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The Ebola Outbreak, 2013-2016: Old Lessons for New Epidemics

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Review

The Ebola Outbreak, 2013-2016: Old Lessons for New Epidemics

Cordelia E M Coltart et al. Philos Trans R Soc Lond B Biol Sci.

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'.

Keywords: Ebola; Ebola outbreak; Ebola virus disease; West Africa.

Conflict of interest statement

A.M.J. is a governor of the Wellcome Trust. The authors have no other conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Timeline of key events with country-specific epidemic curves. Case numbers are total reported confirmed, probable, and suspected cases provided in WHO situation reports throughout the epidemic. We have calculated weekly case number (Monday–Sunday). Asterisk indicates where negative case numbers are reported (as per WHO data) when suspected/probable cases subsequently test negative for Ebola PCR or as a result of data errors. MOH, Ministry of Health; MSF, Médecins Sans Frontières; ETCs, Ebola treatment centres. Where events happened multiple times, only the first occurrence has been shown.
Figure 2.
Figure 2.
Geographical map of Guinea, Sierra Leone and Liberia showing districts and total number of confirmed cases by district. (Adapted from WHO [21].)
Figure 3.
Figure 3.
Initial transmission chain in Guinea. HCW, healthcare worker. (Adapted from Baize et al. [29] and Coltart et al. [30].)
Figure 4.
Figure 4.
Where the outbreak began—map to show Kissi tribal area spanning Guinea, Sierra Leone and Liberia. (Online version in colour.)

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