August 8, 2014
Ebola: 2014 Outbreak in West Africa
persons face a high risk of infection, as do health care and
Overview
funeral workers. Asymptomatic patients are not contagious.
An ongoing outbreak of Ebola Virus Disease (EVD), the
Symptoms. Symptoms typically include fever; weakness;
largest, most persistent ever documented, and the first in
head, joint, muscle, throat, and stomach aches; and then
West Africa, began in March 2014 in Guinea, Sierra Leone,
vomiting and diarrhea, rashes, and bleeding, often via the
and Liberia (the “affected countries”) and has spread to
skin and from internal organs. Kidney and liver function
Nigeria. More people have contracted and died from EVD
may be impaired; white blood cell and platelet counts may
in this outbreak than in any single prior outbreak. In the
drop; and shock and death may occur. Early symptoms are
current outbreak, the case fatality rate (the estimated
akin to many common illnesses. This may cause some
percentage of infected persons dying) is about 55%; past
infected persons not to seek treatment and may increase
outbreak rates have ranged between 41% and 88%.
rates of EVD transmission. The incubation period (the time
between viral infection and the onset of symptoms) ranges
Prior human EVD outbreaks had occurred in the
from 2 to 21 days, and is usually 8 to 10 days.
Democratic Republic of Congo, Gabon, Sudan, and
Treatment. There is no cure for EVD, but EVD treatments
Uganda, primarily in rural and forested areas (Figure 2).
and vaccines are being developed. Treatment focuses on
The current outbreak is more geographically extensive and
balancing fluids and electrolytes; maintaining blood
cases are emerging in both urban and rural settings. Health
pressure and access to oxygen; and treating attendant
experts are accelerating efforts to contain the outbreak, as
complicating infections. Prompt treatment extends survival
transmission in densely populated urban areas may be far
and recovery prospects.
more difficult to control and lead to higher death tolls.
According to the World Health Organization (WHO), from
March through August 6, Ebola was known or suspected to
“The current outbreak is bad. It's the biggest, most
have infected 1,779 persons and caused 961 deaths; of
complex and the first time it's been present in this region
these, 1,134 cases had been confirmed in laboratories.
of the world. CDC Director, July 31, 2014
Figure 1. Global Ebola Outbreaks: 1976-2014
Prevention. In clinical settings, suspected EVD cases are
isolated, and health workers wear personal protective
equipment (PPE) and sterilize and avoid contact with
contaminated objects, but some health centers in the
affected are unable to undertake such responses. Lack of
knowledge of EVD in the region has hindered efforts to
avert person-to-person transmission (see below), but public
education campaigns focusing on EVD prevention and non-
stigmatization of known or suspected EVD patients are
under way. Health workers are working with community
leaders to develop alternatives to cultural practices (e.g.,
funeral rites and visiting the ill) that might spread EVD.
Responses
International Response.
The WHO, which on August 8
declared EVD a Public Health Emergency of International
Concern, is coordinating the international response to the
outbreak. Through its Global Alert and Response Network
Source: Created by CRS based on 2014 WHO data.
(GOARN), WHO is coordinating with the U.S. Centers for
Ebola Viral Disease
Disease Control and Prevention (CDC), the U.S. Agency
for International Development (USAID), United Nations
Transmission. Fruit bats are the suspected natural reservoir
agencies, and others to support affected countries’
of EVD in West Africa, where some people consume bats
responses. On July 31, WHO announced that it was
and other potentially infected forest animals. Humans can
launching a $100 million Ebola response plan, which will
contract EVD through exposure to bodily fluids of EVD-
channel resources through the newly established Ebola
infected animals and persons, or through contact with
Outbreak Coordination Center, in Conakry, Guinea. On
contaminated surfaces or items (e.g., needles). Inter-human
August 4, 2014, the World Bank Group pledged up to $200
transmission is the suspected primary source of infection in
million in emergency funding to help the affected countries
West Africa. During outbreaks, close associates of infected
contain EVD. Such international support is critical; the
www.crs.gov | 7-5700


Ebola: 2014 Outbreak in West Africa
affected countries lack adequate numbers of nurses,
epidemiologists, social mobilization experts, logisticians,
and data managers. These experts detect, trace, and contain
cases; treat EVD patients; train local health practitioners
how to use PPE; and conduct EVD awareness campaigns.
U.S. Response. U.S. agencies, primarily the CDC and
USAID, are partnering with international agencies and local
health authorities to counter the outbreak. USAID has
provided financial support to WHO and donated PPE. CDC
is deploying more technical and medical specialists to the
affected region, where it began operations in March. These
experts are helping with case tracing, EVD testing, national
plan responses, and other work. The State Department is
coordinating U.S. responses with affected country host
governments and helping to provide public EVD prevention
and awareness messaging. A small Department of Defense
(DOD) medical unit in Liberia is aiding efforts to counter
EVD there. DOD is considering how it may further
respond.
Challenges
Low Country Capacity.
The technical and institutional
capacities of affected country health sector and other public
institutions are weak. This is especially true in rural areas,
Figure 2. Map of Affected Countries and Areas
where most EVD cases have occurred, in addition to a
Source: CRS adaptation of CDC map at http://go.usa.gov/NKCw
smaller number of urban ones. Clinics are often ill-
equipped to contain highly infectious agents like Ebola, and
U.S. Policy and Congressional Actions
the few that are face overwhelming case loads. This,
together with the breadth of the outbreak area, has hindered
In late July, the Peace Corps removed its volunteers from
control efforts. Limited access to training and equipment
the affected region due to the threat of EVD. Ebola was
has also increased EVD infection risks among healthcare
discussed at the August U.S. Africa Leaders Summit (see
workers, who account for about a tenth of EVD cases.
CRS Report R43655, U.S.-Africa Leaders Summit:
Local Responses. Affected countries are responding by, for
Frequently Asked Questions and Background). Attendees
instance, closing schools and borders (Liberia) and
from the affected region were screened. The leaders of
controlling internal movements in EVD hotspots (Sierra
Liberia and Sierra Leone did not attend as planned, as they
Leone), and undertaking the types of actions noted above.
are leading their countries’ counter EVD efforts. U.S.
Responses have faced multiple deterrents. As West Africa
embassy dependents in Monrovia, Liberia are being
has never experienced an Ebola outbreak, public awareness
evacuated from the country out of an abundance of caution.
of EVD and how to effectively respond to it is low. Social
practices (e.g., familial care, visitation of patients, and local
On August 7, a House Foreign Affairs Committee
funeral practices) and strongly held local beliefs have also
Subcommittee held a hearing on EVD, at which the CDC
hindered efforts to halt the spread of EVD. Misinformation
director said that the most crucial means of containing the
about EVD and mistrust of health workers have led some
outbreak are efforts to identify cases; treat them
communities to resist external EVD tracking and treatment
appropriately; and prevent further transmission. On July 31,
efforts, including by national authorities. Attacks on health
Representative Karen Bass, with 57 original co-sponsors,
workers have occurred. Such factors, and fear of EVD-
introduced H.Res.701, a resolution acknowledging the
linked stigma, have prompted some ill persons to avoid
historical severity of the West African EVD outbreak.
health centers or to flee clinics while being treated,
Multiple Members have called for effective U.S. EVD
increasing EVD transmission risks.
surveillance efforts and contingency planning, should any
EVD cases occur in the United States; and for continuing or
Containment. CDC views the risk of EVD entry into the
expanded and effective U.S. collaboration with multilateral
United States as low, but is monitoring U.S. traveler
agencies and West African governments to counter EVD.
arrivals. The cross-border spread of EVD has been
Other possible issues for Congress may include whether the
highlighted by cases in which persons with suspected EVD
U.S. and international response in West Africa is
have traveled from the affected region to Saudi Arabia and
technically appropriate and is adequately funded.
Nigeria. In July, Nigerian officials quarantined a hospital
where a U.S. EVD-symptomatic citizen traveling from
Nicolas Cook, ncook@crs.loc.gov, 7-0429
Liberia died after arriving in Nigeria by air. On August 8,
Tiaji Salaam-Blyther, tsalaam@crs.loc.gov, 7-7677
2014, WHO reported that suspected or probable EVD had
caused two deaths and infected 13 persons in Nigeria. Two

IF00044
U.S. health workers infected with EVD in Liberia are being
treated, with CDC help, at an Atlanta, Georgia, hospital.
www.crs.gov | 7-5700

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