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Ebola Virus Disease, West Africa outbreak 2014 An update on cases 21/04/2015 To update slides with most recent figures, please follow links and instructions provided in the notes section of the relevant slides

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Background Ebola Virus Disease First discovered in 1976; two simultaneous human outbreaks South Sudan Northern Zaire (now Democratic Republic of the Congo) Latter in village near Ebola river, from which disease takes its name 1976-2012: Several outbreaks in African regions

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Ebola outbreaks, 1976-2014

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How does EVD outbreak 2014 compare with past outbreaks? www.nytimes.com

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EVD Outbreak 2014 Key events Apr 2014Mar 2014Feb 2014Jan 2014 Dec 2013 06-Dec: Death of index case 2 year old, Meliandou village, Guckdou, Guinea. Followed by deaths of his mother, sister, grandmother All retrospectively identified 18 Mar: Guinea announces outbreak 20 Mar: Lab tests confirm Ebola 23 Mar: WHO notified of outbreak in Guinea 25 Mar: First WHO report released 31 Mar: Liberia reports confirmed case 01 Apr: MSF warns outbreak unprecedented

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EVD Outbreak 2014 Key events Aug 2014Jul 2014Jun 2014 May 2014 12 May: EVD cases in Guinean capital, Conakry 17 Jun: EVD cases now in Liberian capital, Monrovia 08 Aug: WHO declares PHEIC 12 Aug: Deaths >1,000 (WHO) 21 Aug: Two medically evacuated cases in US, successfully treated with experimental therapy ZMapp 29 Aug: Senegal reports first EVD case 25 Jul: Nigeria reports first EVD case

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EVD Outbreak 2014 Key events Jan 2015Dec 2014 Nov 2014 Oct 2014 Sept 2014 28 Sept: First EVD case in US 06 Oct: First EVD case in Europe (nurse in Spain) 08 Oct: Death of first US EVD case 12 Oct: Nurse tests positive in US (2 o case) 15 Oct: 2 nd nurse tests positive in US 17 Oct: Outbreak declared over in Senegal 20 Oct: Outbreak declared over in Nigeria 23 Oct: First EVD case in Mali 12 Nov: Three more cases in Mali; no links to first case 02 Dec: Outbreak declared over in Spain 29 Dec: First EVD case diagnosed in UK (Scottish nurse) 18 Jan : Outbreak declared over Mali

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Ebola Outbreak 2014 in West Africa Affected countries Widespread transmission Sierra Leone Liberia Guinea Outbreak declared over Nigeria Senegal Mali

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Number of EVD cases and deaths, 2014/2015 WHO update 15 th April 2015 *Outbreaks declared over, Senegal (17 Oct) and Nigeria (20 Oct) Widespread and intense transmission

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Cases of EVD by country, 2014/2015 WHO Update 15 April 2015 CountryCases*Deaths* Guinea35482346 Liberia100424486 Sierra Leone122013857 Mali86 Nigeria208 Senegal10 Spain10 United Kingdom10 United States41 Total2582610704 *Confirmed, probable or suspected but not repatriations

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Geographical distribution of new cases and total cases in Guinea, Liberia, and Sierra Leone WHO Update 17th April 2015

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Days since last confirmed case in Guinea, Liberia and Sierra Leone, 15 th April 2015 Source: WHO Ebola Situation Report 17 April 2015

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Clinically compatible cases Guinea, Liberia and Sierra Leone as of 12 April 2015 Source: Public Health England, 17 April 2015

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Cases in Guinea, Liberia and Sierra Leone, 2014/2015 WHO update 15 April 2015

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Number of new confirmed cases per report week, 23 November 2014 12 April 2015 Graphs from Public Health England EVD Epidemiological Update 12 April 2015

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Case fatality rate, EVD outbreak 2014 WHO (10 Dec 2014): Case fatality rate 71% Sierra Leone*: 74% CFR overall 57% CFR < 21 years 94% CFR >45 years Positive correlation between viral load and risk of death *Clinical illness and outcomes in patients with Ebola in Sierra Leone, Schieffelin et al, NEJM, 29 Oct 2014

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Clinical illness in first 106 patients with EVD, Sierra Leone, May-June 2014 (n=106) Schieffelin et al, NEJM, 29 Oct 2014

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EVD cases and deaths in healthcare workers WHO Update 15 April 2015 CountryCasesDeaths Guinea187 504 Liberia374 Sierra Leone303 Mali2 Nigeria11 Spain2 United Kingdom*3 United States9 Total918 *All cases infected in Sierra Leone Three cases infected in Sierra Leone, three in Liberia, two cases in US, one in Guinea

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Non-repatriated cases of EVD outside of West Africa, as of 15 April 2015 (n=6) Date of diagnosis Country of diagnosis Country of infection TypeHCWStatus 30 Sep 2014USALiberiaImportedNoDied 06 Oct 2014Spain Local transmission YesEVD free 11 Oct 2014USA Local transmission YesEVD free 15 Oct 2014USA Local transmission YesEVD free 23 Oct 2014USAGuineaImportedYesEVD free 29 Dec 2014UKSierra LeoneImportedYesEVD free

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Medical evacuations and repatriations from West Africa, as of 17 th April 2015 65 individuals evacuated or repatriated (includes confirmed cases or those with an Ebola exposure) 38 evacuated to Europe 13 confirmed EVD cases Germany 3 ; Spain 2 France 2; UK 2 Norway 1; Netherlands 1 Italy 1; Switzerland 1 25 tested negative 27 evacuated to US

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Countries involved in the management of EVD cases www.wikipedia.com

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Ongoing updates on the EVD situation available at: http://www.who.int/csr/disease/ebola/situati on-reports/en/