Perspectives on West Africa Ebola Virus Disease Outbreak, 2013-2016

Abstract

The variety of factors that contributed to the initial undetected spread of Ebola virus disease in West Africa during 2013-2016 and the difficulty controlling the outbreak once the etiology was identified highlight priorities for disease prevention, detection, and response. These factors include occurrence in a region recovering from civil instability and lacking experience with Ebola response; inadequate surveillance, recognition of suspected cases, and Ebola diagnosis; mobile populations and extensive urban transmission; and the community's insufficient general understanding about the disease. The magnitude of the outbreak was not attributable to a substantial change of the virus. Continued efforts during the outbreak and in preparation for future outbreak response should involve identifying the reservoir, improving in-country detection and response capacity, conducting survivor studies and supporting survivors, engaging in culturally appropriate public education and risk communication, building productive interagency relationships, and continuing support for basic research.

Keywords: Ebola; Ebola hemorrhagic fever; Ebola virus disease; West Africa; emergence; epizootic; outbreak; spillover; viral hemorrhagic fever; viruses; zoonoses.

Figure 1

Geographic distribution of diagnostic laboratories currently or previously operational in West Africa during the 2014–2015 Ebola virus response, as of December 9, 2015. Data are from World Health Organization Ebola virus disease situation reports.

Figure 2

Relationship between location of index case in Ebola virus (Zaire ebolavirus) outbreaks and putative reservoir distribution. Ebola virus outbreaks (red dots) and distribution of Eidolon helvum, Mops condylurus, Myonycteris torquata, Epomops franqueti, and Hypsignathus monstrosus bats (insets) are shown. Data are from the Centers for Disease Control and Prevention and the International Union for the Conservation of Nature.