The Ebola outbreak, 2013–2016: old lessons for new epidemics

Abstract

Ebola virus causes a severe haemorrhagic fever in humans with high case fatality and significant epidemic potential. The 2013–2016 outbreak in West Africa was unprecedented in scale, being larger than all previous outbreaks combined, with 28 646 reported cases and 11 323 reported deaths. It was also unique in its geographical distribution and multicountry spread. It is vital that the lessons learned from the world's largest Ebola outbreak are not lost. This article aims to provide a detailed description of the evolution of the outbreak. We contextualize this outbreak in relation to previous Ebola outbreaks and outline the theories regarding its origins and emergence. The outbreak is described by country, in chronological order, including epidemiological parameters and implementation of outbreak containment strategies. We then summarize the factors that led to rapid and extensive propagation, as well as highlight the key successes, failures and lessons learned from this outbreak and the response.This article is part of the themed issue ‘The 2013–2016 West African Ebola epidemic: data, decision-making and disease control’.

Recently Identified Mutations in the Ebola Virus-Makona Genome Do Not Alter Pathogenicity in Animal Models

“…Overwhelmed poor health care systems at the beginning and changes/improvements in case patient management during the epidemic will likely have interfered with disease outcome in patients and, thus, affected pathogenicity (case fatality rates) in opposite directions (Janke et al, 2017; Shoman et al, 2017). The high mobility of the population across borders and closer proximity to urban centers, even when living remotely, will probably have increased transmission frequency in the three heavily affected countries (Coltart et al, 2017; WHO Ebola Response Team et al, 2016). Higher survival rates of patients and virus persistence in convalescents may have further increased the chances for transmission (Garske et al, 2017; Sissoko et al, 2017a, 2017b).…”

‘Tiny Iceland’ preparing for Ebola in a globalized world

“…During the devastating Ebola epidemic in West Africa that spread to neighbouring sub-Saharan countries, North America, and Europe [32], preparedness plans were widely elaborated and later evaluated. Evaluations have, for example, been conducted in 11 African countries close to the epidemic [33], in the EU region [34,35], and the US [36].…”

UK vaccines network: Mapping priority pathogens of epidemic potential and vaccine pipeline developments

“…In 2015, there was no approved vaccine for Ebola virus and arguably this lack of an effective vaccine for use in emergency situations was one of the factors that contributed to the size and duration of that outbreak. While effective vaccines were produced and tested during the outbreak [4][5][6]17], which may prove important in future control, they were available too late to make a significant impact on disease control in 2013-2016 [18]. It is notable that the Democratic Republic of Congo, which has had repeated Ebola virus outbreaks since 1976, had outbreaks in both 2014 (before vaccines were available) and 2018, after vaccines had been tested in West Africa.…”

“…Significant challenges remain for the control of epidemic diseases, despite more clearly defined priorities in terms of pathogen selection. In particular, early identification and reaction to an outbreak is critical [18], there is a need to provide sustained investment in surveillance for disease outbreaks. Maps that predict outbreak risk may help to guide resource allocation with respect to infrastructure development and surveillance.…”