Ebola and Its Control in Liberia, 2014-2015

Abstract

The severe epidemic of Ebola virus disease in Liberia started in March 2014. On May 9, 2015, the World Health Organization declared Liberia free of Ebola, 42 days after safe burial of the last known case-patient. However, another 6 cases occurred during June-July; on September 3, 2015, the country was again declared free of Ebola. Liberia had by then reported 10,672 cases of Ebola and 4,808 deaths, 37.0% and 42.6%, respectively, of the 28,103 cases and 11,290 deaths reported from the 3 countries that were heavily affected at that time. Essential components of the response included government leadership and sense of urgency, coordinated international assistance, sound technical work, flexibility guided by epidemiologic data, transparency and effective communication, and efforts by communities themselves. Priorities after the epidemic include surveillance in case of resurgence, restoration of health services, infection control in healthcare settings, and strengthening of basic public health systems.

Keywords: Ebola; Ebola virus disease; Liberia; epidemic; health systems; hemorrhagic fever; outbreak; public health; response; viruses.

Figure 1

Locations of Ebola case-patients and associated facilities, Liberia, 2014–2015. ELWA, Eternal Love Winning Africa; EOC, emergency operations center; ETU, Ebola treatment unit; JFK, John Fitzgerald Kennedy; MoD, Ministry of Defense.

Figure 2

Organizational flowchart for Ebola response Incident Management System, Liberia Ministry of Health and Social Welfare (MOHSW), August 2014. UNMIL, United Nations Mission in Liberia. Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6341a4.htm

Figure 3

Trends over time for suspected, probable, and confirmed cases of Ebola virus disease from situation reports (sitreps); for confirmed cases from laboratory reports (lab); and for numbers of Ebola treatment unit beds, Liberia 2014–2015. Ebola treatment unit build completion: A, Foya; B, Firestone; C, Eternal Love Winning Africa (ELWA) 1; D, ELWA2; F, ELWA3, John Fitzgerald Kennedy Hospital; H, Bong, Island; K, Unity; L, Ministry of Defense; M, Monrovia Medical Unit; N, Bomi, Kakata; O, China; P, Buchanan; SKD*; Q, Sinje, Ganta, Gbediah; R, Bopulu; S, Tappita, Zwedru; T, Voinjama; U, Zorzor, Greenville*; V, Barclayville; W, Fishtown*; X, Harper.* Other response events: E, Incident Management System implemented; G1–G2, burial teams trained and deployed. *Ebola treatment units built but never opened.

Figure 4

Epidemic curve for laboratory-confirmed cases of Ebola virus disease, Liberia, April 2014–May 2015. Confirmed cases were based on laboratory data per 21-day moving average.

Figure 5

Proposed algorithm for management of dead bodies and associated contact tracing for Ebola virus disease, Liberia, 2014–2015.

Figure 6

Trends for reported Ebola virus infections among 202 healthcare workers, by status and month, Liberia, March 2014–May 2015. Data source: daily aggregate reports of new cases in healthcare workers in Liberia and Liberia Ministry of Health and Social Welfare situation reports.