Ebola Virus


Global, origins in West Africa

Bringing forth socioeconomic chaos and major causes of death in the region, the Western African Ebola virus epidemic which took place in 2013–2016 was the most widespread outbreak of Ebola virus disease in history, starting in Guinea then moving across land borders to Sierra Leone and Liberia. Small outbreaks occurred in Nigeria and Mali, whilst consequently there were isolated cases and secondary infections of medical workers occurring in the United States, Spain, Senegal, United Kingdom and Italy.

Although the virus was first discovered in 1976 near the Ebola River, the ongoing outbreak re-emerged in the Democratic Republic of the Congo in August 2018. Primarily with an experimental vaccine ready to be used, public health officials were hopeful they would be able to contain it. However with violent attacks on healthcare workers and hindered access to the locations most in need of care and equipment, such hopes soon disappeared. The sudden arrival of outsiders interested in regions where there’s been violence for years makes people from the local communities feel cynical, and the actions of armed groups limit medical intervention.

Criticisms on pharmaceutical companies and NGO’s from the Congolese Health Department has only amplified suspicions within local communities. In the Congo these circumstances are among the main reasons for the spread of Ebola. With more than 100 armed groups active in this region, the epicentre of the Ebola outbreak is in North Kivu, which has been an area of conflict for over 25 years. Also neglected by international stakeholders and the Congolese government, the region Beni, which stands at the heart of the Ebola epidemic has been gripped by violence from armed groups for decades. Access to health care for these communities has been restricted due to the violence and political unrest, even though the number of new confirmed Ebola cases have continued to grow.

By making it difficult to trace contacts, conduct vital community outreach activities and identify new cases, security constraints are hindering the Ebola response. While Ebola could be eradicated temporarily, other threats could still arise in this zone dangering public health and the security of the region, if the international community does not seriously commit to finding a security solution to the situation in the DRC. The World Health Organisation has declared the Democratic Republic of the Congo’s Ebola epidemic as a global health emergency of international concern.

Key Facts

15,311

People killed

34,718

Cases

24

Major Outbreaks

Major outbreak examples:

  • 1976: South Sudan and the Democratic Republic of the Congo (DRC)
  • 2014-2016: Starting in Guinea and spreading to other West African countries
  • 2018-2020: Democratic Republic of Congo (DRC)

Ebola vaccines?

  •  rVSV-ZEBOV/Ervebo

Licensed in February 2020 by four African countries—Burundi, the DRC, Ghana and Zambia. Already approved by the United States, European Union, and WHO, the vaccine was highly effective in trials during the West African outbreak and more recent DRC outbreaks. WHO Director-General hailed the licensing as a “milestone in the fight against this unforgiving disease.”

What is Ebola?

Ebola, formerly known as the Ebola haemorrhagic fever is a life-threatening disease that attacks the immune system causing extreme fluid loss often leading to death.

How do Ebola outbreaks start?

The disease is contracted by people from being in contact with animals—usually bats but sometimes primates or from cooking or eating contaminated foods. Through their bodily fluids, human carriers can then transmit Ebola to others. After death, their bodies remain contagious.

Why was the 2014 outbreak in West Africa so deadly?

This epidemic had spread to several communities before being identified as Ebola, unlike past outbreaks, which were generally confined to remote areas in Central Africa. In early March 2014 by the time the first diagnosis was made, cases were suspected in Liberia and Sierra Leone and the virus had already struck multiple villages in Guinea. Experts say the poor health infrastructure of the stricken countries was the reason the disease was able to spread so quickly.

The Key Actors

Timeline

The outbreak happened in the cities of south Sudan Tumbura, Juba, Maridi and Nzara. Workers in a cotton factory were the index cases. Usually from patients to their nurses, the disease was spread by close contact with an acute case. Amongst the infected were many medical personnel.

Country – Sudan

Virus – SUDV

Human Cases – 284

Human Deaths – 151

Case fatality rate 53%

Presently known as the Democratic Republic of the Congo, the outbreak occurred in the city of Yambuku. It spread through the use of contaminated needles in hospital/clinics and also through personal contact.

Country – Democratic Republic of Congo

Virus – EBOV

Human Cases – 318

Human Deaths – 280

Case fatality Rate – 88%

This was a recurrent outbreak in Maridi and Nzara, which took place at the same location as the 1976 Sudan epidemic

Country – Sudan

Virus – SUDV

Human Cases – 34

Human Deaths – 22

Case Fatality Rate – 65%

The outbreak occurred in Makokou and deep in the rain forest along the Ivindo River in gold mining camps. It had been wrongly classified as yellow fever until 1995.

Country – Gabon

Virus – EBOV

Human Cases – 52

Human Deaths – 31

Case Fatality Rate – 60%

A patient who worked in a forest adjoining the city of Kikwit is where the outbreak was traced to. Mainly through families the epidemic was spread but also hospital admissions too.

Country – Zaire

Virus – EBOV

Human Cases – 315

Human Deaths – 254

Case Fatality Rate – 81%

The outbreak occurred in the village of Mayibout and its surrounding areas. A chimpanzee found dead in the forest was eaten by villagers hunting for food. Whilst more cases occurred in their family members, nineteen people involved in the butchery of the animal became ill.

Country – Gabon

Virus – EBOV

Human Cases – 31

Human Deaths – 21

Case Fatality Rate – 68%

With transport of patients to Liberville the outbreak occurred in the Booue area. A hunter who lived in a forest timber camp was the index case patient. At the time a dead chimpanzee was determined to be infected which was found in the forest. Close contact with infected people is how the disease spread.

Country – Gabon

Virus – EBOV

Human Cases – 60

Human Deaths – 45

Case Fatality Rate – 75%

The districts located in Uganda called Masindi, Mbarara and Gulu is where the outbreak occurred. The three greatest risks associated with Sudan virus infection were providing medical care to case-patients without using suitable personal protective procedures, having contact with case-patients in one’s family and attending funerals of case-patients. Victims included Matthew Lukwiya.

Country – Uganda

Virus – SUDV

Human Cases – 425

Human Deaths – 224

Case Fatality Rate – 53%

This outbreak occurred on both sides of the border between Gabon and the Republic of the Congo.

Country – Gabon

Virus – EBOV

Human Cases – 65

Human Deaths – 53

Case Fatality Rate – 82%

This outbreak occurred on both sides of the border between Gabon and the Republic of the Congo (RC). Ebola virus disease in the Republic Of Congo had its first reported occurrence included in this outbreak.

Country – Republic Of Congo

Virus – EBOV

Human Cases – 59

Human Deaths – 44

Case Fatality Rate – 75%

The outbreak occurred in the Cuvette-Ouest Department in the districts of Mobomo and Kelle

Country – Republic Of Congo

Virus – EBOV

Human Cases – 143

Human Deaths – 128

Case Fatality Rate – 90%

located in Mbomo District in the Cuvette-Ouest Department, the outbreak occurred in the villages of Mbomo and Mbandza.

Country – Republic Of Congo

Virus – EBOV

Human Cases – 35

Human Deaths – 29

Fatality Rate – 83%

In Western Equatoria, which in the present day is known as south Sudan, the outbreak occurred in the Yambio county. Several suspected EVD cases were reclassified later as measles cases because this outbreak was concurrent with an outbreak of measles in the same area.

Country – Sudan

Virus – SUDV

Human Cases – 17

Human Deaths – 7

Case Fatality Rate – 41%

Occurred in the Etoumbi district of Cuvette Ouest Department of the Republic of the Congo

Country – Republic Of Congo

Virus – EBOV

Human Cases – 12

Human Deaths – 10

Case Fatality Rate – 83%

Country – Democratic Republic Of Congo

Virus – EBOV

Human Cases – 246

Human Deaths – 187

Case Fatality Rate – 71%

The outbreak occurred in western Uganda’s Bundibugyo’s District. This was the first identification of the Bundibugyo virus (BDBV).

Country – Uganda

Virus – BDBV

Human Cases – 149

Human Deaths – 37

Case Fatality Rate – 25%

This outbreak occurred in the Mweka and Luebo health zones of the Kasaï-Occidental province.

Country – Democratic Republic Of The Congo

Virus – EBOV

Human Cases – 32

Human Deaths – 14

Case Fatality Rate – 45%

This outbreak occurred in the Kibaale District.

Country – Uganda

Virus – SUDV

Human Cases – 24

Human Deaths – 17

Case Fatality Rate – 71%

This outbreak occurred in the Orientale Province.

Country – Democratic Republic Of Congo

Virus – BDBV

Human Cases – 57

Human Deaths – 29

Case Fatality Rate – 51%

In regards to both the number of human cases and fatalities, this was the most severe Ebola outbreak in recorded history. In December 2013 it began in Guéckédou, Guinea and spread abroad. Whilst flare-ups of the disease still continued into 2016 the outbreak was declared over on 9 June 2016.

Countries –      Liberia, Sierra Leone, Guinea (Widespread)

                            Nigeria, Mali, United States, Senegal, Spain, United Kingdom, Italy (Limited and Local)

 

Virus – EBOV

Human Cases – 28,616

Human Deaths – 11,310

Case Fatality Rate – 70 -71%

 Appealing to member States with experience, AU Ministers of Health convened in Angola to assist with action and fight Ebola.

Announcing cooperation on a plan to co-ordinate support to combat the epidemic, the World Health Organization (WHO) arranged an emergency meeting with health ministers from eleven countries.

Seventeen suspected Ebola patients were missing in Liberia after a health centre in the capital was attacked, the government says. The attack on the quarantine centre in Liberia, took place in Monrovia’s densely populated West Point township. There were conflicting reports over what sparked the riot, in which medical supplies were stolen. Assistant Health Minister Tolbert Nyenswah said the protesters were unhappy that patients were being taken there from other parts of the capital. Other reports suggested the protesters had believed Ebola was a hoax and wanted to force the centre to close.

Ebola was declared a threat to international peace and security by the UN Security Council

There was Ebola related violence and rioting in the eastern town of Koidu, with police imposing a curfew. Local youth fired at police with shotguns after a former youth leader refused health authorities permission to take her relative for an Ebola test. Several buildings were attacked and youth gangs roamed the streets shouting “No more Ebola”. A local leader reported seeing two bodies with gunshot wounds in the aftermath. Police denied that anyone had been killed. Doctors reported two dead. The local district medical officer said he had been forced to abandon the local hospital because of the rioting.

The outbreak occurred on the 24th of August in Equateur province. As of 28 October 2014, according to the WHO, twenty days had passed since the last reported case was cleared and no new contacts were being followed. Declared over on 15 November 2014.

Country – Democratic Republic Of Congo

Virus – EBOV

Human Cases – 66

Human Deaths – 49

Case Fatality Rate – 74%

Making it the first reputable vaccine against the disease, a study found the VSV-EBOV vaccine to be 95–100% effective against the Ebola virus.

In the northwestern town of Bikoro, the government of the Democratic Republic of the Congo reported two confirmed cases of Ebola infection, On 8 May 2018. In the city of Mbandaka On 17th May, a case was confirmed. An experimental Ebola vaccine rVSV-ZEBOV had been developed to contain the outbreak which health authorities were planning on using to ring vaccinate. On July 24, 2018 the outbreak was declared over.

Country – Democratic Republic Of Congo

Virus – EBOV

Human Cases – 54

Human Deaths – 33

Case Fatality Rate – 61%

When 4 individuals tested positive for the Ebola virus On 1 August 2018, the Democratic Republic of the Congo Ministry of Health declared an outbreak. After being diagnosed with Ebola the WHO confirmed that a five-year-old boy in Uganda died On 11 June 2019. On 25 June, 2020 the second biggest EVD outbreak ever was declared over.

Country – Democratic Republic Of Congo and Uganda (Widespread)

Human Cases – 3470

Human Deaths – 2280

Case Fatality Rate – 66%

Ebola prevention activities have been suspended in the DRC city of Beni after a deadly rebel attack. Lasting for several hours the rebel attack in Beni killed eighteen people including 14 civilians.

Although not confirmed local sources say that behind the attack was a Ugandan Islamist militant group active in the area since the 1990s.

Two attacks in eastern Democratic Republic of the Congo (DRC) have killed 4 workers responding to the Ebola outbreak and injured 5 others. The attacks occurred overnight on a shared living camp in Biakato Mines and an Ebola response coordination office in Mangina. The dead include a member of a vaccination team, two drivers and a police officer.

Separate to the ongoing Kivu Ebola epidemic, on May 31st an announcement was made by the DRC Health Minister Eteni Longondo that there is an additional Ebola outbreak. Equateur province is where the latest outbreak is located (which is the same place the 2018 Equateur province Ebola outbreak took place). Due to the EVD outbreak, on the 21th of August it had become 100 cases with 43 deaths.

Country- Democratic Republic Of Congo

Virus – EBOV

Human Cases – 100

Human Deaths – 43

Case Fatality Rate – Ongoing

Carrying the virus without being affected by it, a significant source of infection are so-called reservoir hosts. For the various types of the Ebola virus, the most likely involved reservoir hosts are various species of bats and fruit bats.

Scientists have discovered for the first time, where nine of such bat and fruit bat species may encounter suitable habitats and climatic conditions in Africa. Based on ecological niche modelling the respective bat and fruit bat species are able to thrive in West and East Africa, including large parts of Central Africa. 

Located between the Ubangi and Congo rivers, the latest area affected by Ebola is Bomongo. Out of the health zones that border the Republic of the Congo, this is the second one to be affected.

At 46 strategic points of control, the WHO said it had screened nearly 1 million travellers for Ebola to prevent the outbreak from spreading further. Helping to reduce the disease’s spread, it said those efforts had identified 72 suspected cases of Ebola.

 

In interviews, 51 women in the Democratic Republic of Congo recounted multiple incidents of sexual exploitation and abuse, mainly by men who said they were international workers from the world health organisation and leading NGo’s during the 2018-2020 Ebola crisis according to an investigation by the New Humanitarian and the Thomas Reuters Foundation.

The majority of the women said numerous had either propositioned them, forced them to have sex in exchange for a job or terminated contracts when they refused.

The food and drug administration approved the first Ebola Virus treatment for adults and children.

The treatment called inmazeb, is a combination of three monoclonal antibodies made by regeneration pharmaceuticals. The drug is approved to treat Zaire Ebolavirus, one of six known types.

The DRC’s minister of health Eteni Longondo, made the official declaration along with the World Health Organization on Wednesday after no new cases were registered in more than 48 days.

In total more than 55 deaths, 119 confirmed cases, 11 probable cases and 75 recoveries were recorded, according to WHO.

A tool that will guide countries on how they can use an Ebola vaccine incase of an outbreak has been launched by scientists. 

A tool called Ebola Vaccines 3C Gap Analysis and Dissemination that was launched in Lira is supposed to clearly define conditions under which the ebola vaccine can be used.

The tool will be used in Uganda, Sierra Leone and Senegal. The implementation of the tool in Uganda will be supported by World Vision Ireland.

 

Research at the University of Delaware have built a complex model to simulate the molecular dynamics within the Ebola Virus. Their findings could assist the development of new treatments for Ebola and other viral diseases such as Covid-19.

The supercomputer simulations have been used to help crack the defences of Ebola’s genetic material, contributing to breakthroughs in treatment and vaccines for Ebola and other viruses.

Humanity faces an unknown number of new and potentially fatal viruses emerging from Africa’s tropical rainforests, according to professor Jean-Jacques Muyembe Tamfum, who helped discover the ebola virus in 1976 and has been on the frontline of the hunt  for new pathogens ever since.

Kinashasa, Democratic Republic of Congo – showing early symptoms of haemorrhage fever, a patient sits quietly on her bed. They are waiting for the results of a test for Ebola. The patient can only communicate with her relatives through a clear plastic observation window.

There is a vaccine and treatment for Ebola which have brought down the rate at which it kills. But the main question here is  what if this woman doesn’t have Ebola? What if, instead, she is the first patient of ‘Disease X’.

The four international Humanitarian organisations that make up the International Coordinating Group (ICG) led the effort with support from Gavi. The Vaccine Alliance has established a global stockpile of Ebola vaccines, which it says will help mitigate against future Ebola epidemics by giving countries at risk timely access to the vaccines during outbreaks.

Health authorities in the Democratic Republic of Congo are racing to contain a possible Ebola outbreak, after a woman died from the virus near the Eastern city of Butembo.

The announcement potentially marks the start of Congo’s twelfth Ebola outbreak since the virus was discovered near the Ebola River in 1976, more than double any other country.

Guinea has officially declared that it is dealing with an Ebola epidemic after the deaths of at least three people from the virus. They and four others fell ill with diarrhoea, vomiting and bleeding after attending the burial of a nurse.

The country has launched an Ebola vaccination campaign to halt the spread of the deadly disease, which hit the country’s south this morning.

As the first shipment of COVID-19 vaccines arrived in Africa this week, another vaccine was being rolled out in Guinea in a bid to stop a fresh outbreak of Ebola in its tracks.

Mass immunization got under way on February the 23rd after 11,000 doses of Ebola vaccines landed in the west african country as part of an emergency response to the outbreak, confirmed the WHO. 

A new Ebola Virus outbreak in Guinea appears to have been sparked by a person who was first infected during the country’s previous epidemic five years ago, suggesting persistent infections in survivors could be a source of future outbreaks.

The Ebola virus disease outbreak has accumulated 23 cases including 16 confirmed and 7 probable cases. 2 people (one confirmed case and one suspected) are currently hospitalized at the ETC of N’Zerekore.

Local health authorities in several parts of the United States are monitoring dozens of travelers for Ebola after the Centers for Disease Control (CDC) ordered airlines to collect information on people who’d been in several western african countries, including Guinea or the Democratic Republic of Congo.

Washington state is monitoring at least 23 travelers. Another 45 are being watched in Ohio and 4 people are being monitored in Oregon.

Ebola vaccination kicked off today in Sierra Leone as the country takes proactive public health measures to protect people at high risk of infection in case of any potential cross border transmission of the disease from the ongoing outbreak in neighbouring Guinea.

Scientists at scripps research have unveiled a new Ebola Virus vaccine design which they say is intended to simulate a better protective immune response than standard vaccine approaches, which often expose the immune system to individual glycoproteins rather than realistic looking virus particles.

An Ebola outbreak in Guinea that started in February, infecting 16 people and killing 12, has been declared over, the world health organisation has said. 

The minister of health, Dr Olorunnimbe Marmora, has said the west african country has learnt sufficiently from the Ebola and Covid-19 outbreaks. Consequently it has developed as well equipped its health system and emergency response, to respond to future pandemics. 

In a study published in mBio, the team reported how a protein of the ebola virus, VP24, interacts with the layered membrane of the cell nucleus (known as the nuclear envelope), leading to significant damage to cells along with virus replication and the propagation of disease.

“The ebola virus is extremely skilled at dodging the body’s immune defences and in our study we characterize an important way in which that evasion occurs through disruption of the nuclear envelope, mediated by the VP24 protein” says co-senior author Adolfio García-sastre. 

The delta variant is more contagious than the virus that causes Ebola as well as viruses that cause MERS, SARS, smallpox, seasonal flu and the common cold. 

Covid delta variant is as contagious as chicken pox but the Ebola virus causes more severe infection: CDC Internal reports. 

WHO is very concerned about an ebola outbreak which has been declared in the capital city of Abidjan, after an 18 year old infected woman travelled 500km on a bus from neighbouring Guinea to see her fiance.

Medics in both countries are currently working around the clock to identify everyone the woman came into contact with.

After a clinical trial in Sierra Leone, new research suggests Johnson & Johnson’s two dose Ebola vaccine regimen is safe, well tolerated and produces a strong immune response in people over the age of one. 

Ebola survivors can relapse and trigger outbreaks at least five years after infection, and long term follow up of former patients is needed to prevent devastating flare ups, according to new research.

Scientists already knew Ebola could lie dormant in survivors, who test negative because the virus is in tissue rather than circulating in the blood. 

An independent inquiry commissioned why the WHO examined about 80 cases of women and girls aged 13-43 being sexually abused from 2018-2020 during the devastating Ebola outbreak in the DRC. 21 employees working for the UN global health body were among the perpetrators of these serious cases. According to the report, the abuse lead to 29 pregnancies, with some of the perpetrators insisting the women have abortions.

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This page was written and is currently being updated by Abdurahman Warsame – Global Health Crises Advisor.

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