By July 2014, the outbreak spread to the capitals of all three countries. This was the first time EVD extended out from more isolated, rural areas and into densely populated urban centers, providing an unprecedented opportunity for transmission. On August 8, 2014, WHO declared the deteriorating situation in West Africa a Public Health Emergency of International Concern (PHEIC), which is designated only for events with a risk of potential international spread or that require a coordinated international response. Over the duration of the epidemic, EVD spread to seven more countries: Italy, Mali, Nigeria, Senegal, Spain, the United Kingdom, and the United States.
Graphs of reported cases, called epidemic curves, show the rate (incidence) of new, probable, and confirmed cases over the duration of the outbreak in the three West African countries with widespread transmission, Guinea, Liberia, and Sierra Leone. Healthcare workers caring for patients with EVD were among those at highest risk for contracting the disease. During the epidemic, Liberia lost 8% of its doctors, nurses, and midwives to EVD. [6] In addition to the devastating effects on the healthcare workforce in Guinea, Liberia, and Sierra Leone, the Ebola epidemic severely impacted the provision of healthcare services and caused setbacks in the treatment and control of HIV, tuberculosis, measles, and malaria in these countries. [7] The epidemic also had a great impact on children.
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To prevent cross-border transmission, travelers leaving West Africa were screened at airports. Exit screening helped identify those at risk for EVD and prevent the spread of the disease to other countries. The United States also implemented enhanced entry screening for travelers coming from Guinea, Liberia, Sierra Leone, and Mali by routing them to designated airports better able to assess travelers for risk. [3] During the height of the response, CDC trained 24, 655 healthcare workers in West Africa on infection prevention and control practices.
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Nearly 20% of all EVD cases occurred in children under 15 years of age, and an estimated 30, 000 children became orphans during this epidemic. As funding and logistics previously dedicated to child vaccination campaigns were redirected to Ebola response or postponed to avoid public gatherings, routine immunizations decreased by 30%, further putting children at risk of getting vaccine-preventable diseases. [8], [9] The epidemic has been estimated to cost a total of $4. 3 billion USD.
Engaging local leaders in prevention programs and messaging, along with careful policy implementation at the national and global level, helped to eventually contain the spread of the virus and put an end to this outbreak. Liberia was first declared Ebola-free in May 2015. Additional cases were found and treated, and the country was again declared Ebola-free in September 2015. More cases were discovered in November 2015. On January 14, 2016, Liberia again announced it was Ebola-free; however, cases were detected in March and April of 2016, and Liberia made its final declaration on June 1, 2016. After an initial declaration in November 2015, Sierra Leone announced a new case of EVD in January 2016 and declared it was Ebola-free on March 17, 2016.
There were an additional 36 cases and 15 deaths that occurred when the outbreak spread outside of these three countries. The table below shows the distribution of cases and deaths in countries with widespread transmission and countries affected by the epidemic. Countries with Widespread Transmission and other Countries Affected During the Epidemic Country Total Cases (Suspected, Probable, Confirmed) Laboratory Confirmed Cases Total Deaths Countries with Widespread Transmission Guinea 3, 814 3, 358 2, 544 Liberia 10, 678 3, 163 4, 810 Sierra Leone 14, 124 8, 706 3, 956 Affected Countries Italy 1 0 Mali 8 7 6 Nigeria 20 19 Senegal Spain United Kingdom United States 4* 4 Total 28, 652 15, 261 11, 325 * While there were 11 patients with EVD in total treated in the United States, only four patients became ill after they arrived in the United States, either after exposure in West Africa or in a healthcare setting.
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