Challenges, opportunities and lessons learned from the Ebola virus outbreak in Guinea, West Africa

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’.

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Successful Implementation of a Multicountry Clinical Surveillance and Data Collection System for Ebola Virus Disease in West Africa: Findings and Lessons Learned

Global Health Science and Practice ◽

10.9745/ghsp-d-16-00186 ◽

2016 ◽

Vol 4 (3) ◽

pp. 394-409 ◽

Cited By ~ 16

Author(s):

Reshma Roshania ◽

Michaela Mallow ◽

Nelson Dunbar ◽

David Mansary ◽

Pranav Shetty ◽

...

Keyword(s):

Data Collection ◽

West Africa ◽

Ebola Virus ◽

Virus Disease ◽

Lessons Learned ◽

Ebola Virus Disease ◽

Successful Implementation ◽

Collection System ◽

Data Collection System ◽

Clinical Surveillance

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Ebola virus disease epidemic in West Africa: lessons learned and issues arising from West African countries

Clinical Medicine ◽

10.7861/clinmedicine.15-1-54 ◽

2015 ◽

Vol 15 (1) ◽

pp. 54-57 ◽

Cited By ~ 23

Author(s):

Obinna O Oleribe ◽

Babatunde L Salako ◽

M Mourtalla Ka ◽

Albert Akpalu ◽

Mairi McConnochie ◽

...

Keyword(s):

West Africa ◽

Ebola Virus ◽

Virus Disease ◽

West African ◽

Lessons Learned ◽

Ebola Virus Disease ◽

African Countries

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COVID-19 Pandemic Readiness Status of West Africa

10.21203/rs.3.rs-42172/v1 ◽

2020 ◽

Author(s):

Virgil Kaussi Lokossou ◽

Basil Benduri Kaburi ◽

Delia Akosua Bandoh ◽

Edgard-Marius Ouendo ◽

Aboubacar Ouédraogo ◽

...

Keyword(s):

West Africa ◽

Emergency Preparedness ◽

Ebola Virus ◽

Virus Disease ◽

Lessons Learned ◽

Incident Management ◽

Pandemic Preparedness ◽

The West ◽

Member States ◽

Regional Coordination

Abstract Background From the onset of COVID-19 pandemic in late December 2019, countries have been stepping up their pandemic preparedness and response activities in accordance with WHO recommendations. Informed by the recent lessons learned from the West Africa Ebola Virus Disease outbreak, and subsequent investments made in public health emergency preparedness and response in the Economic Community of West African States (ECOWAS) region, the West Africa Health Organisation (WAHO) is providing regional leadership in the COVID-19 pandemic preparedness and response. We assessed the COVID-19 pandemic readiness status of West Africa. Methods We conducted survey of all 15 ECOWAS member states between February 27 and March 15, 2020. We purposively selected a minimum of two respondents from each of the 15 ECOWAS member states – interviewing 37 in all using an interviewer-administered questionnaire based on the nine item WHO national capacity review tool for novel corona virus (nCOV). We also reviewed reports of COVID-19 pandemic preparedness meetings and trainings organized by WAHO. We performed a thematic analysis on the data and described the strengths and weaknesses of the ongoing pandemic readiness efforts of West Africa. Results Overall, the strengths of pandemic readiness of the region were: capacity to test 86.7% (13/15) of member states; functional incident management systems (100%); rapid response teams 100%, and at least two of the three tiers of field epidemiology workforce (100%). Within the region also, there existed good cross-border collaborations among member states, active participation of health ministers of member states in regional coordination meetings and decision making. Member states described the numbers of qualified biomedical scientists/technicians, field epidemiologists, risk communicators, and COVID-19 case management teams as inadequate. None of the member states had stockpiles of COVID-19 test kits, laboratory supplies, and personal protective equipment. Conclusion ECOWAS member states are taking appropriate COVID-19 pandemic preparedness measures in all pillars towards a regional response. Rather than a total lack, there are insufficiencies in numbers of skilled workforce, logistics, and supplies. Governments of member states are supportive of the coordination and technical direction of WAHO and WHO.

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Marginalisation, Ebola and Health for All: From Outbreak to Lessons Learned

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16173023 ◽

2019 ◽

Vol 16 (17) ◽

pp. 3023 ◽

Cited By ~ 1

Author(s):

Clare Shelley-Egan ◽

Jim Dratwa

Keyword(s):

West Africa ◽

Ebola Virus ◽

Democratic Republic ◽

Cultural Practices ◽

Virus Disease ◽

Lessons Learned ◽

The Past ◽

Multiple Dimensions ◽

Republic Of The Congo ◽

Main Components

The Ebola epidemic in West Africa between 2014 and 2015 was the deadliest since the discovery of the virus four decades ago. With the second-largest outbreak of Ebola virus disease currently raging in the Democratic Republic of the Congo, (DRC) it is clear that lessons from the past can be quickly forgotten—or be incomplete in the first instance. In this article, we seek to understand the health challenges facing marginalised people by elaborating on the multiple dimensions of marginalisation in the case of the West Africa Ebola epidemic. We trace and unpack modes of marginalisation, beginning with the “outbreak narrative” and its main components and go on to examine other framings, including the prioritisation of the present over the past, the positioning of ‘Us versus Them’; and the marginalisation—in responses to the outbreak—of traditional medicine, cultural practices and other practices around farming and hunting. Finally, we reflect on the ‘lessons learned’ framing, highlighting what is included and what is left out. In conclusion, we stress the need to acknowledge—and be responsive to—the ethical, normative framings of such marginalisation.

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Ebola or Not? Evaluating the Ill Traveler From Ebola-Affected Countries in West Africa

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw005 ◽

2016 ◽

Vol 3 (1) ◽

Cited By ~ 7

Author(s):

Jessica K. Fairley ◽

Phyllis E. Kozarsky ◽

Colleen S. Kraft ◽

Jeannette Guarner ◽

James P. Steinberg ◽

...

Keyword(s):

West Africa ◽

Infection Control ◽

Ebola Virus ◽

Virus Disease ◽

Plasmodium Falciparum Malaria ◽

The United States ◽

Case Definition ◽

Lessons Learned ◽

Treatment Unit ◽

Life Threatening

Abstract Background. The 2014–2015 Ebola epidemic in West Africa had global impact beyond the primarily affected countries of Guinea, Liberia, and Sierra Leone. Other countries, including the United States, encountered numerous patients who arrived from highly affected countries with fever or other signs or symptoms consistent with Ebola virus disease (EVD). Methods. We describe our experience evaluating 25 travelers who met the US Centers for Disease Control and Prevention case definition for a person under investigation (PUI) for EVD from July 20, 2014 to January 28, 2015. All patients were triaged and evaluated under the guidance of institutional protocols to the emergency department, outpatient tropical medicine clinic, or Emory's Ebola treatment unit. Strict attention to infection control and early involvement of public health authorities guided the safe evaluation of these patients. Results. None were diagnosed with EVD. Respiratory illnesses were common, and 8 (32%) PUI were confirmed to have influenza. Four patients (16%) were diagnosed with potentially life-threatening infections or conditions, including 3 with Plasmodium falciparum malaria and 1 with diabetic ketoacidosis. Conclusions. In addition to preparing for potential patients with EVD, Ebola assessment centers should consider other life-threatening conditions requiring urgent treatment, and travelers to affected countries should be strongly advised to seek pretravel counseling. Furthermore, attention to infection control in all aspects of PUI evaluation is paramount and has presented unique challenges. Lessons learned from our evaluation of potential patients with EVD can help inform preparations for future outbreaks of highly pathogenic communicable diseases.

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Characterisation of the T-cell response to Ebola virus glycoprotein amongst survivors of the 2013–16 West Africa epidemic

Nature Communications ◽

10.1038/s41467-021-21411-0 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

T. R. W. Tipton ◽

Y. Hall ◽

J. A. Bore ◽

A. White ◽

L. S. Sibley ◽

...

Keyword(s):

T Cell ◽

West Africa ◽

Cell Response ◽

Ebola Virus ◽

Medical Condition ◽

Virus Disease ◽

T Cell Response ◽

Ebola Virus Disease ◽

Cell Phenotype ◽

T Cell Epitopes

AbstractZaireebolavirus (EBOV) is a highly pathogenic filovirus which can result in Ebola virus disease (EVD); a serious medical condition that presents as flu like symptoms but then often leads to more serious or fatal outcomes. The 2013–16 West Africa epidemic saw an unparalleled number of cases. Here we show characterisation and identification of T cell epitopes in surviving patients from Guinea to the EBOV glycoprotein. We perform interferon gamma (IFNγ) ELISpot using a glycoprotein peptide library to identify T cell epitopes and determine the CD4+ or CD8+ T cell component response. Additionally, we generate data on the T cell phenotype and measure polyfunctional cytokine secretion by these antigen specific cells. We show candidate peptides able to elicit a T cell response in EBOV survivors and provide inferred human leukocyte antigen (HLA) allele restriction. This data informs on the long-term T cell response to Ebola virus disease and highlights potentially important immunodominant peptides.

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SARS-CoV-2 Cellular Infection and Therapeutic Opportunities: Lessons Learned from Ebola Virus

Membranes ◽

10.3390/membranes11010064 ◽

2021 ◽

Vol 11 (1) ◽

pp. 64

Author(s):

Jordana Muñoz-Basagoiti ◽

Daniel Perez-Zsolt ◽

Jorge Carrillo ◽

Julià Blanco ◽

Bonaventura Clotet ◽

...

Keyword(s):

Viral Entry ◽

Ebola Virus ◽

Lessons Learned ◽

Productive Infection ◽

Target Cells ◽

Emerging Viruses ◽

Highly Pathogenic ◽

Life Threatening ◽

Pathogenic Viruses ◽

Cellular Machinery

Viruses rely on the cellular machinery to replicate and propagate within newly infected individuals. Thus, viral entry into the host cell sets up the stage for productive infection and disease progression. Different viruses exploit distinct cellular receptors for viral entry; however, numerous viral internalization mechanisms are shared by very diverse viral families. Such is the case of Ebola virus (EBOV), which belongs to the filoviridae family, and the recently emerged coronavirus SARS-CoV-2. These two highly pathogenic viruses can exploit very similar endocytic routes to productively infect target cells. This convergence has sped up the experimental assessment of clinical therapies against SARS-CoV-2 previously found to be effective for EBOV, and facilitated their expedited clinical testing. Here we review how the viral entry processes and subsequent replication and egress strategies of EBOV and SARS-CoV-2 can overlap, and how our previous knowledge on antivirals, antibodies, and vaccines against EBOV has boosted the search for effective countermeasures against the new coronavirus. As preparedness is key to contain forthcoming pandemics, lessons learned over the years by combating life-threatening viruses should help us to quickly deploy effective tools against novel emerging viruses.

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COVID-19 in West Africa: regional resource mobilisation and allocation in the first year of the pandemic

BMJ Global Health ◽

10.1136/bmjgh-2020-004762 ◽

2021 ◽

Vol 6 (5) ◽

pp. e004762

Author(s):

Césaire Ahanhanzo ◽

Ermel Ameswue Kpogbe Johnson ◽

Ejemai Amaize Eboreime ◽

Sombié Issiaka ◽

Ben Idrissa Traoré ◽

...

Keyword(s):

West Africa ◽

Ebola Virus ◽

Virus Disease ◽

First Year ◽

African Countries ◽

Response Strategies ◽

African Health ◽

The Usa ◽

Health Organization ◽

Resource Mobilisation

The world continues to battle the ongoing COVID-19 pandemic. Whereas many countries are currently experiencing the second wave of the outbreak; Africa, despite being the last continent to be affected by the virus, has not experienced as much devastation as other continents. For example, West Africa, with a population of 367 million people, had confirmed 412 178 cases of COVID-19 with 5363 deaths as of 14 March 2021; compared with the USA which had recorded almost 30 million cases and 530 000 deaths, despite having a slightly smaller population (328 million). Several postulations have been made in an attempt to explain this phenomenon. One hypothesis is that African countries have leveraged on experiences from past epidemics to build resilience and response strategies which may be contributing to protecting the continent’s health systems from being overwhelmed. This practice paper from the West African Health Organization presents experience and data from the field on how countries in the region mobilised support to address the pandemic in the first year, leveraging on systems, infrastructure, capacities developed and experiences from the 2014 Ebola virus disease outbreak.

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