July 30, 2015

Health workers pray before the start of their shift at an Ebola treatment center in Liberia, on Oct. 6, 2014. Daniel Berehulak was awarded the Pulitzer Prize for feature photography on April 20, 2015, for his coverage of the Ebola outbreak in West Africa for The New York Times. Credit: © Daniel Berehulak, The New York Times/Redux Pictures

The world’s largest and most deadly outbreak of the Ebola virus is not yet ended, even as coverage of the epidemic has faded from news headlines in most countries. The outbreak that began in West Africa in 2014 continues, as health care agencies struggle to contain the disease. In the first half of 2015, the World Health Organization (WHO) reported between 20 and 30 new Ebola infections each week in Guinea and Sierra Leone. Before this outbreak, such a rate of Ebola infection would have been considered a seriously dangerous outbreak. Today, it is a sign of progress. During the worst days of the West Africa outbreak, hundreds of infections were reported each week.

A public health worker sprays disinfectant on the body of a person thought to have died from Ebola virus infection during the 2014 outbreak in West Africa. AP Photo

In humans, Ebola hemorrhagic fever causes illness marked by fever, headache, diarrhea, vomiting, and massive internal bleeding. Symptoms appear within 5 to 10 days of infection. There is no known cure or vaccine for Ebola. Fatality rates for Ebola infection vary. In early outbreaks, about 80 to 90 percent of people who became infected died. Prevention efforts involve educating people about how the virus is transmitted and isolating infected individuals.

Nearly all Ebola infections in the 2014 outbreak occurred in the countries of Guinea, Liberia, and Sierra Leone. Since the outbreak was first reported in 2014,WHO officials tallied a total of 27,748 Ebola infections. The outbreak has caused 11,279 deaths, including more than 500 among health care workers. Despite the risk, American and European health care workers continue to travel to west Africa to assist in the fight against the disease.

Although the recent decline of new infections indicates health workers have gained the upper hand in the West African outbreak, the danger has not yet passed. More than 2,000 people who may have been exposed to the Ebola virus remain under watch. These patients must be monitored for 21 days for doctors to be sure they are free of infection. Health officials know that a single missed case can spark a new cluster of infections that can spread rapidly. In West Africa, where the deadly disease has strained an already poor health care system to the limit, the risk of a renewed outbreak remains great.

Other Behind the headlines articles

• Ebola Epidemic Advances in West Africa (July 28, 2014)
• Ebola Outbreak in West Africa Continues to Spread (August 1, 2014)
• U.S. Troops Deploy to West Africa To Help Contain Ebola Outbreak (September 17, 2014)

October  24, 2014

Yesterday, an emergency-room physician who returned to the United States earlier this month after caring for Ebola patients in Africa became the first person to test positive for the disease in New York City. Craig Spencer was immediately placed in quarantine at the city’s Bellevue Hospital, one of eight hospitals in New York certified as “Ebola ready” by state health officials. Spencer had been volunteering with Doctors Without Borders in Guinea, one of the African countries hardest hit by the Ebola outbreak. He is the fourth person diagnosed with Ebola hemorrhagic fever in the United States, and the first outside Texas. Only one of these patients—Thomas Eric Duncan, a Liberian man diagnosed with Ebola in Dallas on September 30—has died.

The Ebola virus causes an illness characterized by fever, headache, diarrhea, vomiting, and external and  internal bleeding. About 80 to 90 percent of all people who become infected die. The current outbreak, largely concentrated in the West African countries of Guinea, Liberia, and Sierra Leone, has resulted in the deaths of at least 5,000 people. Ebola is spread by direct contact with such bodily fluids as saliva and blood and unsterilized needles or other equipment. Unlike the flu, Ebola fever does not spread through the air.

Ebola Virus Disease Distribution Map—the Ebola virus responsible for the 2014 outbreak was Zaire ebolavirus. (Center for Disease Control and Protection)

New York City Health Commissioner Mary Bassett said that Spencer, who had no symptoms during his journey from Africa, had begun to feel sluggish on Tuesday. On Thursday morning, he called health officials to report that he was suffering from a fever of 100.3 F. degrees (38 C. degrees). Between those times, he had ridden in a taxi and on at least three New York City subway lines and had gone to a bowling alley in the Williamsburg neighborhood of Brooklyn. Bassett said the bowling alley had been closed “out of an abundance of caution.”

A colorized image of the Ebola virus made using a transmission electron microscope. (Cynthia Goldsmith)

Health officials also said only three people had been in close contact with Spencer during that time and all of them had been placed under quarantine. A team of epidemiologists (epidemic disease “detectives”) from the Centers for Disease Control and Prevention was also searching for others who may have had contact with Spencer. However, health officials stressed that other New Yorkers have only an extremely slim chance of contracting the disease. “Ebola is an extremely hard disease to contract,” New York City Mayor Bill de Blasio stressed at a news conference on Thursday evening. “Being on the same subway car or living near a person with Ebola does not in itself put someone at risk. There is no reason for New Yorkers to be alarmed.”

Additional World Book article:

• Disease Detectives (a special report)
• The Origin of New Diseases (a special report)

October 16, 2014

A second Dallas hospital nurse, Amber  Vinson, who treated Liberian Ebola victim Thomas Duncan before his death has tested positive for the deadly virus, Texas Health Presbyterian Hospital confirmed yesterday. Public health officials in Texas continue to monitor some 48 contacts of Duncan and the health care workers who treated him. However, that number is rising.

The Centers for Disease Control and Prevention (CDC) disclosed yesterday that Ms. Vinson flew on a commercial jet from Cleveland to Dallas on October 13. “She should not have traveled on a commercial airline,” CDC Director Tom Frieden subsequently stated. “The CDC guidance in this setting outlines the need for what is called controlled movement.” However, it was revealed today that Ms. Vinson did, in fact, contact the CDC before flying home to Dallas and reported that she had a fever with a temperature of 99.5 °F (37.5 °C). CDC officials did not stop her from boarding the plane because her temperature was below the range the CDC then categorized as dangerous. The CDC is currently attempting to contact the more than 130 passengers and crew aboard Frontier Airlines Flight 1143 on Monday.

Scientists remain unsure about the exact ways in which the Ebola virus (above) is transmitted. (Cynthia Goldsmith)

CDC Director Frieden has expressed regret about his agency’s initial response to the first Ebola case in Dallas. “In retrospect, with 20/20 hindsight, we could have sent a more robust hospital infection control team and been more hands-on with the hospital from Day 1.” The CDC has since issued stricter guidelines for U.S. hospitals with Ebola patients. The guidelines are closer to the procedures used by Doctors Without Borders, a Paris-based relief organization that is currently battling the Ebola epidemic that has killed some 4,500 people in West Africa.

Amber Vinson was flown last night from Dallas to Atlanta, where she entered Emory University Hospital. An American doctor and nurse, Kent Brantly and Nancy Writebol, who contracted Ebola while working in Africa, were successfully treated at Emory in September. The physician who oversaw their treatment, Sean G. Kaufman, today condemned the earlier CDC guidelines as “absolutely irresponsible and dead wrong.”

Additional World Book article:

• Disease Detectives (a special report)
• The Origin of New Diseases (a special report)

October 13, 2014

A nurse who treated Liberian Ebola victim Thomas Eric Duncan before he died has been infected with the virus. The case is the first known transmission of the Ebola virus on U.S. soil. The unnamed woman is in stable condition in an isolation ward in a Dallas, Texas, hospital.

Tom Frieden, head of the Atlanta-based Centers for Disease Control and Prevention (CDC), stated yesterday that while the nurse wore full protective gear while treating Duncan, there obviously had been a clear breach of safety protocol. He informed the media that the CDC will carry out a complete investigation into how the infection had occurred, focusing on two “high-risk procedures”–dialysis and respiratory intubation–carried out on Duncan before he died.

The first known transmission of the Ebola virus in the United States has been  reported. (Frederick Murphy)

The Ebola virus causes a hemorrhagic fever, an illness characterized by fever, headache, diarrhea, vomiting, and massive internal bleeding. About 80 to 90 percent of all people who become infected die. The current outbreak, largely concentrated in the West African countries of Guinea, Liberia, and Sierra Leone, has resulted in the deaths of more than 4,000 people.

Additional World Book article:

• Disease Detectives (a special report)
• The Origin of New Diseases (a special report)

October 2, 2014

Texas health officials are checking as many as 100 people for exposure to Ebola. They include all “potential or possible contacts” with Thomas Eric Duncan, a Liberian man diagnosed with Ebola in Dallas on September 30. His is the first case diagnosed outside of West Africa, where more than 3,300 people have died in the current Ebola outbreak.

Duncan is believed to have contracted the virus in Liberia before he flew to the United States nearly two weeks ago to visit relatives. He initially sought medical attention for a low-grade fever and abdominal pain on September 25. Blood tests were performed, but he was not screened for the Ebola virus, despite the fact that he had informed a nurse that he had recently arrived from Liberia. The Ebola epidemic is raging in Liberia as well as Guinea and Sierra Leone. Duncan was given antibiotics and a pain reliever and sent home, where his condition rapidly deteriorated.

The ebola virus causes Ebola hemorrhagic fever, an illness characterized by fever, headache, diarrhea, vomiting, and massive internal bleeding. About 80 to 90 percent of all people who become infected die. There is no cure or vacccine for Ebola virus. (Centers for Disease Control and Prevention: Frederick A. Murphy)

On September 28, Duncan’s nephew contacted the Center for Disease Control (CDC). “I called CDC to get some actions taken because I was concerned for his life and he was not getting the appropriate care,” the nephew, Josephus Weeks, stated in a television interview. “And I feared that other people might get infected if he was not taken care of.” CDC officials instructed Weeks to call the Texas Department of Health, which moved Duncan into an isolation unit at a Dallas hospital.

The commissioner of Texas State Health Services, David Lakey, today confirmed that four of Thomas Eric Duncan’s “close relatives” are under a quarantine order until October 19. The medical technicians who rushed the patient to the hospital are also being monitored. “We have tried and true protocols to protect the public and stop the spread of this disease,” declared Dr. Lakey. “This order gives us the ability to monitor the situation in the most meticulous way.”

Thomas Eric Duncan remains in isolation in stable but serious condition.

Additional World Book article:

• Disease Detectives (a special report)
• The Origin of New Diseases (a special report)

September 17, 2014

Map of Ebola virus outbreak in West Africa as of 2014. (E. Ervin, CDC/ESVP, Sept. 4, 2014)

Yesterday, speaking at Atlanta’s Center for Disease Control and Prevention (CDC), United States President Barack Obama announced that he was sending 3,000 troops to Western Africa to aid the hard-hit nations of Liberia, Sierra Leone, and Guinea in fighting an outbreak of the Ebola virus. The 2014 outbreak of the disease has been the largest in history; more than 5,000 cases have been reported in West Africa, with 2,961 people dead.

Ebola can have up to a 90 percent fatality rate in people infected with the disease. It is a hemorrhagic disease, meaning that, in addition to vomiting and diarrhea, patients often bleed uncontrollably both internally and externally (from the eyes and under the skin, for example), with fluid loss causing shock and death. Most hemorrhagic viruses have a host, often a rodent or insect, which carries the virus but does not become ill. Scientists have not yet identified the host for Ebola virus, but a species of fruit bat is strongly suspected. Ebola enters the human population via an infected animal—for example, by people preparing bushmeat infected with the disease.  The virus is then spread within the human population by contact with the blood or other bodily fluids of an infected person, body tissue, or unsterilized needles or other equipment. A shortage of hospitals, health care workers, and medical equipment have seriously hindered West African nations in stopping the spread of the disease.

The U.S. military will train up to 500 health care workers per week on how to treat people with such highly infectious diseases and set up field hospitals to treat Ebola patients. In addition, home health-care kits will be provided for hundreds of thousands of households to allow families to more safely care for patients at home.

Additional World Book articles:

• The Origin of New Diseases (a special report)
• Overpopulation and the Threat of Infectious Disease (a special report)

August 1, 2014

Efforts to control the Ebola outbreak in West Africa are not keeping up with the speed with which the deadly virus is spreading, World Health Organization (WHO) General-Director Margaret Chan declared today. Speaking at a summit of regional leaders, Dr. Chan warned that failure to contain the deadly disease could be “catastrophic in terms of lost lives but also severe socioeconomic disruption and a high risk of spread to other countries. . . . Cases are occurring in rural areas which are difficult to access, but also in densely populated capital cities.” However, Chan does believe that the current outbreak can be stopped, and she announced that WHO is launching a $100-million Ebola response plan in the worst affected countries–Guinea, Liberia, and Sierra Leone.

Yesterday, Tom Frieden, the director of the U.S. Centers for Disease Control and Prevention (CDC),   announced that the agency is sending 50 additional personnel over the next 30 days to help the 12 staff members already on the ground in West Africa. “The bottom line is that Ebola is worsening in West Africa,” he said. The announcement came after the CDC raised its travel health alert to Level 3, the highest level, for Guinea, Liberia, and Sierra Leone. The CDC warned people to avoid nonessential travel to those countries.

According to the World Health Organization, the latest outbreak of Ebola has left 729 people dead, including top physicians in Liberia and Sierra Leone. The outbreak has also sickened two Americans–a doctor and a medical aid–who are being flown to CDC medical facilities in Atlanta. There is no vaccine to prevent the illness, and no specific treatment for it beyond attempting to nurse people through the worst of the fevers, bleeding, and other symptoms. The only way to stop an outbreak is to isolate each infected patient and trace all of his or her contacts and isolate them in turn.

The current outbreak of Ebola fever began in southern Guinea and quickly spread to Liberia and Sierra Leone. (World Book map; map data © MapQuest.com, Inc.)

Lansana Gberie, a prominent scholar from Sierra Leone, has condemned his government’s response to the outbreak: “The whole thing has been very incompetently handled. If the government had quarantined this area [in remote northwestern Sierra Leone] they could have contained it. Instead they opened a treatment center in Kenema, a major population center.”

Two of the three affected countries have begun to respond to the crisis. Sierra Leone has declared a public health emergency, and the president, Ernest Bai Koroma, has ordered security forces deployed to support health professionals. “All epicenters of the disease will be quarantined,” said Koroma, along with “localities and homes where the disease is identified and searched for infected people.” Public meetings are restricted, and he ordered top officials to cancel all but essential overseas travel.

In Liberia, the government has closed most border crossings and ordered the deployment of security forces to combat the outbreak. Public gatherings have been banned and schools closed. Nonessential government workers have been put on compulsory leave for 30 days.

Additional World Book articles:

• Africa 1995 (a Back in Time article)
• Africa 1996 (a Back in Time article)
• Uganda 2012 (a Back in Time article)
• The Origin of New Diseases (a special report)

July 28, 2014

The worst recorded epidemic of the deadly and highly contagious Ebola virus led the West African nation of Liberia today to close most of its border crossings. Liberia is one of three nations, along with Sierra Leone and Guinea, that are being hard hit by the virus. Liberia’s President Ellen Johnson-Sirleaf also issued restrictions on public gatherings and said areas hit by the virus could be quarantined. The current outbreak of Ebola hemorrhagic fever, which began in  March in southern Guinea, has killed at least 670 people, including the Liberian doctor who was heading his country’s efforts to contain the epidemic. Yesterday, Nigeria’s Arik Air suspended all flights into Sierra Leone and Guinea after Nigerian officials confirmed the first Ebola death in Lagos, Nigeria’s capital and the most populous city in Africa. Meanwhile, medical workers in Guinea were meeting hostility and resistance from residents who blamed them for spreading the disease.

Ebola hemorrhagic fever is characterized by massive internal bleeding as well as diarrhea and vomiting. It is spread by direct contact with such bodily fluids as saliva and blood and by contact with towels and other objects cotaminated by the virus. While animals, including chimpanzees and gorillas, can transmit the virus, the natural source is unknown. There is no cure or vaccine for the disease. Symptoms appear within 5 to 10 days of infection. About 80 to 90 percent of all people who become infected die, though patients who receive treatment while in the early stages of the disease have a slightly better chance of recovery. Treatment consists mainly of rehydration to replace lost body fluids.

The current Ebola outbreak began in southern Guinea in March and has spread to Liberia and Sierra Leone. (World Book map; map data © MapQuest.com, Inc.)

As of July 20, Ebola had killed 454 people in Sierra Leone; 314 in Guinea; and 224 in Liberia, according to the World Health Organization (WHO). Forty-five cases, including 28 deaths, were reported in those three countries between July 18 and 20 alone.

Most hemorrhagic viruses have a host, often a rodent or insect, which carries the virus but does not become ill. Scientists have not yet identified the host for the Ebola virus. However, the bushmeat trade is highly suspected of spreading the virus among people. The WHO has warned people against eating raw bushmeat and avoiding contact with infected apes, bats, and monkeys.

Additional World Book article:

• Disease Detectives (a special report)
• The Origin of New Diseases (a special report)

August 1, 2012

Twenty cases of Ebola infection in western Uganda were reported this week by the World Health Organization. At least 14 people have died so far in the outbreak, which began in a rural area about 125 miles (200 kilometers) west of Kampala, the capital. One victim was treated in a Kampala hospital, raising fears that the virus had spread to the capital, and the Ugandan Health Ministry was monitoring 34 health workers who may have been exposed. Uganda’s President Yoweri Museveni issued an appeal for all Ugandans to report suspected cases and to avoid human contact as much as possible, including the shaking of hands.

The outbreak in Uganda prompted the government of Kenya to place its laboratories on high alert and dispatch protective medical gear to its provinces bordering Uganda. Rwanda, Uganda’s southern neighbor, also instituted measures to protect its population from exposure, the Health Ministry announced on July 31 in Kigali, the capital.

The treatment of an Ebola victim in a hospital in Kampala raised fears that the deadly disease had spread to this city of 1.2 million, which is Uganda's capital and chief commercial center. (© David Keith Jones, Alamy Images)

According to the U.S. Centers for Disease Control, the current outbreak of Ebola is the worst in Uganda since 2007, when 42 people died from the disease. Ebola is spread by direct contact with such bodily fluids as saliva and blood and unsterilized needles or other equipment. In human beings and primates, the virus causes Ebola hemorrhagic fever, an illness characterized by massive internal bleeding as well as diarrhea and vomiting. While animals, including chimpanzees and gorillas, can transmit the virus, the natural source is unknown. There is no cure or vaccine for the disease. About 80 to 90 percent of all people who become infected die.

Additional World Book article:

• Disease Detectives (a special report)
• The Origin of New Diseases (a special report)