistance for an estimated 1 million people living in restricted access areas.[223]

### World Bank Group

The World Bank Group has pledged up to US $200 million in emergency funding to help Guinea, Liberia, and Sierra Leone contain the spread of Ebola infections, help their communities cope with the economic impact of the crisis, and improve public health systems throughout West Africa. [89]

## Virology

A researcher working with the Ebola virus while wearing a BSL-4 positive pressure suit to avoid infection
Main article: Ebola virus

The strain of virus affecting people in the current outbreak is a member of the Zaire lineage.[224]

An article published in the New England Journal of Medicine on-line in April 2014 asserted that while the Zaire ebolavirus (EBOV) in Guinea shared 97% of its genetic code with the Zaïre lineage, it was of a different clade than the strains from outbreaks in the Democratic Republic of Congo and Gabon, and constituted a new strain indigenous to Guinea, and was not imported from Central Africa to West Africa.[14] This result, however was contradicted by two subsequent reports.

The first of these reports reached the conclusion that the outbreak "is likely caused by a Zaire ebolavirus lineage that has spread from Central Africa into Guinea and West Africa in recent decades, and does not represent the emergence of a divergent and endemic virus."[225]

A second report published in June 2014 also supports the latter view, determining that it was "extremely unlikely that this virus falls outside the genetic diversity of the Zaïre lineage" and that their analysis "unambiguously supports Guinea 2014 EBOV as a member of the Zaïre lineage."[224]

Scientists from the Broad Institute and Harvard University, in partnership with the Sierra Leone Ministry of Health and Sanitation, may have uncovered clues that set this Ebola outbreak apart from previous outbreaks. For this study, 99 Ebola virus genomes were collected and sequenced from 78 patients diagnosed with the Ebola virus during the first 24 days of the outbreak in Sierra Leone. The team found more than 300 genetic changes that make the 2014 Ebola virus distinct from previous outbreaks. It is still unclear whether these differences are related to the severity of the current outbreak.[226][227] Five members of the research team became ill and died from Ebola before the study was published in August.[228][227][229]

## Popular culture

"Ebola in Town," a dance tune by a group of West African rappers warning people of the dangers of the Ebola virus and explaining how to react, became popular in Guinea and Liberia during the first quarter of 2014.[230][231]

In August 2014, George Weah and Ghanaian musician Sidney produced a song to raise awareness about Ebola.[232]

There are a number of Ebola-themed jokes circulating in West Africa.[233]

## Timeline of the outbreak

A timeline of the outbreak follows, using data reported by the Centers for Disease Control and Prevention[234] and the World Health Organization (WHO).[235] The table also includes suspected cases that have yet to be confirmed for the virus. The reports are sourced from official information from the affected countries' health ministries. WHO has stated the reported numbers "vastly underestimate the magnitude of the outbreak".[236] Cases in remote areas may also be missed.[237]

Note that numbers for cases and deaths are in constant flux. Numbers reported for cases may include probable or suspected cases; numbers are revised downward if a suspected case turns out to be negative.

- Cumulative totals of cases and deaths over time

- Cumulative totals in log scale

- Average new cases and deaths per day (between WHO reporting dates)

Ebola cases and deaths by country and by date
Date | Total | Guinea | Liberia | Sierra Leone | Nigeria | Senegal | Refs
--- | --- | --- | --- | --- | --- | --- | ---
Cases | Deaths | Cases | Deaths | Cases | Deaths | Cases | Deaths | Cases | Deaths | Cases | Deaths
5 Sept 2014 | 3,967 | 2,105 | 812 | 517 | 1,871 | 1,089 | 1,261 | 491 | 22 | 8 | 1 | 0 | ✓[238]
31 Aug 2014 | 3,707 | 1,848 | 771 | 494 | 1,698 | 871 | 1,216 | 476 | 21 | 7 | 1 | 0 | ✓[239]
26 Aug 2014 | 3,069 | 1,552 | 648 | 430 | 1,378 | 694 | 1,026 | 422 | 17 | 6 |  |  | ✓[240]
20 Aug 2014 | 2,615 | 1,427 | 607 | 406 | 1,082 | 624 | 910 | 392 | 16 | 5 |  |  | ✓[241]
18 Aug 2014 | 2,473 | 1,350 | 579 | 396 | 972 | 576 | 907 | 374 | 15 | 4 |  |  | ✓[242]
16 Aug 2014 | 2,240 | 1,229 | 543 | 394 | 834 | 466 | 848 | 365 | 15 | 4 |  |  | ✓[243]
13 Aug 2014 | 2,127 | 1,145 | 519 | 380 | 786 | 413 | 810 | 348 | 12 | 4 |  |  | ✓[244]
11 Aug 2014 | 1,975 | 1,069 | 510 | 377 | 670 | 355 | 783 | 334 | 12 | 3 |  |  | ✓[245]
9 Aug 2014 | 1,848 | 1,013 | 506 | 373 | 599 | 323 | 730 | 315 | 13 | 2 |  |  | ✓[246]
6 Aug 2014 | 1,779 | 961 | 495 | 367 | 554 | 294 | 717 | 298 | 13 | 2 |  |  | ✓[247]
4 Aug 2014 | 1,711 | 932 | 495 | 363 | 516 | 282 | 691 | 286 | 9 | 1 |  |  | ✓[248]
1 Aug 2014 | 1,603 | 887 | 485 | 358 | 468 | 255 | 646 | 273 | 4 | 1 |  |  | ✓[249]
30 Jul 2014 | 1,440 | 826 | 472 | 346 | 391 | 227 | 574 | 252 | 3 | 1 |  |  | ✓[250]
27 Jul 2014 | 1,323 | 729 | 460 | 339 | 329 | 156 | 533 | 233 | 1 | 1 |  |  | ✓[251]
23 Jul 2014 | 1,201 | 672 | 427 | 319 | 249 | 129 | 525 | 224 |  |  |  |  | ✓[252]
20 Jul 2014 | 1,093 | 660 | 415 | 314 | 224 | 127 | 454 | 219 |  |  |  |  | ✓[253]
17 Jul 2014 | 1,048 | 632 | 410 | 310 | 196 | 116 | 442 | 206 |  |  |  |  | ✓[254]
14 Jul 2014 | 982 | 613 | 411 | 310 | 174 | 106 | 397 | 197 |  |  |  |  | ✓[255]
12 Jul 2014 | 964 | 603 | 406 | 304 | 172 | 105 | 386 | 194 |  |  |  |  | ✓[256]
8 Jul 2014 | 888 | 539 | 409 | 309 | 142 | 88 | 337 | 142 |  |  |  |  | ✓[257]
6 Jul 2014 | 844 | 518 | 408 | 307 | 131 | 84 | 305 | 127 |  |  |  |  | ✓[258]
2 Jul 2014 | 779 | 481 | 412 | 305 | 115 | 75 | 252 | 101 |  |  |  |  | ✓[259]
30 Jun 2014 | 759 (6/25)+22 | 467 +14 | 413 +3 | 303 +5 | 107 +8 | 65 +7 | 239 +11 | 99 +2 |  |  |  |  | ✓[260]
22 Jun 2014 | 599 | 338 | — | — | 51 | 34 | — | — |  |  |  |  | ✓[261]
20 Jun 2014 | 581 | 328 | 390 +0 | 270 +3 | — | — | 158 +0 | 34 +4 |  |  |  |  | ✓[261]
17 Jun 2014 | 528 | 337 | — | — | — | — | 97 (6/15)+31 | 49 +4 |  |  |  |  | ✓[262]
16 Jun 2014 | 526 | 334 | 398 | 264 | 33 (6/11)+9 | 24 +5 | — | — |  |  |  |  | ✓[262]
15 Jun 2014 | 522 | 333 | 394 | 263 | 33 | 24 | 95 | 46 |  |  |  |  | ✓[263]
10 Jun 2014 | 474 | 252 | 372 | 236 | — | — | — | — |  |  |  |  | CDC[16]
6 Jun 2014 | 453 | 245 | — | — | — | — | 89 +8 | 7 +1 |  |  |  |  | ✓[264]
5 Jun 2014 | 445 | 244 | 351 +7 | 226 +6 | — | — | — | — |  |  |  |  | ✓[264]
5 Jun 2014 | 438 | 233 | — | — | — | — | 81 +9 | 6 |  |  |  |  | ✓[265]
3 Jun 2014 | 436 | 233 | 344 +11 | 215 +3 | — | — | — | — |  |  |  |  | ✓[265]
1 Jun 2014 | 383 | 211 | 328 | 208 +21 | — | — | 79 +13 | 6 |  |  |  |  | ✓[266]
29 May 2014 | 354 | 211 | — | — | — +1 | — +1 | 50 +34 | 6 +1 |  |  |  |  | ✓[267]
28 May 2014 | 319 | 209 | 291 | 193 | — | — | — | — |  |  |  |  | ✓[267]
27 May 2014 | 309 | 202 | 281 | 186 | — | — | 16 | 5 |  |  |  |  | ✓[268][269]
23 May 2014 | 270 | 185 | 258 | 174 | — | — | — | — |  |  |  |  | ✓[270]
18 May 2014 | 265 | 187 | 253 | 176 | — | — | — | — |  |  |  |  | ✓[271]
12 May 2014 | 260 | 182 | 248 | 171 | — | — | — | — |  |  |  |  | ✓[272]
10 May 2014 | 245 | 168 | 233 | 157 | 12 | 11 | — | — |  |  |  |  | ✓[273]
7 May 2014 | 249 | 169 | 236 | 158 | — | — | — | — |  |  |  |  | ✓[274]
3 May 2014 | 244 | 166 | 231 | 155 | — | — | 0 | 0 |  |  |  |  | ✓[275]
2 May 2014 | 239 | 160 | — | — | 13 | 11 |  |  |  |  |  |  | ✓[276]
1 May 2014 | 237 | 158 | 226 | 149 | — | — |  |  |  |  |  |  | ✓[276]
30 Apr 2014 | 233 | 155 | 221 | 146 | — | — |  |  |  |  |  |  | CDC[16]
24 Apr 2014 | 253 | 152 | — | — | 35 | — |  |  |  |  |  |  | ✓[277]
23 Apr 2014 | 252 | 152 | 218 | 141 | — | — |  |  |  |  |  |  | ✓[277]
21 Apr 2014 | 242 | 147 | — | — | 34 ↓26? | 11 -2 |  |  |  |  |  |  | ✓[278]
20 Apr 2014 | 235 | 149 | 208 | 136 | — | — |  |  |  |  |  |  | ✓[278]
17 Apr 2014 | 230 | 142 | 203 | 129 | 27 | 13 |  |  |  |  |  |  | GU[279] LI✓[280]
16 Apr 2014 | 224 | 135 | 197 | 122 | 27 | 13 | (1) |  |  |  |  |  | ✓[281]
14 Apr 2014 | 194 | 121 | 168 | 108 | — | — |  |  |  |  |  |  | ✓[282]
11 Apr 2014 | 184 | 114 | — | — | 26 | 13 |  |  |  |  |  |  | ✓[282]
10 Apr 2014 | 183 | 113 | — | — | 25 | 12 | — | — |  |  |  |  | ✓[283]
9 Apr 2014 | 179 | 111 | 158 | 101 | — | — | — | — |  |  |  |  | ✓[283]
7 Apr 2014 | 172 | 105 | 151 | 95 | 21 | 10 | — (-2) | — |  |  |  |  | ✓[284][285]
1 Apr 2014 | 135 | 88 | 127 | 83 | 8 +0 | 5 +1 |  |  |  |  |  |  | ✓[286]
31 Mar 2014 | 130 | 82 | 122 | 80 | 8 | 2 | — | — |  |  |  |  | ✓[287]
29 Mar 2014 | 114 | 71 | — | — | 2 ↓5 | 1 ↓1 | — | — |  |  |  |  | ?[288]
28 Mar 2014 | 120 | 76 | 112 | 70 | — | — | (2) | (2) |  |  |  |  | ✓[289]
27 Mar 2014 | 111 | 72 | 103 | 66 | 8 | 6 | (6) | (5) |  |  |  |  | ✓[290]
26 Mar 2014 | 86 | 62 | 86 | 62 |  |  |  |  |  |  |  |  | ✓[291]
25 Mar 2014 | 86 | 60 | 86 | 60 |  |  |  |  |  |  |  |  | ✓[292]
24 Mar 2014 | 86 | 59 | 86 | 59 |  |  |  |  |  |  |  |  | ✓[293]
22 Mar 2014 | 49 | 29 | 49 | 29 |  |  |  |  |  |  |  |  | ✓[294]

  Notes:
    Date is the "as of" date from the reference. A single source may report statistics for multiple "as of" dates.
    Total cases and deaths before 1 July 2014 are calculated.
    Numbers with ± are deltas from a previous report. The deltas may not be consistent.
    Numbers with a ↓ indicate cases that were eliminated.
    Liberia:
      29 Mar: LI data is confused. Earlier, there were 8 suspected cases and 6 deaths (no confirmed cases). Seven suspected cases were tested by 29 Mar, and five were not Ebola. That should take suspected cases to 3, but a total was not stated; it also implies deaths should be at most 3. The report states only 2 suspected deaths were tested, and one was not Ebola.[288]
      21 Apr: reduced deaths by 2: one in Guinea total and one case discarded. 26 samples negative for Ebola.[278]
      24 Apr: stated it was reviewing its 27 suspected cases and may toss all of them;[277]
      2 May: reclassification complete.[276]
    Sierra Leone: cases were reported, but by 3 May there were no cases.[275] Early reports are marked with parens "()".
      7 Apr: 2 suspected cases of EVD were confirmed as Lassa Fever.[284]
      15 Apr: Of 12 suspected cases, 11 were tested for Ebola but came up negative.[281]
    Mali: 4 possible cases were reported on 7 April,[284][285] but they were not EVD.[281]

## References

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14. ^ a b 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. doi:10.1056/NEJMoa1404505.
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244. ^ Ebola virus disease, West Africa – update 15 August 2014, WHO
245. ^ Ebola virus disease, West Africa – update 13 August 2014, WHO
246. ^ Ebola virus disease, West Africa – update 11 August 2014, WHO
247. ^ Ebola virus disease, West Africa – update 8 August 2014, WHO
248. ^ Ebola virus disease, West Africa – update 6 August 2014, WHO
249. ^ Ebola virus disease, West Africa – update 4 August 2014, WHO
250. ^ Ebola virus disease, West Africa – update 31 July 2014, WHO
251. ^ Ebola virus disease, West Africa – update 29 July 2014, WHO
252. ^ Ebola virus disease, West Africa – update 25 July 2014, WHO
253. ^ Ebola virus disease, West Africa – update 23 July 2014, WHO
254. ^ Ebola virus disease, West Africa – update 18 July 2014, WHO
255. ^ Ebola virus disease, West Africa – update 17 July 2014, WHO
256. ^ Ebola virus disease, West Africa – update 14 July 2014, WHO
257. ^ Ebola virus disease, West Africa – update 10 July 2014, WHO
258. ^ Ebola virus disease, West Africa – update 7 July 2014, WHO
259. ^ Ebola virus disease, West Africa – update 3 July 2014 , WHO
260. ^ Ebola virus disease, West Africa – update 1 July 2014, WHO
261. ^ a b Ebola virus disease, West Africa – update 23 June 2014, WHO
262. ^ a b Ebola virus disease, West Africa (Situation as of 17 June 2014), WHO
263. ^ Dashboard - Ebola Virus Disease (EVD) in West Africa (Situation as of 16 June 2014), WHO
264. ^ a b Ebola virus disease, West Africa (Situation as of 7 June 2014), WHO
265. ^ a b Ebola virus disease, West Africa (Situation as of 5 June 2014), WHO
266. ^ Ebola virus disease, West Africa (Situation as of 01 June 2014), WHO
267. ^ a b Ebola virus disease, West Africa (Situation as of 30 May 2014), WHO
268. ^ Ebola virus disease, West Africa (Situation as of 27 May 2014), WHO
269. ^ Dashboard - Ebola Virus Disease (EVD) in West Africa (Situation as of 27 May 2014), WHO
270. ^ Ebola virus disease, West Africa (Situation as of 23 May 2014), WHO
271. ^ Ebola virus disease, West Africa (Situation as of 18 May 2014), WHO
272. ^ Ebola virus disease, West Africa (Situation as of 15 May 2014), WHO
273. ^ Ebola virus disease, West Africa (Situation as of 10 May 2014), WHO
274. ^ Ebola virus disease, West Africa (Situation as of 9 May 2014), WHO
275. ^ a b Ebola virus disease, West Africa (Situation as of 5 May 2014), WHO
276. ^ a b c Ebola virus disease, West Africa (Situation as of 2 May 2014), WHO
277. ^ a b c Ebola virus disease, West Africa (Situation as of 25 April 2014), WHO
278. ^ a b c Ebola virus disease, West Africa (Situation as of 22 April 2014), WHO
279. ^ Ebola virus disease, West Africa (Situation as of 19 April 2014), WHO
280. ^ Ebola Virus Disease (EVD) in West Africa Dashboard (17 April 2014), WHO
281. ^ a b c Ebola virus disease, West Africa (Situation as of 16 April 2014), WHO
282. ^ a b Ebola virus disease, West Africa (Situation as of 14 April 2014), WHO
283. ^ a b Ebola virus disease, West Africa (Situation as of 10 April 2014), WHO
284. ^ a b c Ebola virus disease, West Africa (Situation as of 7 April 2014), WHO
285. ^ a b Dashboard - Ebola Virus Disease in West Africa (07 April 2014), WHO
286. ^ Ebola virus disease, West Africa (Situation as of 2 April 2014), WHO
287. ^ Ebola virus disease, West Africa (Situation as of 1 April 2014), WHO
288. ^ a b Ebola virus disease, Liberia (Situation as of 30 March 2014), WHO
289. ^ Ebola virus disease, Guinea (Situation as of 30 March 2014), WHO
290. ^ Ebola virus disease, Guinea (Situation as of 27 March 2014), WHO
291. ^ Ebola virus disease in Guinea (Situation as of 26 March 2014), WHO
292. ^ Ebola virus disease in Guinea (Situation as of 25 March 2014), WHO
293. ^ WHO (24 March 2014), "Ebola Hemorrhagic Fever in Guinea", Outbreak Bulletin 4 (1)
294. ^ Ebola virus disease in Guinea, WHO, 23 March 2014

## External links

| Wikimedia Commons has media related to 2014 West Africa Ebola outbreak.

- Outbreak Updates, World Health Organization (WHO) .
- Outbreak Updates, US Centers for Disease Control and Prevention (CDC) .
- The Spread of Ebola Outbreaks (1976-2015), GoogleMaps .

Guinea topics

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Retrieved from "http://en.wikipedia.org/w/index.php?title=Ebola_virus_epidemic_in_West_Africa&oldid=624550715"
Categories:

- 2010s medical outbreaks
- 2014 health disasters
- 2014 in Guinea
- 2014 in Liberia
- 2014 in Nigeria
- 2014 in Sierra Leone
- Disasters in Guinea
- Disasters in Liberia
- Disasters in Nigeria
- Disasters in Sierra Leone
- Ebola
- Health in Guinea
- Health in Liberia
- Health in Nigeria
- Health in Sierra Leone
- Ongoing events

Hidden categories:

- Articles with French-language external links
- CS1 errors: dates
- Articles with Spanish-language external links
- Use dmy dates from June 2014
- Use British English from August 2014
- Articles containing potentially dated statements from September 2014
- All articles containing potentially dated statements
- Articles containing potentially dated statements from 2014
- All articles with unsourced statements
- Articles with unsourced statements from September 2014
- Articles which use infobox templates with no data rows
- Commons category with local link same as on Wikidata
- Use dmy dates from August 2014