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

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 : Several outbreaks in African regions

Ebola outbreaks,

How does EVD outbreak 2014 compare with past outbreaks?

EVD Outbreak 2014 – Key events Apr 2014Mar 2014Feb 2014Jan 2014 Dec Dec: Death of index case 2 year old, Meliandou village, Guéckédou, 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

EVD Outbreak 2014 – Key events Aug 2014Jul 2014Jun 2014 May 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

EVD Outbreak 2014 – Key events Jan 2015Dec 2014 Nov 2014 Oct 2014 Sept 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

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

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

Cases of EVD by country, 2014/2015 WHO Update 15 April 2015 CountryCases*Deaths* Guinea Liberia Sierra Leone Mali86 Nigeria208 Senegal10 Spain10 United Kingdom10 United States41 Total *Confirmed, probable or suspected but not repatriations

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

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

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

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

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

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

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

EVD cases and deaths in healthcare workers WHO Update 15 April 2015 CountryCasesDeaths Guinea Liberia374 Sierra Leone303 Mali2 Nigeria11 Spain2 United Kingdom*3 United States†9 Total918 *All cases infected in Sierra Leone †Three cases infected in Sierra Leone, three in Liberia, two cases in US, one in Guinea

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

Medical evacuations and repatriations from West Africa, as of 17 th April 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

Countries involved in the management of EVD cases

Ongoing updates on the EVD situation available at: on-reports/en/