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Ebola virus epidemic in Liberia

January 11, 2023

An epidemic of Ebola virus disease occurred in Liberia from 2014 to 2015, along with the neighbouring countries of Guinea and Sierra Leone. The first cases of virus were reported by late March 2014.[2] The Ebola virus, a biosafety level four pathogen, is an RNA virus discovered in 1976.[3]

Ebola virus epidemic in Liberia
A map of Liberia
Cases contracted in Liberia10,675 (as of 7 April 2016)[1]
Deaths4,809 (as of 7 April 2015)[1]
Location of Liberia in Africa

Before the outbreak of the Ebola epidemic the country had 50 doctors for its population of 4.3 million. The country's health system was seriously weakened by a civil war that ended in 2003.[4]

History

West African outbreak

Main article: West African Ebola virus epidemic

Researchers generally believe that a two-year-old boy,[5] later identified as Emile Ouamouno, who died in December 2013 in the village of Meliandou, Guéckédou Prefecture, Guinea, was the index case of the current Ebola virus disease epidemic.[6][7] His mother, sister, and grandmother then became ill with similar symptoms and also died. People infected by those initial cases spread the disease to other villages.[8][9] Although Ebola represents a major public health issue in sub-Saharan Africa, no cases had ever been reported in West Africa and the early cases were diagnosed as other diseases more common to the area. Thus, the disease had several months to spread before it was recognized as Ebola.[7][8]

Start of outbreak: 2014

On 30 March 2014, Liberia confirmed its first two cases of Ebola virus disease in Foya, Lofa County.[10]

Early events

By 23 April, thirty-four cases and six deaths from Ebola in Liberia were recorded.[11] By 17 June, sixteen people had died from the disease in the country.[12] The initial cases were thought to be malaria, an extremely common disease in Liberia, and thus leading to doctors being infected with the Ebola virus.[13]

By 17 June, the first deaths occurred in Monrovia from Ebola when seven patients died from the disease.[14] Among them was a nurse, along with other members of her household.[14] At the time, there were about 16 cases reported in Liberia in total.[15] The nurse was treated at Redemption Hospital, a free state-run health care facility in New Kru Town, west of Monrovia.[16][17]

On 2 July, the head surgeon of Redemption Hospital died from the disease. He was treated at the JFK Medical Center in Monrovia.[16] Following his death Redemption Hospital was shut down, and patients were either transferred or referred to other facilities in the area.[16] By 21 July, four nurses at Phebe Hospital in Bong County contracted the disease.[18] On 27 July, Dr. Samuel Brisbane, one of Liberia's top doctors, died from Ebola. A doctor from Uganda also died from the disease.[19] Two U.S. health care workers, one a doctor (Dr. Kent Brantly) and the other a nurse were also infected with the disease. Both of them missionaries, they were medically evacuated from Liberia to the US for treatment where they made a full recovery.[20]

By 28 July, most border crossings had been closed, with medical checkpoints set up at the remaining ports and quarantines in some areas. Arik Air suspended all flights between Nigeria and Liberia.[21] On 30 July, Liberia shut down its schools in an attempt to prevent the outbreak from spreading.[22]

August

On the first weekend of August, locals quarreled with a burial team trying to bury 22 bodies. The police were summoned and order was restored.[23] On 4 August, the Liberian government ordered all corpses of those who died to be cremated.[23] The body of a patient who died from Ebola is highly contagious in the days following the death.[24] At the time, there were 156 recorded deaths from the disease in Liberia.[23]

On 11 August, the Ivorian government announced the suspension of all flights to and from countries affected by Ebola.[25] Ten days later, it decided to close its borders as well with Guinea and Liberia, the two countries most affected by Ebola.[26] On 27 August, wild dogs were seen eating the corpses that had not been collected for burial. A pack of dogs were observed digging up bodies and eating them in Liberia.[27] One study indicated that dogs may eat at Ebola-infected carcasses and may become carriers of the disease.[27]

West Point quarantine (19–30 Aug)

 
A view of the West Point area of Monrovia

On 18 August, a mob of residents from West Point, an impoverished area of Monrovia, descended upon a local Ebola clinic to protest its presence. The protesters turned violent, threatening the caretakers, removing the infected patients, and looting the clinic of its supplies, including blood-stained bed sheets and mattresses. Police and aid workers expressed fear that this would lead to mass infections of Ebola in West Point.[28][29]

On 19 August, the Liberian government quarantined the entirety of West Point and issued a curfew statewide.[30][31] Violence again broke out on 22 August, after the military fired on protesting crowds.[32] An inquiry into the incident found the security forces at fault, stating they "fired with complete disregard for human life".[33] The quarantine blockade of the West Point area was lifted on 30 August. The Information Minister, Lewis Brown, said that this step was taken to ease efforts to screen, test, and treat residents.[34]

September

By 1 September, Ivory Coast announced the opening of humanitarian corridors with its two affected neighboring countries.[26] On 20 September, Liberia opened a new 150-bed treatment unit clinic in Monrovia. At the opening ceremony of the Old Island Clinic on Bushrod Island six ambulances were already waiting with suspected Ebola patients. More patients were waiting by the clinic after making their way on foot with the help of relatives.[35] Two days later 112 beds were already filled with 46 patients testing positive for Ebola, while the rest were admitted for observation.[36] This expanded the number of beds in the city beyond 240.[37] Its capacity was exceeded within 24 hours with a shortage of staff and logistics to take care of a patient with correct precautions in place.[37] One source says it opened on 21 September 2014, with a 100-bed capacity.[38] As of 23 September, there had been 3,458 total cases, 1,830 deaths, and 914 lab confirmed cases according to the World Health Organization.[39]

By late September, there were three clinics in Monrovia. Despite this patients waiting to be treated died outside as the clinics had run out of space to treat the increasing number of patients.[40] If patients could not get a bed in the clinic they sometimes waited in holding centers until a bed opened up.[41] There were additional cases in Monrovia where the bodies were dumped into the river.[42] One woman used trash bags to protect herself as she cared for four other family members ill with Ebola.[43] Her father became ill in late July, but they could not find a place of treatment for him and ended up doing home-care.[43]

On 25 September, Liberia's chief medical official went on a self-enforced quarantine after her assistant died from the disease, fearing she might have been accidentally exposed to the virus.[44] By 29 September it was announced she tested negative for Ebola and government officials praised her for following the self quarantine protocol.[45]

On 28 September Ivory Coast resumed flights to Liberia which had been suspended since 11 August 2014, after WHO's critique for tending to economically strangle the affected nations. From the beginning of the crisis, WHO has discouraged closing the borders with affected countries.[26]

On 30 September, a cameraman was tested positive for Ebola in a Texas hospital after contracting the disease before traveling back to the United States from Liberia. He covered the Ebola outbreak for NBC News[46][47] (see 2014 Ebola virus cases in the United States). Following this the Liberian government enacted strict restrictions on journalistic coverage aimed at protecting patients' privacy.[48]

October

 
The 25-bed Monrovia Medical Unit was constructed for health care workers supporting Operation United Assistance.

In early October, Ellen Johnson Sirleaf, the President of Liberia, continued requesting more aid to fight the disease.[49] On 2 October, a new 60-bed clinic was opened in Kenema.[50] By then, the outbreak was described as being out of control and an exponential growth in cases was seen. The focus shifted to slowing the outbreak down. A key element was the fact that the health care establishments were overwhelmed thus leading to those infected being turned away from treatment centers. This eventually led to the infection of others taking care of sick or dying patients at home.[51]

By 3 October, at least eight Liberian soldiers died after contracting the disease from a female visitor.[52] On 3 October more medical supplies arrived from Germany.[53] On that same day Gerlib opened up an Ebola isolation ward at its 48-bed facility in Paynesville (Monrovia).[54] On 10 October all journalists were banned from entering Ebola clinics.[55]

On 14 October, a hundred U.S. troops arrived in Liberia, bringing the total to 565 to aid in the fight against the deadly disease.[56] On 16 October, U.S. President Obama authorized, via executive order, the use of National Guard and reservists in Liberia.[57] A report on 15 October indicates that Liberia may need 80,000 more body bags and about 1 million protective suits for the next six months.[58] In October, WHO pushed for its 70-70-60 plan to control the outbreak.[59] By 19 October, it was reported that 223 health care workers had been infected with Ebola, and 103 of them had died in Liberia.[60]

On 19 October, the President of Liberia apologized to the Mayor of Dallas, for the Liberian national that brought the disease to the United States.[61] By 19 October, only one area in Liberia, Grand Gedeh County, had yet to report an Ebola case. 14 out of the 15 districts have reported cases.[60] The disease had been noted to be spreading in Monrovia, the nation's capital with over one million inhabitants.[62][63] Monrovia was particularly affected with 305 new cases reported in the week ending 19 October.[60]

November

 
The reported weekly cases of Ebola in Liberia as listed on Wikipedia's 2014 Ebola Virus in West Africa timeline of reported cases and deaths; some values are interpolated.

By 5 November, Liberia had 6,525 cases (including 1,627 probable, 2,447 suspected cases) and 2,697 deaths.[64] The 5 November WHO situation report noted that, "There appears to be some evidence of a decline at the national level in Liberia, although new case numbers remain high in parts of the country."[65] A report by CDC released on 14 November, based on data collected from Lofa county, indicates that there has been a genuine reduction in new infections. This is credited to an integrated strategy combining isolation and treatment with community behaviour change including safe burial practices, case finding and contract tracing – this strategy might serve as a model to implement in other affected areas to accelerate control of Ebola.[66] Roselyn Nugba-Ballah led the Safe & Dignified Burial Practices Team for the Liberian Red Cross and was awarded the Florence Nightingale Medal for her work during the crisis in 2017.[67]

On 13 November, the Liberian President announced the lifting of the state of emergency in the country following the decrease in the number of new cases in the country.[68] The decline in Liberia cases was contradicted in reports from WHO with 439 new cases reported between 23 and 28 November.[69][70]

December

On 4 December, it was reported that President Sirleaf banned all rallies and gatherings in Monrovia before the senatorial election, fearing that the risk of the Ebola virus spreading may be increased.[71]

Outbreak continues: 2015

 
Doctors from Médecins Sans Frontières and the American CDC put on protective gear before entering an Ebola treatment ward in Liberia, August 2014.

On 13 January 2015, the Liberian government announced that new cases of Ebola in Liberia were now restricted to only two of its counties: Grand Cape Mount County and Montserrado County.[72] On 28 January, the ELWA-3 Ebola treatment centre in Monrovia was partially dismantled. When the centre opened in August it had been swamped with patients, even needing to turn some away, but according to staff it was now down to only two patients. The MSF field coordinator said that as of that date Liberia was down to only five confirmed cases in all of Liberia.[73] On 30 January, Liberia extended school reopenings by two weeks.[74] On 10 February, the U.S. military indicated it would end its relief mission.[75] On 20 February, Liberia opened its land borders.[76]

In the first week of March, the World Health Organization announced that Liberia had released its last Ebola patient after going a week without any new cases of the virus being reported. If the country had reported no new cases for 42 days, it would be declared Ebola-free according to the WHO.[77]

On 5 March Tolbert Nyeswah, the assistant health minister of Liberia, reported that the country have released their last confirmed case of Ebola from a Chinese-staffed treatment centre. Beatrice Yardoldo was the last confirmed case and has been treated since 18 February.[78] No new cases were reported for two weeks. On 20 March Dr. Moses Massaquoi, leader of the Clinton Health Access Initiative in Liberia, reported a new confirmed case in the country. The patient developed symptoms on 15 March, and was tested positive on 20 March.[79] Subsequently, the patient died on 27 March.[80]

The countdown restarted on 28 March, following the burial of the last casualty.[81] The country was officially declared Ebola-free on 9 May, after 42 days passed with no new cases of Ebola being reported.[82] As of May 2015, the country remained on high alert against recurrence of the disease.[83]

June/July

Three months passed with no new reports of cases. However, on 29 June, Liberia reported that the body of a 17-year-old youth, who had been treated for malaria, tested positive for Ebola.[84] The patient was from Nedowein, a village in Margibi County[85] near the capital Monrovia's international airport.[86]

The WHO announced the male youth had been in close contact with at least 102 people with no recent history of traveling. Contact tracing followed with visitors from affected areas and those attending his funeral. On 1 July a second case was confirmed.[84][87] By 2 July a third new case was confirmed leading to the possibility that they might have been infected with the Ebola virus lurking in animal meat according to researchers. All three cases may be linked to a dog meat meal they shared.[88][89]

September

"Today, 3 September 2015, WHO declares Liberia free of Ebola virus transmission in the human population. Forty-two days have passed since the second negative test on 22 July 2015 of the last laboratory-confirmed case. Liberia now enters a 90-day period of heightened surveillance...".[90]

"WHO commends the Government of Liberia and its people on the successful response to this recent re-emergence. It is in full accord with government calls for sustained vigilance...".[90]

November

After two months of going Ebola-free, on 20 November, a new case was confirmed when a 15-year-old boy was diagnosed with Ebola[91][92] and two family members subsequently tested positive as well.[93][94] Health officials were concerned because the child had not recently travelled or been exposed to someone with Ebola and the WHO stated, "we believe that this is probably again, somehow, someone who has come in contact with a virus that had been persisting in an individual, who had suffered the disease months ago." Two members of the US CDC were sent to the country to help to ascertain the cause of the new cases.[95] The infected boy died on 24 November,[96] and on 3 December the two remaining cases were released after recovering from the virus.[97] The 42-day countdown toward Liberia being declared Ebola-free, for the third time, started on 4 December 2015 and ended on 14 January 2016 when Liberia was declared Ebola-free.[98] On 16 December, WHO reaffirmed that the cases in Liberia were the result of re-emergence of the virus in a previously infected person,[99] and there was speculation that the boy may have been infected by an individual who became infectious once more due to pregnancy which may have weakened her immune system.[100] On 18 December, the WHO indicated that it still considers Ebola in West Africa a public health emergency, though progress has been made.[101]

January 2016

After having completed the 42 day time period, Liberia was declared free from the virus on 14 January 2016, effectively ending the outbreak started in neighbouring Guinea 2 years earlier. Liberia however had a 90-day period of heightened surveillance which was scheduled to conclude on 13 April 2016.[102]

April–June 2016

On 1 April, it was reported that a new Ebola fatality had occurred in Liberia,[103] and on 3 April, a second case was reported in Monrovia.[104] On 4 April, it was reported that 84 individuals were under observation due to contact with the 2 confirmed cases of the virus.[105] On 7 April, Liberia confirmed three new cases since the virus resurfaced. A total of 97 contacts, including 15 healthcare workers were being monitored.[106] The index case of the new flare up was reported to be the wife of a patient who died from the virus in Guinea. She traveled to Monrovia after the funeral of her husband but died from the disease.[1] The national Incident Management System (IMS) was immediately reactivated to coordinate the response to this flare-up and the counties enhanced the surveillance and prevention for a quick detention and interruption of transmission in case of eventual importation of cases from Monrovia.[107] On 9 June, after 42 days, the country was declared Ebola-free.[108]

Healthcare capacity

Clinics

On 20 September 2014, Liberia opened the 150-bed Old Island Clinic on Bushrod Island in Monrovia.[35] Another clinic in Monrovia is a 160-bed facility staffed and run by Médecins Sans Frontières.[109] On 25 November China opened a "state of the art clinic" outside Monrovia. The 100-bed clinic was mostly staffed by Chinese medical and other personnel.[110]

JFK (John F. Kennedy Medical Center) is another treatment center, and could hold 35 beds but expanded to 75 because of the increasing demand for beds.[111] On 10 November, the U.S. opened the first of 17 Ebola treatment facilities it was building for Liberia, in Tubmanburg.[112]

Confounding factors

 
A CDC official consulting with a Liberian District representative about Ebola

Sanitation

Sanitation is a major struggle in most parts of Monrovia. There are four public toilets in the West Point area in Monrovia, an area with 70,000 inhabitants.[113] The beach and river surrounding West Point area are often used as a lavatory. The Mesurado River is a source of drinking water, and the fish from the water are a primary source of food for many.[113]

Corruption

Further information: Corruption in Liberia

It has been reported that body-collection teams, dispatched to collect the body of a suspected Ebola death, accepted bribes to issue falsified death certificates to family members. Due to the stigma of Ebola some families did not want to admit that their relative died from Ebola. The body of the deceased would then be left with relatives for a traditional funeral.[114]

During the 10-day Liberian government quarantine of the West Point slum in Monrovia, residents were able to leave the quarantine area by bribing soldiers and police officers.[115] A journalist inside West Point told a local radio station that Liberian soldiers and police were seen "daily soliciting monies from those being quarantined in the area to escape". The journalist reported that "many of those even suspected of having the disease were given free passage to leave West Point for Monrovia city center."[116] An American non-governmental organization journalist reported that Liberian police threatened arrest and demanded bribes in order for him to leave the MSF compound.[117]

Hiding of Ebola infected and dead

In October, it was noted that many of the Ebola deaths and those dying were not being reported to health authorities. While the epidemic had been accelerating, the number of bodies being collected was falling. "Very, very few of those dying in the community are being brought forward," said Cokie van der Velde, who organized the collections of bodies with Médecins Sans Frontières.[118]

Van der Velde announced that the main crematorium in Monrovia was running at full capacity in Monrovia. It was cremating 80 bodies at its mass pyre per day. In early October, the number of cremations drastically decreased to 30 or 40 per day. Van der Velde said, "That means they're being kept hidden and buried in secret". Traditional funeral rituals are a risk factor in the spread of Ebola, as the body is at its most contagious stage post-mortem.[118][119]

By late October, it was reported that many beds in Liberian Ebola treatment centers were empty due to people no longer reporting suspected Ebola cases to health authorities. The assistant Liberian health minister announced at the time that an assessment of Ebola treatment units discovered that out of the 742 beds only 351 were occupied by patients.[120] The non-reporting is believed to be due to a policy decision in August to cremate all bodies of suspected Ebola cases in Monrovia. Cremation was against local culture of a traditional burial. The cremation order came after people in Monrovia's neighborhoods resisted the burial of hundreds of Ebola victims near their homes.[120]

Issues within government

On 6 August 2014, President Sirleaf, in an emergency announcement, informed absent government ministers and civil service leaders to return to their duties in Liberia.[121] In late August Sirleaf dismissed 10 government officials, including deputy ministers in the central government who refused to return to work. The benefits and pay for nearly twenty other high-ranking officials who refused to return were halted.[122]

In mid-November, President Sirleaf reshuffled the country's cabinet in response to widespread criticism of the government's heavy-handed yet ineffective response to the Ebola crisis. George Warner, previously the head of civil service, would replace Walter Gwenigale as health minister. Sirleaf commented Gwenigale had her "full confidence" and would continue as an adviser.[123]

Transfusions of blood from Ebola survivors

A black market for the blood of Ebola survivors was reported in Liberia. Buyers of the blood hoped to gain immunity or recovery via a blood transfusion.[124] These transfusions have been noted as posing a risk for the transmission of HIV/AIDS, malaria and other blood-borne diseases. "This has the potential to divert time and resources originally allocated to control Ebola", according to a US military report.[125]

Local conspiracy theories

See also: Ebola conspiracy theories
  • The Liberian Observer, a major Liberian newspaper, has repeatedly published Ebola-related conspiracy theories. In September, it published an article claiming that Ebola and the AIDS virus are genetically modified organisms to be used as bio-weapons on Africans in an attempt to reduce Africa's population.[126][127] In October, the story went viral on social media.[128]
  • In late October, it was reported that harassment of gay Liberians in Monrovia was occurring after some church leaders said that "God was angry with Liberians over corruption and immoral acts such as homosexuality, and that Ebola was a punishment". The harassment included car windows being smashed and some gay people being forced from their homes and into hiding.[129]
  • "The Ebola outbreak was sparked by a bewitched aircraft that crashed in a remote part of Sierra Leone, casting a spell over three West African countries – but a heavily alcoholic drink called bitter Kola can cure the virus."[130]
  • "Some members of the community thought it was a bad spirit, a devil or poisoning."[131]
  • At the beginning of the outbreak, many did not believe that the disease existed. "I thought it was a lie (invented) to collect money because at that moment I hadn't seen people affected in my community."[131]

Effects

 
A sign in a Monrovia radio station advising people not to shake hands, as Ebola can be spread through physical contact via body fluids.

Evacuations

On 5 August 2014, the Brothers Hospitallers of St. John of God confirmed that Brother Miguel Pajares had been infected after volunteering in Liberia. The Spanish military assisted with his transfer on 6 August.[132] Authorities stated he would be treated in the 'Carlos III' hospital in Madrid. This attracted controversy, amid questions as to the authorities' ability to guarantee no risk of transmission.[133] Brother Pajares died from the virus on 12 August.[134]

Kent Brantly, a physician and medical director in Liberia for the aid group Samaritan's Purse, and co-worker Nancy Writebol were infected while working in Monrovia.[135][136][137] Both were flown to the United States at the beginning of August for further treatment.[138] On 21 August, Brantly and Writebol recovered and were discharged.[139]

A French volunteer health worker working for MSF in Liberia contracted Ebola there and was flown to France on 18 September 2014. French Health Minister Marisol Touraine stated the nurse would receive the experimental drug favipiravir.[140] By 4 October she had recovered and was released from hospital.[141]

After a news-network's cameraman came down with Ebola, he was evacuated to the U.S. and the rest of the crew also returned and went into quarantine.[142]

Local works derived from the Ebola crisis

Main article: Cultural effects of the Ebola crisis
  • "White Ebola", a political song by Mr. Monrovia, AG Da Profit and Daddy Cool, centered on the general mistrust of foreigners.[143]
  • "Ebola in Town", a dance tune by a group of West African rappers, D-12, Shadow and Kuzzy Of 2 Kings warns people of the dangers of the Ebola virus.[144]
  • Senegalese rapper Xuman parodied Rihanna's "Umbrella" in "Ebola est là" (Ebola Is Here). The song's lyrics warns locals that, "The disease is among our neighbours, Liberians and Guineans."[145][146]
  • "Ebola is Real", A hip hop tune done in collaboration with Liberian artists F.A., Soul Fresh, DenG, Adolphus Scott (a Liberian communication specialist for UNICEF) and Liberia's Ministry of Health & Social Welfare.[145][147]
  • A 5-minute public service advert was carefully crafted by Adolphus Scott and others, to increase general Ebola awareness. The clip runs an estimated 5 times a day on local TV stations.[147]
  • "State of Emergency", a hip hop tune by Tan Tan B and Quincy B, produced without government involvement.[147][148]
  • In August 2014, George Weah and Ghanaian musician Sidney produced a song to raise awareness about Ebola.[146] All proceeds from the track been donated to the Liberian Health Ministry.[149]
  • Charles Yegba, leader of the AFROCO music group, plans to record a song and video to raise awareness about Ebola across Liberia.[131]
  • There were a number of Ebola-themed jokes circulating in West Africa.[150]
  • Liberian Radio programme directors have increased vernacular Ebola prevention programs' air time on 44 community radio stations to include most of the 30 minority languages used in the rural areas. Programmes of 30 minutes, 3 times a day, include commercials, phone-ins and news, broadcast in the local language. Only about 20% of Liberians understand English.[151]

On 24 May 2016, Liberian Child's right and Environmental Activist, Chair-Person of the National Children and Youth Advisory Board Wantoe Teah Wantoe, acknowledged The United Nations body, Government body, and civil society actors at the World Humanitarian Summit through his Preliminary address on the need to contribute to Liberia's resilience and recovery after the casualties of the Ebola virus disease. He spoke of the vulnerabilities of Liberian children whose status had been changed to orphans and semi-orphans due to the deaths caused by the Ebola virus.[152]

See also

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Further reading

  • "PREVAIL treatment trial for men with persistent Ebola viral RNA in semen opens in Liberia". 5 July 2016. Retrieved 11 July 2016.NIH
  • "Media Availability: NIH Explores Connection Between Ebola Survival and Co-Infection with Malaria Parasites". www.niaid.nih.gov. National Institute of Health. Retrieved 18 August 2016.
  • Soka, Moses (2016). "Prevention of sexual transmission of Ebola in Liberia through a national semen testing and counselling programme for survivors: an analysis of Ebola virus RNA results and behavioural data". The Lancet. 4 (10): e736–e743. doi:10.1016/S2214-109X(16)30175-9. PMID 27596037.
  • Bausch, Daniel G; Crozier, Ian (August 2016). "The Liberia Men's Health Screening Program for Ebola virus: win-win-win for survivor, scientist, and public health". The Lancet Global Health. 4 (10): e672–e673. doi:10.1016/S2214-109X(16)30207-8. ISSN 2214-109X. PMID 27596040.
  • Shoman, Haitham; Karafillakis, Emilie; Rawaf, Salman (4 January 2017). "The link between the West African Ebola outbreak and health systems in Guinea, Liberia and Sierra Leone: a systematic review". Globalization and Health. 13 (1): 1. doi:10.1186/s12992-016-0224-2. ISSN 1744-8603. PMC 5210305. PMID 28049495.
  • Kennedy, Stephen B.; Bolay, Fatorma; Kieh, Mark; Grandits, Greg; Badio, Moses; Ballou, Ripley; Eckes, Risa; Feinberg, Mark; Follmann, Dean; Grund, Birgit; Gupta, Swati; Hensley, Lisa; Higgs, Elizabeth; Janosko, Krisztina; Johnson, Melvin; Kateh, Francis; Logue, James; Marchand, Jonathan; Monath, Thomas; Nason, Martha; Nyenswah, Tolbert; Roman, François; Stavale, Eric; Wolfson, Julian; Neaton, James D.; Lane, H. Clifford (12 October 2017). "Phase 2 Placebo-Controlled Trial of Two Vaccines to Prevent Ebola in Liberia". New England Journal of Medicine. 377 (15): 1438–1447. doi:10.1056/NEJMoa1614067. ISSN 0028-4793. PMC 5705229. PMID 29020589.
  • "Study to Examine Genetic Susceptibility to Ebola Launches in Liberia | NIH: National Institute of Allergy and Infectious Diseases". www.niaid.nih.gov. Retrieved 10 November 2017.

External links

  • , Republic of Liberia
  • at the US Centers for Disease Control and Prevention
  • Control of Ebola Virus Disease – Firestone District, Liberia, 2014

January 11, 2023
ebola, virus, epidemic, liberia, epidemic, ebola, virus, disease, occurred, liberia, from, 2014, 2015, along, with, neighbouring, countries, guinea, sierra, leone, first, cases, virus, were, reported, late, march, 2014, ebola, virus, biosafety, level, four, pa. An epidemic of Ebola virus disease occurred in Liberia from 2014 to 2015 along with the neighbouring countries of Guinea and Sierra Leone The first cases of virus were reported by late March 2014 2 The Ebola virus a biosafety level four pathogen is an RNA virus discovered in 1976 3 Ebola virus epidemic in LiberiaA map of LiberiaCases contracted in Liberia10 675 as of 7 April 2016 update 1 Deaths4 809 as of 7 April 2015 update 1 Location of Liberia in Africa Before the outbreak of the Ebola epidemic the country had 50 doctors for its population of 4 3 million The country s health system was seriously weakened by a civil war that ended in 2003 4 Contents 1 History 1 1 West African outbreak 2 Start of outbreak 2014 2 1 Early events 2 2 August 2 2 1 West Point quarantine 19 30 Aug 2 3 September 2 4 October 2 5 November 2 6 December 3 Outbreak continues 2015 3 1 June July 3 2 September 3 3 November 4 January 2016 4 1 April June 2016 5 Healthcare capacity 5 1 Clinics 6 Confounding factors 6 1 Sanitation 6 2 Corruption 6 3 Hiding of Ebola infected and dead 6 4 Issues within government 6 5 Transfusions of blood from Ebola survivors 6 6 Local conspiracy theories 7 Effects 7 1 Evacuations 7 2 Local works derived from the Ebola crisis 8 See also 9 References 10 Further reading 11 External linksHistory EditWest African outbreak Edit Main article West African Ebola virus epidemic Researchers generally believe that a two year old boy 5 later identified as Emile Ouamouno who died in December 2013 in the village of Meliandou Gueckedou Prefecture Guinea was the index case of the current Ebola virus disease epidemic 6 7 His mother sister and grandmother then became ill with similar symptoms and also died People infected by those initial cases spread the disease to other villages 8 9 Although Ebola represents a major public health issue in sub Saharan Africa no cases had ever been reported in West Africa and the early cases were diagnosed as other diseases more common to the area Thus the disease had several months to spread before it was recognized as Ebola 7 8 Start of outbreak 2014 EditOn 30 March 2014 Liberia confirmed its first two cases of Ebola virus disease in Foya Lofa County 10 Early events Edit By 23 April thirty four cases and six deaths from Ebola in Liberia were recorded 11 By 17 June sixteen people had died from the disease in the country 12 The initial cases were thought to be malaria an extremely common disease in Liberia and thus leading to doctors being infected with the Ebola virus 13 By 17 June the first deaths occurred in Monrovia from Ebola when seven patients died from the disease 14 Among them was a nurse along with other members of her household 14 At the time there were about 16 cases reported in Liberia in total 15 The nurse was treated at Redemption Hospital a free state run health care facility in New Kru Town west of Monrovia 16 17 On 2 July the head surgeon of Redemption Hospital died from the disease He was treated at the JFK Medical Center in Monrovia 16 Following his death Redemption Hospital was shut down and patients were either transferred or referred to other facilities in the area 16 By 21 July four nurses at Phebe Hospital in Bong County contracted the disease 18 On 27 July Dr Samuel Brisbane one of Liberia s top doctors died from Ebola A doctor from Uganda also died from the disease 19 Two U S health care workers one a doctor Dr Kent Brantly and the other a nurse were also infected with the disease Both of them missionaries they were medically evacuated from Liberia to the US for treatment where they made a full recovery 20 By 28 July most border crossings had been closed with medical checkpoints set up at the remaining ports and quarantines in some areas Arik Air suspended all flights between Nigeria and Liberia 21 On 30 July Liberia shut down its schools in an attempt to prevent the outbreak from spreading 22 August Edit On the first weekend of August locals quarreled with a burial team trying to bury 22 bodies The police were summoned and order was restored 23 On 4 August the Liberian government ordered all corpses of those who died to be cremated 23 The body of a patient who died from Ebola is highly contagious in the days following the death 24 At the time there were 156 recorded deaths from the disease in Liberia 23 On 11 August the Ivorian government announced the suspension of all flights to and from countries affected by Ebola 25 Ten days later it decided to close its borders as well with Guinea and Liberia the two countries most affected by Ebola 26 On 27 August wild dogs were seen eating the corpses that had not been collected for burial A pack of dogs were observed digging up bodies and eating them in Liberia 27 One study indicated that dogs may eat at Ebola infected carcasses and may become carriers of the disease 27 West Point quarantine 19 30 Aug Edit A view of the West Point area of Monrovia On 18 August a mob of residents from West Point an impoverished area of Monrovia descended upon a local Ebola clinic to protest its presence The protesters turned violent threatening the caretakers removing the infected patients and looting the clinic of its supplies including blood stained bed sheets and mattresses Police and aid workers expressed fear that this would lead to mass infections of Ebola in West Point 28 29 On 19 August the Liberian government quarantined the entirety of West Point and issued a curfew statewide 30 31 Violence again broke out on 22 August after the military fired on protesting crowds 32 An inquiry into the incident found the security forces at fault stating they fired with complete disregard for human life 33 The quarantine blockade of the West Point area was lifted on 30 August The Information Minister Lewis Brown said that this step was taken to ease efforts to screen test and treat residents 34 September Edit By 1 September Ivory Coast announced the opening of humanitarian corridors with its two affected neighboring countries 26 On 20 September Liberia opened a new 150 bed treatment unit clinic in Monrovia At the opening ceremony of the Old Island Clinic on Bushrod Island six ambulances were already waiting with suspected Ebola patients More patients were waiting by the clinic after making their way on foot with the help of relatives 35 Two days later 112 beds were already filled with 46 patients testing positive for Ebola while the rest were admitted for observation 36 This expanded the number of beds in the city beyond 240 37 Its capacity was exceeded within 24 hours with a shortage of staff and logistics to take care of a patient with correct precautions in place 37 One source says it opened on 21 September 2014 with a 100 bed capacity 38 As of 23 September there had been 3 458 total cases 1 830 deaths and 914 lab confirmed cases according to the World Health Organization 39 By late September there were three clinics in Monrovia Despite this patients waiting to be treated died outside as the clinics had run out of space to treat the increasing number of patients 40 If patients could not get a bed in the clinic they sometimes waited in holding centers until a bed opened up 41 There were additional cases in Monrovia where the bodies were dumped into the river 42 One woman used trash bags to protect herself as she cared for four other family members ill with Ebola 43 Her father became ill in late July but they could not find a place of treatment for him and ended up doing home care 43 On 25 September Liberia s chief medical official went on a self enforced quarantine after her assistant died from the disease fearing she might have been accidentally exposed to the virus 44 By 29 September it was announced she tested negative for Ebola and government officials praised her for following the self quarantine protocol 45 On 28 September Ivory Coast resumed flights to Liberia which had been suspended since 11 August 2014 after WHO s critique for tending to economically strangle the affected nations From the beginning of the crisis WHO has discouraged closing the borders with affected countries 26 On 30 September a cameraman was tested positive for Ebola in a Texas hospital after contracting the disease before traveling back to the United States from Liberia He covered the Ebola outbreak for NBC News 46 47 see 2014 Ebola virus cases in the United States Following this the Liberian government enacted strict restrictions on journalistic coverage aimed at protecting patients privacy 48 October Edit The 25 bed Monrovia Medical Unit was constructed for health care workers supporting Operation United Assistance In early October Ellen Johnson Sirleaf the President of Liberia continued requesting more aid to fight the disease 49 On 2 October a new 60 bed clinic was opened in Kenema 50 By then the outbreak was described as being out of control and an exponential growth in cases was seen The focus shifted to slowing the outbreak down A key element was the fact that the health care establishments were overwhelmed thus leading to those infected being turned away from treatment centers This eventually led to the infection of others taking care of sick or dying patients at home 51 By 3 October at least eight Liberian soldiers died after contracting the disease from a female visitor 52 On 3 October more medical supplies arrived from Germany 53 On that same day Gerlib opened up an Ebola isolation ward at its 48 bed facility in Paynesville Monrovia 54 On 10 October all journalists were banned from entering Ebola clinics 55 On 14 October a hundred U S troops arrived in Liberia bringing the total to 565 to aid in the fight against the deadly disease 56 On 16 October U S President Obama authorized via executive order the use of National Guard and reservists in Liberia 57 A report on 15 October indicates that Liberia may need 80 000 more body bags and about 1 million protective suits for the next six months 58 In October WHO pushed for its 70 70 60 plan to control the outbreak 59 By 19 October it was reported that 223 health care workers had been infected with Ebola and 103 of them had died in Liberia 60 On 19 October the President of Liberia apologized to the Mayor of Dallas for the Liberian national that brought the disease to the United States 61 By 19 October only one area in Liberia Grand Gedeh County had yet to report an Ebola case 14 out of the 15 districts have reported cases 60 The disease had been noted to be spreading in Monrovia the nation s capital with over one million inhabitants 62 63 Monrovia was particularly affected with 305 new cases reported in the week ending 19 October 60 November Edit The reported weekly cases of Ebola in Liberia as listed on Wikipedia s 2014 Ebola Virus in West Africa timeline of reported cases and deaths some values are interpolated By 5 November Liberia had 6 525 cases including 1 627 probable 2 447 suspected cases and 2 697 deaths 64 The 5 November WHO situation report noted that There appears to be some evidence of a decline at the national level in Liberia although new case numbers remain high in parts of the country 65 A report by CDC released on 14 November based on data collected from Lofa county indicates that there has been a genuine reduction in new infections This is credited to an integrated strategy combining isolation and treatment with community behaviour change including safe burial practices case finding and contract tracing this strategy might serve as a model to implement in other affected areas to accelerate control of Ebola 66 Roselyn Nugba Ballah led the Safe amp Dignified Burial Practices Team for the Liberian Red Cross and was awarded the Florence Nightingale Medal for her work during the crisis in 2017 67 On 13 November the Liberian President announced the lifting of the state of emergency in the country following the decrease in the number of new cases in the country 68 The decline in Liberia cases was contradicted in reports from WHO with 439 new cases reported between 23 and 28 November 69 70 December Edit On 4 December it was reported that President Sirleaf banned all rallies and gatherings in Monrovia before the senatorial election fearing that the risk of the Ebola virus spreading may be increased 71 Outbreak continues 2015 Edit Doctors from Medecins Sans Frontieres and the American CDC put on protective gear before entering an Ebola treatment ward in Liberia August 2014 On 13 January 2015 the Liberian government announced that new cases of Ebola in Liberia were now restricted to only two of its counties Grand Cape Mount County and Montserrado County 72 On 28 January the ELWA 3 Ebola treatment centre in Monrovia was partially dismantled When the centre opened in August it had been swamped with patients even needing to turn some away but according to staff it was now down to only two patients The MSF field coordinator said that as of that date Liberia was down to only five confirmed cases in all of Liberia 73 On 30 January Liberia extended school reopenings by two weeks 74 On 10 February the U S military indicated it would end its relief mission 75 On 20 February Liberia opened its land borders 76 In the first week of March the World Health Organization announced that Liberia had released its last Ebola patient after going a week without any new cases of the virus being reported If the country had reported no new cases for 42 days it would be declared Ebola free according to the WHO 77 On 5 March Tolbert Nyeswah the assistant health minister of Liberia reported that the country have released their last confirmed case of Ebola from a Chinese staffed treatment centre Beatrice Yardoldo was the last confirmed case and has been treated since 18 February 78 No new cases were reported for two weeks On 20 March Dr Moses Massaquoi leader of the Clinton Health Access Initiative in Liberia reported a new confirmed case in the country The patient developed symptoms on 15 March and was tested positive on 20 March 79 Subsequently the patient died on 27 March 80 The countdown restarted on 28 March following the burial of the last casualty 81 The country was officially declared Ebola free on 9 May after 42 days passed with no new cases of Ebola being reported 82 As of May 2015 the country remained on high alert against recurrence of the disease 83 June July Edit Three months passed with no new reports of cases However on 29 June Liberia reported that the body of a 17 year old youth who had been treated for malaria tested positive for Ebola 84 The patient was from Nedowein a village in Margibi County 85 near the capital Monrovia s international airport 86 The WHO announced the male youth had been in close contact with at least 102 people with no recent history of traveling Contact tracing followed with visitors from affected areas and those attending his funeral On 1 July a second case was confirmed 84 87 By 2 July a third new case was confirmed leading to the possibility that they might have been infected with the Ebola virus lurking in animal meat according to researchers All three cases may be linked to a dog meat meal they shared 88 89 September Edit Today 3 September 2015 WHO declares Liberia free of Ebola virus transmission in the human population Forty two days have passed since the second negative test on 22 July 2015 of the last laboratory confirmed case Liberia now enters a 90 day period of heightened surveillance 90 WHO commends the Government of Liberia and its people on the successful response to this recent re emergence It is in full accord with government calls for sustained vigilance 90 November Edit After two months of going Ebola free on 20 November a new case was confirmed when a 15 year old boy was diagnosed with Ebola 91 92 and two family members subsequently tested positive as well 93 94 Health officials were concerned because the child had not recently travelled or been exposed to someone with Ebola and the WHO stated we believe that this is probably again somehow someone who has come in contact with a virus that had been persisting in an individual who had suffered the disease months ago Two members of the US CDC were sent to the country to help to ascertain the cause of the new cases 95 The infected boy died on 24 November 96 and on 3 December the two remaining cases were released after recovering from the virus 97 The 42 day countdown toward Liberia being declared Ebola free for the third time started on 4 December 2015 and ended on 14 January 2016 when Liberia was declared Ebola free 98 On 16 December WHO reaffirmed that the cases in Liberia were the result of re emergence of the virus in a previously infected person 99 and there was speculation that the boy may have been infected by an individual who became infectious once more due to pregnancy which may have weakened her immune system 100 On 18 December the WHO indicated that it still considers Ebola in West Africa a public health emergency though progress has been made 101 January 2016 EditAfter having completed the 42 day time period Liberia was declared free from the virus on 14 January 2016 effectively ending the outbreak started in neighbouring Guinea 2 years earlier Liberia however had a 90 day period of heightened surveillance which was scheduled to conclude on 13 April 2016 102 April June 2016 Edit On 1 April it was reported that a new Ebola fatality had occurred in Liberia 103 and on 3 April a second case was reported in Monrovia 104 On 4 April it was reported that 84 individuals were under observation due to contact with the 2 confirmed cases of the virus 105 On 7 April Liberia confirmed three new cases since the virus resurfaced A total of 97 contacts including 15 healthcare workers were being monitored 106 The index case of the new flare up was reported to be the wife of a patient who died from the virus in Guinea She traveled to Monrovia after the funeral of her husband but died from the disease 1 The national Incident Management System IMS was immediately reactivated to coordinate the response to this flare up and the counties enhanced the surveillance and prevention for a quick detention and interruption of transmission in case of eventual importation of cases from Monrovia 107 On 9 June after 42 days the country was declared Ebola free 108 Healthcare capacity EditClinics Edit On 20 September 2014 Liberia opened the 150 bed Old Island Clinic on Bushrod Island in Monrovia 35 Another clinic in Monrovia is a 160 bed facility staffed and run by Medecins Sans Frontieres 109 On 25 November China opened a state of the art clinic outside Monrovia The 100 bed clinic was mostly staffed by Chinese medical and other personnel 110 JFK John F Kennedy Medical Center is another treatment center and could hold 35 beds but expanded to 75 because of the increasing demand for beds 111 On 10 November the U S opened the first of 17 Ebola treatment facilities it was building for Liberia in Tubmanburg 112 Confounding factors Edit A CDC official consulting with a Liberian District representative about Ebola Sanitation Edit Sanitation is a major struggle in most parts of Monrovia There are four public toilets in the West Point area in Monrovia an area with 70 000 inhabitants 113 The beach and river surrounding West Point area are often used as a lavatory The Mesurado River is a source of drinking water and the fish from the water are a primary source of food for many 113 Corruption Edit Further information Corruption in Liberia It has been reported that body collection teams dispatched to collect the body of a suspected Ebola death accepted bribes to issue falsified death certificates to family members Due to the stigma of Ebola some families did not want to admit that their relative died from Ebola The body of the deceased would then be left with relatives for a traditional funeral 114 During the 10 day Liberian government quarantine of the West Point slum in Monrovia residents were able to leave the quarantine area by bribing soldiers and police officers 115 A journalist inside West Point told a local radio station that Liberian soldiers and police were seen daily soliciting monies from those being quarantined in the area to escape The journalist reported that many of those even suspected of having the disease were given free passage to leave West Point for Monrovia city center 116 An American non governmental organization journalist reported that Liberian police threatened arrest and demanded bribes in order for him to leave the MSF compound 117 Hiding of Ebola infected and dead Edit In October it was noted that many of the Ebola deaths and those dying were not being reported to health authorities While the epidemic had been accelerating the number of bodies being collected was falling Very very few of those dying in the community are being brought forward said Cokie van der Velde who organized the collections of bodies with Medecins Sans Frontieres 118 Van der Velde announced that the main crematorium in Monrovia was running at full capacity in Monrovia It was cremating 80 bodies at its mass pyre per day In early October the number of cremations drastically decreased to 30 or 40 per day Van der Velde said That means they re being kept hidden and buried in secret Traditional funeral rituals are a risk factor in the spread of Ebola as the body is at its most contagious stage post mortem 118 119 By late October it was reported that many beds in Liberian Ebola treatment centers were empty due to people no longer reporting suspected Ebola cases to health authorities The assistant Liberian health minister announced at the time that an assessment of Ebola treatment units discovered that out of the 742 beds only 351 were occupied by patients 120 The non reporting is believed to be due to a policy decision in August to cremate all bodies of suspected Ebola cases in Monrovia Cremation was against local culture of a traditional burial The cremation order came after people in Monrovia s neighborhoods resisted the burial of hundreds of Ebola victims near their homes 120 Issues within government Edit On 6 August 2014 President Sirleaf in an emergency announcement informed absent government ministers and civil service leaders to return to their duties in Liberia 121 In late August Sirleaf dismissed 10 government officials including deputy ministers in the central government who refused to return to work The benefits and pay for nearly twenty other high ranking officials who refused to return were halted 122 In mid November President Sirleaf reshuffled the country s cabinet in response to widespread criticism of the government s heavy handed yet ineffective response to the Ebola crisis George Warner previously the head of civil service would replace Walter Gwenigale as health minister Sirleaf commented Gwenigale had her full confidence and would continue as an adviser 123 Transfusions of blood from Ebola survivors Edit A black market for the blood of Ebola survivors was reported in Liberia Buyers of the blood hoped to gain immunity or recovery via a blood transfusion 124 These transfusions have been noted as posing a risk for the transmission of HIV AIDS malaria and other blood borne diseases This has the potential to divert time and resources originally allocated to control Ebola according to a US military report 125 Local conspiracy theories Edit See also Ebola conspiracy theories The Liberian Observer a major Liberian newspaper has repeatedly published Ebola related conspiracy theories In September it published an article claiming that Ebola and the AIDS virus are genetically modified organisms to be used as bio weapons on Africans in an attempt to reduce Africa s population 126 127 In October the story went viral on social media 128 In late October it was reported that harassment of gay Liberians in Monrovia was occurring after some church leaders said that God was angry with Liberians over corruption and immoral acts such as homosexuality and that Ebola was a punishment The harassment included car windows being smashed and some gay people being forced from their homes and into hiding 129 The Ebola outbreak was sparked by a bewitched aircraft that crashed in a remote part of Sierra Leone casting a spell over three West African countries but a heavily alcoholic drink called bitter Kola can cure the virus 130 Some members of the community thought it was a bad spirit a devil or poisoning 131 At the beginning of the outbreak many did not believe that the disease existed I thought it was a lie invented to collect money because at that moment I hadn t seen people affected in my community 131 Effects Edit A sign in a Monrovia radio station advising people not to shake hands as Ebola can be spread through physical contact via body fluids Evacuations Edit On 5 August 2014 the Brothers Hospitallers of St John of God confirmed that Brother Miguel Pajares had been infected after volunteering in Liberia The Spanish military assisted with his transfer on 6 August 132 Authorities stated he would be treated in the Carlos III hospital in Madrid This attracted controversy amid questions as to the authorities ability to guarantee no risk of transmission 133 Brother Pajares died from the virus on 12 August 134 Kent Brantly a physician and medical director in Liberia for the aid group Samaritan s Purse and co worker Nancy Writebol were infected while working in Monrovia 135 136 137 Both were flown to the United States at the beginning of August for further treatment 138 On 21 August Brantly and Writebol recovered and were discharged 139 A French volunteer health worker working for MSF in Liberia contracted Ebola there and was flown to France on 18 September 2014 French Health Minister Marisol Touraine stated the nurse would receive the experimental drug favipiravir 140 By 4 October she had recovered and was released from hospital 141 After a news network s cameraman came down with Ebola he was evacuated to the U S and the rest of the crew also returned and went into quarantine 142 Local works derived from the Ebola crisis Edit Main article Cultural effects of the Ebola crisis White Ebola a political song by Mr Monrovia AG Da Profit and Daddy Cool centered on the general mistrust of foreigners 143 Ebola in Town a dance tune by a group of West African rappers D 12 Shadow and Kuzzy Of 2 Kings warns people of the dangers of the Ebola virus 144 Senegalese rapper Xuman parodied Rihanna s Umbrella in Ebola est la Ebola Is Here The song s lyrics warns locals that The disease is among our neighbours Liberians and Guineans 145 146 Ebola is Real A hip hop tune done in collaboration with Liberian artists F A Soul Fresh DenG Adolphus Scott a Liberian communication specialist for UNICEF and Liberia s Ministry of Health amp Social Welfare 145 147 A 5 minute public service advert was carefully crafted by Adolphus Scott and others to increase general Ebola awareness The clip runs an estimated 5 times a day on local TV stations 147 State of Emergency a hip hop tune by Tan Tan B and Quincy B produced without government involvement 147 148 In August 2014 George Weah and Ghanaian musician Sidney produced a song to raise awareness about Ebola 146 All proceeds from the track been donated to the Liberian Health Ministry 149 Charles Yegba leader of the AFROCO music group plans to record a song and video to raise awareness about Ebola across Liberia 131 There were a number of Ebola themed jokes circulating in West Africa 150 Liberian Radio programme directors have increased vernacular Ebola prevention programs air time on 44 community radio stations to include most of the 30 minority languages used in the rural areas Programmes of 30 minutes 3 times a day include commercials phone ins and news broadcast in the local language Only about 20 of Liberians understand English 151 On 24 May 2016 Liberian Child s right and Environmental Activist Chair Person of the National Children and Youth Advisory Board Wantoe Teah Wantoe acknowledged The United Nations body Government body and civil society actors at the World Humanitarian Summit through his Preliminary address on the need to contribute to Liberia s resilience and recovery after the casualties of the Ebola virus disease He spoke of the vulnerabilities of Liberian children whose status had been changed to orphans and semi orphans due to the deaths caused by the Ebola virus 152 See also EditEbola virus epidemic in West Africa Ebola virus epidemic in Guinea Ebola virus epidemic in Sierra Leone Ebola virus disease in Mali Ebola virus disease in Nigeria Health in Liberia 2014 Ebola Virus in West Africa timeline of reported cases and deaths Fatu KekulaReferences Edit a b c Liberia and Guinea step up coordination to stem new cases of Ebola WHO 8 April 2016 Archived from the original on 8 April 2016 Retrieved 7 April 2016 2 of 5 Test Positive for Ebola in Liberia Liberian Observer 31 March 2014 archived from the original on 9 July 2014 retrieved 6 July 2014 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ifrc org Retrieved 4 October 2014 Liberia braces for worst as Ebola death toll jumps Business Insider businessinsider com 9 September 2014 Retrieved 6 October 2014 Ebola Kills 8 Soldiers 3 October 2014 Retrieved 24 October 2014 Germany s first Ebola aid arrives in Liberia DW dw de Retrieved 6 October 2014 Gerlib Clinic Sets Up Ebola Isolation Center Liberia News Agency liberianewsagency org Retrieved 6 October 2014 Liberia bans journalists from Ebola centres Yahoo News 10 October 2014 Retrieved 24 October 2014 Another 100 U S Troops Arrive in Liberia to Fight Ebola NBC News Retrieved 14 October 2014 Obama Authorizes Guard Reserve Call up for Ebola ABC News Retrieved 17 October 2014 Ebola Outbreak Liberia Needs 79 940 More Body Bags NBC News Retrieved 18 October 2014 Paye Layleh Jonathan Roy MaCaulay Clarence 23 October 2014 Liberians in Ebola quarantine desperate for food Detroit Free Press Associated Press Retrieved 24 October 2014 a b c WHO 22 October 2014 Ebola Response Roadmap 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Wantoe Liberia World Humanitarian Summit Istanbul 2016 Member States and Stakeholders Announcements Further reading Edit PREVAIL treatment trial for men with persistent Ebola viral RNA in semen opens in Liberia 5 July 2016 Retrieved 11 July 2016 NIH Media Availability NIH Explores Connection Between Ebola Survival and Co Infection with Malaria Parasites www niaid nih gov National Institute of Health Retrieved 18 August 2016 Soka Moses 2016 Prevention of sexual transmission of Ebola in Liberia through a national semen testing and counselling programme for survivors an analysis of Ebola virus RNA results and behavioural data The Lancet 4 10 e736 e743 doi 10 1016 S2214 109X 16 30175 9 PMID 27596037 Bausch Daniel G Crozier Ian August 2016 The Liberia Men s Health Screening Program for Ebola virus win win win for survivor scientist and public health The Lancet Global Health 4 10 e672 e673 doi 10 1016 S2214 109X 16 30207 8 ISSN 2214 109X PMID 27596040 Shoman Haitham Karafillakis Emilie Rawaf Salman 4 January 2017 The link between the West African Ebola outbreak and health systems in Guinea Liberia and Sierra Leone a systematic review Globalization and Health 13 1 1 doi 10 1186 s12992 016 0224 2 ISSN 1744 8603 PMC 5210305 PMID 28049495 Kennedy Stephen B Bolay Fatorma Kieh Mark Grandits Greg Badio Moses Ballou Ripley Eckes Risa Feinberg Mark Follmann Dean Grund Birgit Gupta Swati Hensley Lisa Higgs Elizabeth Janosko Krisztina Johnson Melvin Kateh Francis Logue James Marchand Jonathan Monath Thomas Nason Martha Nyenswah Tolbert Roman Francois Stavale Eric Wolfson Julian Neaton James D Lane H Clifford 12 October 2017 Phase 2 Placebo Controlled Trial of Two Vaccines to Prevent Ebola in Liberia New England Journal of Medicine 377 15 1438 1447 doi 10 1056 NEJMoa1614067 ISSN 0028 4793 PMC 5705229 PMID 29020589 Study to Examine Genetic Susceptibility to Ebola Launches in Liberia NIH National Institute of Allergy and Infectious Diseases www niaid nih gov Retrieved 10 November 2017 External links EditMinistry of Health and Social Welfare Republic of Liberia Ebola in Liberia at the US Centers for Disease Control and Prevention Control of Ebola Virus Disease Firestone District Liberia 2014 Portals Africa Current events Medicine Viruses Retrieved from https en wikipedia org w index php title Ebola virus epidemic in Liberia amp oldid 1118909585, wikipedia, wiki, book, books, library,

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