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West African Ebola 2013-16
The Western African Ebola virus epidemic was the most widespread outbreak of Ebola virus disease in history, causing major loss of life and socioeconomic disruption in the region, mainly in Guinea, Liberia and Sierra Leone.
The Western African Ebola virus epidemic (2013–2016) was the most widespread outbreak of Ebola virus disease (EVD) in history, causing major loss of life and socioeconomic disruption in the region, mainly in Guinea, Liberia, and Sierra Leone. The first cases were recorded in Guinea in December 2013; later, the disease spread to neighboring Liberia and Sierra Leone, with minor outbreaks occurring elsewhere. It caused significant mortality, with the case fatality rate reported which was initially considerable, while the rate among hospitalized patients was 57–59%, the final numbers 28,616 people, including 11,310 deaths, for a case-fatality rate of 40%. Small outbreaks occurred in Nigeria and Mali, and secondary infections of medical workers occurred in the United States and Spain. In addition, isolated cases were recorded in Senegal, the United Kingdom, and Italy. The number of cases peaked in October 2014 and then began to decline gradually, following the commitment of substantial international resources. As of 8 May 2016, the World Health Organization (WHO) and respective governments reported a total of 28,646 suspected cases and 11,323 deaths (39.5%), though the WHO believes that this substantially understates the magnitude of the outbreak.
On 8 August 2014, a Public Health Emergency of International Concern was declared and on 29 March 2016, the WHO terminated the Public Health Emergency of International Concern status of the outbreak. Subsequent flare-ups occurred; the epidemic was finally declared over on 9 June 2016, 42 days after the last case tested negative on 28 April 2016 in Monrovia
The outbreak left about 17,000 survivors of the disease, many of whom report post-recovery symptoms termed post-Ebola syndrome, often severe enough to require medical care for months or even years. An additional cause for concern is the apparent ability of the virus to "hide" in a recovered survivor's body for an extended period of time and then become active months or years later, either in the same individual or in a sexual partner. In December 2016, the WHO announced that a two-year trial of the rVSV-ZEBOV vaccine appeared to offer protection from the variant of EBOV responsible for the Western Africa outbreak. The vaccine is considered to be effective and is the only prophylactic which offers protection; hence, 300,000 doses have been stockpiled. rVSV-ZEBOV received regulatory approval in 2019.
Ebola virus disease (commonly known as "Ebola") was first described in 1976 in two simultaneous outbreaks in the Democratic Republic of the Congo and what is now South Sudan. The 2013–2016 outbreak, caused by Ebola virus (EBOV) was the first anywhere in the world to reach epidemic proportions. Previous outbreaks had been brought under control in a much shorter period of time. Extreme poverty, dysfunctional healthcare systems, distrust of government after years of armed conflict, and the delay in responding for several months, all contributed to the failure to control the epidemic. Other factors, per media reports, included local burial customs of washing the body and the unprecedented spread of Ebola to densely populated cities.
As the outbreak progressed, the media reports, many hospitals, short on both staff and supplies, were overwhelmed and closed down, leading some health experts to state that the inability to treat other medical needs may have been causing "an additional death toll [that is] likely to exceed that of the outbreak itself". Hospital workers, who worked closely with the highly contagious body fluids of the victims, were especially vulnerable to contracting the virus; in August 2014, the WHO reported that ten per cent of the dead had been healthcare workers. In September 2014, it was estimated that the affected countries' capacity for treating Ebola patients was insufficient by the equivalent of 2,122 beds; however, by December 2014 there were enough beds to treat and isolate all reported cases, although the uneven distribution of cases was resulting in serious shortfalls in some areas.
The WHO has been widely criticised for its delay in taking action to address the epidemic. On 8 August 2014, it declared the outbreak a public health emergency of international concern. By September 2014, Médecins Sans Frontières/Doctors Without Borders (MSF), the non-governmental organisation with the largest working presence in the affected countries, had grown increasingly critical of the international response. Speaking on 3 September, the International President of MSF spoke out concerning the lack of assistance from United Nations (UN) member countries: "Six months into the worst Ebola epidemic in history, the world is losing the battle to contain it." In a 26 September statement, the WHO stated that "[t]he Ebola epidemic ravaging parts of Western Africa is the most severe acute public health emergency seen in modern times" and its Director-General called the outbreak "the largest, most complex and most severe we've ever seen". In March 2015, the United Nations Development Group reported that due to a decrease in trade, closing of borders, flight cancellations, and drop in foreign investment and tourism activity fuelled by stigma, the epidemic had resulted in vast economic consequences in both the affected areas in Western Africa and even in other African nations with no cases of Ebola.
On 28 January 2015, the WHO reported that for the first time since the week ending 29 June 2014, there had been fewer than 100 new confirmed cases reported in a week in the three most-affected countries. The response to the epidemic then moved to a second phase, as the focus shifted from slowing transmission to ending the epidemic. On 8 April 2015, the WHO reported a total of only 30 confirmed cases, and the weekly update for 29 July reported only seven new cases. Cases continued to gradually dwindle and on 7 October 2015, all three of the most seriously affected countries, per media reports, recorded their first joint week without any new cases. However, as of late 2015, while the large-scale epidemic had ended, according to media reports, sporadic new cases were still being recorded, frustrating hopes that the epidemic could be declared over.
On 31 July 2015, the WHO announced "an extremely promising development" in the search for an effective vaccine for Ebola virus disease. While the vaccine had shown high efficacy in individuals, more conclusive evidence was needed regarding its capacity to protect populations through herd immunity. In August 2015, after substantial progress in reducing the scale of the epidemic, the WHO held a meeting to work out a "Comprehensive care plan for Ebola survivors" and identify research needed to optimise clinical care and social well-being. Stating that "the Ebola outbreak has decimated families, health systems, economies, and social structures", the WHO called the aftermath of the epidemic "an emergency within an emergency." Of special concern is recent research that shows some Ebola survivors experience a so-called "post-Ebola Syndrome", with symptoms so severe that survivors may require medical care for months and even years. As the main epidemic was coming to an end in December 2015, the UN announced that 22,000 children had lost one or both parents to Ebola. On 29 March 2016, the Director-General of WHO terminated the Public Health Emergency of International Concern status of the Western African Ebola virus epidemic.
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