Is the 2014 West African Ebola epidemic over?

UPDATE: On Nov 7th the WHO declared Sierra Leone free from Ebola.

The West African Ebola epidemic that started back in 2014 has certainly slowed down compared to this time last year, when many new cases were being diagnosed each week and it looked like the epidemic would be hard to stop. As of September 3rd 2015, the WHO declared Liberia free from Ebola. Although Liberia did have a handful of breakthrough cases after they had passed their first 42 day (two incubation period) window without cases, they have again passed that 42 day window (and counting) with no new cases. The CDC has changed their traveler alert status for Liberia back to Level 1: Usual Precautions, which means that  travelers arriving in the US from Liberia will no longer be formally monitored for Ebola for 21 days. Liberia has now entered a 90 day intensive surveillance time period in which samples are being taken from many people and tested for Ebola to ensure that cases are not still circulating without being recognized.

In Sierra Leone, the situation is also much better than it was at this time last year. Sierra Leone has only had 7 new cases of Ebola since the week of August 30th. If no additional cases are found in Sierra Leone, the country will be declared Ebola free on November 7th.

Courtesy WHO, 21 October 2015 Situation Report.

Geographical distribution of new and total confirmed cases in Guinea, Liberia and Sierra Leone. Courtesy WHO, 21 October 2015 Situation Report.

Guinea is still having a few cases pop up every couple weeks or so. The last report from the week of October 18th showed 3 new cases of Ebola that week. These new cases are very geographically linked so there is no widespread transmission of Ebola at this time.

Geographical distribution of confirmed cases reported in the week to 11 October 2015. Courtesy WHO, 21 October 2015 Situation Report.

Geographical distribution of confirmed cases reported in the week to 11 October 2015. Courtesy WHO, 21 October 2015 Situation Report.

As of the WHO’s 21 October 2015 Situation Report, the total Ebola case count is at 28, 512 cases, with 11, 313 deaths.

Because the number of cases in Guinea and Sierra Leone have so drastically decreased, and are now located in geographically confined areas, the Ebola epidemic has moved into a distinct phase-3 response. This response aims to incorporate new knowledge and tools into the ongoing response and recovery efforts to achieve and maintain zero cases of Ebola. This plan builds upon the rapid scale up of treatment facilities, safe and dignified burials, and behavior change accomplished in Phase 1 (August – December 2014). Phase 3 also builds upon Phase 2 (January – July 2015) which included enhanced case finding and contact tracing capabilities and community engagement.

However, the world has seen some previously unknown late stage side effects arise in persons who have had previous Ebola infection. Since the 2014 Ebola epidemic was the largest in the world, thus far, the number of cases was far greater than anything previously seen. With the large numbers of cases who’ve recovered from their initial Ebola infection, health care workers are starting to see persistent virus that has evaded the immune system and is now causing additional problems, after the person has been declared free of Ebola. Ebola virus can live in the semen, eyes, amniotic fluid, placenta, breast milk and central nervous system. Recently a Scottish nurse who survived her initial Ebola infection developed meningitis nine months after her infection. Ebola was found in her spinal fluid and blood at time of meningitis diagnosis. Her blood has subsequently tested negative upon treatment for Ebola.

There are some things we still do not know about Ebola but the epidemic appears to be coming to an end. And the end of the epidemic hopefully means the world will have learned from this experience and will be better prepared for the next major outbreak of an infectious disease.

 

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