2018 Kivu Democratic Republic of the Congo Ebola virus outbreak

2018 Kivu Democratic Republic of the Congo Ebola outbreak
Initial case: 1 August 2018
Location of North Kivu province in the Democratic Republic of the Congo
Location of the Democratic Republic of the Congo in Africa
Confirmed cases 172[1]
Probable cases 35[1]
Suspected cases 32[2]
Total cases 239[1]
Deaths 130[1]

The 2018 Kivu Democratic Republic of the Congo Ebola virus outbreak[note 1] began on August 1, 2018, when it was confirmed that four cases had tested positive for Ebola virus in the eastern region of Kivu in the Democratic Republic of the Congo (DRC).[4][5][6] The viral infection outbreak also includes Ituri Province, after the first case was confirmed on 13 August.[3]

The affected province and general area are currently undergoing a military conflict, which is hindering treatment and prevention efforts. The World Health Organization's Deputy Director-General for Emergency Preparedness and Response has described the combination of military conflict and civilian distress as a potential "perfect storm" that could lead to a rapid worsening of the outbreak.[7][8] Due to the deteriorating situation in DRC (North Kivu and surrounding areas) the World Health Organization, on September 27, has raised the risk assessment at the national and regional level from 'high' to 'very high'.[9]

On 3 October, the United Nations Security Council stressed that all armed hostility should come to a stop in the Democratic Republic of the Congo, to better fight the ongoing Ebola virus outbreak.[10]

Epidemiology

First cases and transmission

The Democratic Republic of Congo declared an Ebola outbreak on 1 August, when four cases had tested positive for the Ebola virus in the province of North Kivu. Additionally, on 1 August, 26 individuals with haemorrhagic signs, and 20 deaths were reported in the area of North Kivu.[11][12] On 2 August, Oxfam indicated it would be taking part in the response to this latest outbreak in the DRC.[13]

By 3 August the virus had developed in multiple locations; cases were reported in five health zones – Beni, Butembo, Oicha, Musienene and Mabalako – in North Kivu province and additionally, Mandima and Mambasa in Ituri Province.[14] However, one month later there had been confirmed cases only in the Mabalako, Mandima, Beni and Oicha health zones. The five suspected cases in the Mambasa Health Zone proved not to be EVD; it was not possible to confirm the one probable case in the Musienene Health Zone and the two probable cases in the Butembo health zone. No new cases had been recorded in any of those health zones. The first confirmed case in Butembo was announced on 4 September, the same day that it was announced that one of the cases registered at Beni had actually come from the Kalunguta Health Zone.[15]

The DRC Ministry of Public Health confirmed that the new Ebola outbreak is caused by the Zaire ebolavirus species. This is the same strain that was involved in the early 2018 outbreak in western DRC.[16] Health authorities in the DRC confirmed they will use the ZEBOV vaccine once again.[16]

On 4 August, the World Health Organization (WHO) indicated that the current situation in the DRC, due to several factors, warranted a "high risk assessment" at the national and regional level for public health.[17]

Timeline of reported cases and deaths[18]
DateCases # DeathsCFRContactsSources
ConfirmedProbableSuspectedTotal
 2018-08-01†42202620--[19]
2018-08-03133033763376.7%‡879[20][21]
2018-08-05162731743479%‡   966[22][23]
2018-08-102527481003975%‡   953[24]
2018-08-1230275811541-997[25]
2018-08-176427121035055.6%‡1,609[26]
2018-08-207527911159-2,408[27]
2018-08-24832861177265%‡   3,421[28]
2018-08-268328101217567.6%‡2,445[29]
2018-08-31903081287865%‡   2,462[30]
2018-09-029131913182-2,512[31]
2018-09-0710031141458968%‡   2,426[32]
2018-09-0910131914191-2,265[33][34]
2018-09-1410631171549267.2%‡1,751[35]
2018-09-1611131714997-2,173[36][37]
2018-09-2111631n/a1479967.3%‡1,641[38]
2018-09-2311931915910067%‡   1,836[39]
2018-09-28126312318010265%‡   1,410[40]
2018-10-02130321717910665.4%‡1,463[41]
2018-10-05142351118811363.8%‡2,045[42]
2018-10-07146352120211563.5%‡2,115[43]

# numbers are subject to revision both up, when new cases are discovered, and down, when tests show cases were not Ebola-related.
† DRC Ministry of Public Health
‡ indicates suspected cases were not counted towards CFR

Increasing cases

Bar graph...DRC Ebola virus outbreak current Oct 2, 2018 (cases are red/fatalities are black) see above table for references[18]

The Uganda Ministry of Health has issued an alert for extra surveillance as the neighboring outbreak in the DRC is just 100 kilometres (62 mi) away from its border.[44] On 7 August, the DRC Ministry of Public Health indicated that the total count had climbed to almost 90 cases;[45] two days later, on 9 August, it was nearly 100 cases.[46] On 16 August, the United Kingdom indicated it would help with EVD diagnosis and monitoring in the Democratic Republic of the Congo.[47]

Line graph..DRC EVD[20][22][48]

On 17 August, the WHO reported that "contacts" numbered about 1500 individuals, however there could be more in certain conflict zones in the DRC that can not be reached.[49] Some 954 contacts were successfully followed up on 18 August, however, Mandima Health Zone indicated resistance; as a consequence, contacts were not followed up there per the World Health Organization.[26] On 3 September WHO stated that 16 health workers had contracted the lethal virus.[31] Health workers must don PPE for protection during treatment of those affected by the virus, as well as various other tasks.[50]

On 4 September, Butembo, a city with almost one million people, logged its first fatality in the Ebola outbreak. The city of Butembo, in the Democratic Republic of the Congo has trade links to Uganda, which it borders.[51][15]

On 24 September it was reported that all contact tracing and vaccinations would stop for the foreseeable future in Beni, due to an attack the day before by rebel groups that left several individuals dead.[52] On 25 September, Peter Salama of the World Health Organization indicated that insecurity is obstructing efforts to stop the virus and believes a combination of factors could establish conditions for an epidemic.[53]

Military conflict

North Kivu

The area in question, North Kivu, is also currently in the middle of the Kivu Conflict, a military conflict with thousands of displaced refugees.[54][55] The affected area has about one million uprooted people and shares borders with Rwanda and Uganda, with cross border movement because of trade activities. The humanitarian crisis and deterioration of the security situation is expected to affect any response to the outbreak.[56][57] The DRC is expected to hold presidential elections at the end of this year.[58]

There are about 70 armed military groups, among them the Alliance of Patriots for a Free and Sovereign Congo and the Mai-Mayi Nduma défense du Congo-Rénové, in North Kivu. The armed fighting has apparently displaced thousands of individuals.[59] According to WHO, health care workers will be accompanied by military personnel for protection; additionally, ring vaccination may not be possible.[60] On 11 August, it was reported that seven individuals were killed in Mayi-Moya due to a military group, about 24 miles from Beni where there are several EVD cases.[61][62] The WHO is asking for safe passage to those areas that are within conflict zones, so that possible EVD cases may be found.[63]

On 24 August, it was reported that an Ebola-stricken physician had been in contact with some 97 individuals in an inaccessible military area, hence those 97 contacts cannot be diagnosed.[64][65]

On 4 September it was reported that on the outskirts of the city of Beni (one of the areas affected by the EVD outbreak) 2 peacekeepers were attacked and wounded by rebel groups in the area which is part of a larger military conflict.[66] On 23 September, it was reported that 14 individuals were killed in a military attack in the city of Beni, which is an area affected by the current EVD outbreak.[67] In September 2018, the World Health Organization's Deputy Director-General for Emergency Preparedness and Response described the combination of military conflict and civilian distress as a potential "perfect storm" that could lead to a rapid worsening of the outbreak.[7][8]

On 5 October the Nobel Peace Prize was awarded to Dr. Denis Mukwege who tends to the female victims of the ongoing internal armed conflict, in the Democratic Republic of the Congo.[68]

Uganda and border points

Uganda

On 11 August a U.N. agency indicated that steps were being taken to assure that those leaving the DRC into Uganda are not infected with Ebola; this is being done via active screening.[3][69] On 13 August the DRC reported a total of 115 cases of the virus within its borders so far.[3][69] Three individuals in Uganda that were suspected of contracting the virus were tested, with negative results.[70]

On 22 August it was reported that the government of Uganda had opened two Ebola treatment centers at the border with the Democratic Republic of the Congo, though there are as yet no confirmed cases in the country of Uganda.[71][72]

According to the International Red Cross, a 'most likely scenario' entails an asymptomatic case will at some point enter the country of Uganda undetected among the numerous refugees coming from the DRC.[73]On 20 September Uganda indicated it was ready for immediate vaccination, should the Ebola virus be detected in any individual[74][75]

On 21 September officials of the Democratic Republic of the Congo indicated a confirmed case of EVD at Lake Albert, an entry point into Uganda, though no case has been confirmed within Ugandan territory.[76][77]

Virology

Fruit bats

Zaire ebolavirus strain is the most lethal of the six known strains (including the newly discovered Bombali strain);[78] it is fatal in up to 90% of cases.[79] Both Ebola and Marburg virus are part of the Filoviridae family.[80]

The filovirus genome contains seven genes, including VP40.[81] The natural reservoir of the virus is thought to be the African fruit bat,[82] which is used in many parts of Africa as bushmeat.[83]

Treatment

For the first time Mab 114 (which is a monoclonal antibody) was used to treat infected individuals during this EVD outbreak; ZMapp, however, has not been used because it requires a −20 °C (−4 °F) storage.[3] On 14 August it was reported that the Mangina Ebola Treatment Center was now operational.[84][85] A fourth Ebola Treatment Center (after those in Mangina, Beni and Butembo) was inaugurated on 18 September in Makeke in the Mandima Health Zone of Ituri Province.[86] Makeke is less than five kilometers from Mangina along a well-traveled local road; the site had been proposed in August when it appeared that a second ETC would be needed in the area, and space was insufficient in Mangina itself to accommodate one.[87] By mid-September, however, there had been only two additional cases in the Mandima Health Zone, and only sporadic cases were being reported in the Mabalako Health Zone.[88]

On 27 August the World Health Organization evaluated the benefits and risks of drug treatment for EVD: Remdesivir (GS-5734), ZMapp, REGN3470-3471-3479, mAb 114 and favipiravir.[89]

Vaccine

On 8 August, the process of vaccination began with rVSV-ZEBOV Ebola vaccine.[90] Although the Ebola vaccine has had efficacy, a review by Medaglini et al. indicates "long-term protection is undefined" via the vaccine mechanism.[91] The DRC Ministry of Public Health reported on 16 August that 316 individuals had been vaccinated.[92]

On 24 August, the Democratic Republic of the Congo Ministry of Public Health indicated it had vaccinated 2,957 individuals, including 1,422 in Mabalako against the Ebola virus.[93] On 29 August it was reported that women who are pregnant are not being given the vaccine,[94] even though more than 6,000 individuals have been and many more continue to be vaccinated.[95]

Prognosis

In terms of prognosis, aside from the possible effects of post-Ebola syndrome,[96] there is also the reality of survivors returning to communities where they might be shunned due to the fear many have in the respective areas of the virus (EVD),[97][98] hence psychosocial assistance is needed.[99]

History

Ebola virus

The Ebola virus disease outbreak in Zaire (Yambuku) started in late 1976, and was the second outbreak ever after the earlier one in Sudan the same year.[100][101] On 1 August 2018 the 10th Ebola outbreak was declared in the Democratic Republic of Congo, only a few days after the prior outbreak in the same country had been declared over on 24 July.[102][103]

World Health Organization chief Tedros Adhanom Ghebreyesus indicated on 15 August that the current outbreak in DRC may be worse than the West Africa outbreak of 2013-2016,[104] due to several factors.[105]

The table below indicates the 10 outbreaks that have occurred since 1976:

Timeline of Ebola outbreaks in the Democratic Republic of the Congo (formerly Zaire)
V・T
Date		CountryMajor locationOutbreak informationSource
StrainCasesDeathsCFR
Aug 1976 ZaireYambukuEBOV31828088%[106]
Jun 1977 ZaireTandalaEBOV11100%[107][108]
May–Jul 1995 ZaireKikwitEBOV31525481%[109]
Aug–Nov 2007 Democratic Republic of the CongoKasai-OccidentalEBOV26418771%[110]
Dec 2008–Feb 2009 Democratic Republic of the CongoKasai-OccidentalEBOV321445%[111]
Jun–Nov 2012 Democratic Republic of the CongoOrientaleBDBV773647%[107]
Aug–Nov 2014 Democratic Republic of the CongoTshuapaEBOV664974%[112]
May–Jul 2017 Democratic Republic of the CongoLikatiEBOV8450%[113]
Apr–Jul 2018 Democratic Republic of the CongoBikoroEBOV543361%[114]
Aug 2018–present Democratic Republic of the CongoKivuEBOVongoingongoingongoing–

Graphs

Below are graphs (and/or tables/additional map) that reflect the evolution of the outbreak in the Democratic Republic of the Congo, with respect to EVD in total case numbers (confirmed, probable and suspected) and total fatalities, as well as other graphs:

Ebola (and Marburg virus) outbreaks on the African continent
Ebola (and Marburg virus) outbreaks on the African continent[115][116]
Evolution of cases and deaths 2018 Kivu Democratic Republic of the Congo Ebola virus outbreak
(data from WHO)[18] August 1 - September 12, 2018
Democratic Republic of the Congo EVD outbreaks 1976-present/Oct 8, 2018[117][18]

See also

Notes

  1. ↑ Ituri province was added to N. Kivu province, in terms of viral infection, when the first case of EVD was confirmed on 13 August.[3]

References

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  2. ↑ "EBOLA RDC - Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Vendredi 12 octobre 2018". mailchi.mp. Retrieved 12 October 2018.
  3. 1 2 3 4 5 "EBOLA RDC - Evolution de la riposte contre l'épidémie d'Ebola dans la province du Nord Kivu au Lundi 13 août 2018". mailchi.mp. Retrieved 17 August 2018.
  4. ↑ Editorial, Reuters. "Congo declares new Ebola outbreak in eastern province". U.S. Retrieved 1 August 2018.
  5. ↑ "Congo announces 4 new Ebola cases in North Kivu province". Washington Post. Retrieved 1 August 2018.
  6. ↑ "Cluster of presumptive Ebola cases in North Kivu in the Democratic Republic of the Congo". World Health Organization. Retrieved 2 August 2018.
  7. 1 2 Belluz, Julia (September 25, 2018). "An Ebola "perfect storm" is brewing in Democratic Republic of the Congo". Vox. Retrieved 2018-09-26.
  8. 1 2 "Ebola-hit DRC faces 'perfect storm' as uptick in violence halts WHO operation - Democratic Republic of the Congo". ReliefWeb. 25 September 2018. Retrieved 2018-09-26.
  9. ↑ "Ebola virus disease – Democratic Republic of the Congo". World Health Organization. Retrieved 28 September 2018.
  10. ↑ "UN calls for end to Congo fighting to combat Ebola outbreak". Washington Post. Retrieved 4 October 2018.
  11. ↑ Press, Saleh Mwanamilongo, Associated. "Congo announces 4 new Ebola cases in North Kivu province". Retrieved 2018-08-05.
  12. ↑ "The Democratic Republic of the Congo: Ebola Virus Disease Outbreak – Epidemiological Situation DG ECHO Daily Map | 03/08/2018". ReliefWeb. Retrieved 5 August 2018.
  13. ↑ "Oxfam responds to the new Ebola Outbreak in Beni, North Kivu, DRC". ReliefWeb. Retrieved 2 August 2018.
  14. ↑ "UNICEF DR Congo (North Kivu) Ebola Situation Report #1 - 3 August 2018". ReliefWeb. Retrieved 4 August 2018.
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  25. ↑ "Democratic Republic of Congo: Ebola Virus Disease - External Situation Report 2". ReliefWeb. Retrieved 15 August 2018.
  26. 1 2 "Outbreaks and Emergencies Bulletin, Week 33: 11 - 17 August 2018". WHO | Regional Office for Africa. Retrieved 20 August 2018.
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  30. ↑ "Outbreaks and Emergencies Bulletin, Week 35: 25 - 31 August 2018". WHO | Regional Office for Africa. Retrieved 3 September 2018.
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  37. ↑ "DR Congo - 2018 Ebola Outbreak in North Kivu Province (September 17, 2018 update) - Democratic Republic of the Congo". ReliefWeb. Retrieved 19 September 2018.
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  39. ↑ "Democratic Republic of Congo: Ebola Virus Disease - External Situation Report 8 - Democratic Republic of the Congo". ReliefWeb. Retrieved 26 September 2018.
  40. ↑ "Outbreaks and Emergencies Bulletin, Week 39: 22 - 28 September 2018". WHO | Regional Office for Africa. Retrieved 1 October 2018.
  41. ↑ "Democratic Republic of Congo: Ebola Virus Disease - External Situation Report 9 - Democratic Republic of the Congo". ReliefWeb. Retrieved 4 October 2018.
  42. ↑ "Outbreaks and Emergencies Bulletin, Week 40: 29 September - 05 October 2018". WHO | Regional Office for Africa. Retrieved 8 October 2018.
  43. ↑ "Democratic Republic of Congo: Ebola Virus Disease - External Situation Report 10 - Democratic Republic of the Congo". ReliefWeb. Retrieved 9 October 2018.
  44. ↑ "Ebola: Health ministry issues alert". ReliefWeb. Retrieved 7 August 2018.
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  46. ↑ "EBOLA RDC - Evolution de la riposte contre l'épidémie d'Ebola dans la province du Nord Kivu au Jeudi 9 août 2018". mailchi.mp. Retrieved 17 August 2018.
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  48. ↑ "EBOLA RDC - Evolution de la riposte contre l'épidémie d'Ebola dans la province du Nord Kivu au Jeudi 13 septembre 2018". mailchi.mp. Retrieved 13 September 2018.
  49. ↑ Editorial, Reuters. "WHO expects more Ebola cases in Congo, can't reach no-go areas". U.K. Retrieved 17 August 2018.
  50. ↑ "Emergencies preparedness, response" (PDF). World Health Organization. Retrieved 5 September 2018.
  51. ↑ Gulland, Anne (6 September 2018). "Ebola death in city of one million prompts fears of urban spread". The Telegraph. Retrieved 6 September 2018.
  52. ↑ "Rebel attack halts DR Congo Ebola work". BBC News. 24 September 2018. Retrieved 24 September 2018.
  53. ↑ Schlein, Lisa. "WHO Warns Ebola Spreading in Eastern DR Congo". VOA. Retrieved 25 September 2018. A perfect storm of active conflict limiting our ability to access civilians, distress by segments of the community already traumatized by decades of conflict and of murder, driven by a fear of a terrifying disease
  54. ↑ "Ebola In A Conflict Zone". NPR.org. Retrieved 2 August 2018.
  55. ↑ "Congo Ebola outbreak compounds already dire humanitarian crisis". ReliefWeb. Retrieved 3 August 2018.
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  102. ↑ "Media Advisory: Expected end of Ebola outbreak". ReliefWeb. Retrieved 1 August 2018.
  103. ↑ Weber, Lauren (1 August 2018). "New Ebola Outbreak Confirmed In Democratic Republic Of Congo". Huffington Post. Retrieved 1 August 2018.
  104. ↑ Schlein, Lisa (15 August 2018). "West Africa: Ebola Outbreak Potentially More Dangerous Than West African Epidemic". Voice of America (Washington, DC). Retrieved 16 August 2018.
  105. ↑ News, A. B. C. (29 August 2018). "Congo's latest Ebola outbreak could become 'worst ever' in East Africa, IRC warns". ABC News. Retrieved 30 August 2018.
  106. ↑ "Ebola haemorrhagic fever in Zaire, 1976". Bulletin of the World Health Organization. 56 (2): 271–293. 1978. ISSN 0042-9686. PMC 2395567.
  107. 1 2 "Years of Ebola Virus Disease Outbreaks". www.cdc.gov. 18 May 2018. Retrieved 22 May 2018.
  108. ↑ Heymann, D. L.; et al. (1980). "Ebola Hemorrhagic Fever: Tandala, Zaire, 1977–1978". Journal of Infectious Diseases. 142: 372–76. doi:10.1093/infdis/142.3.372.
  109. ↑ Khan, A. S.; Tshioko, F. K.; Heymann, D. L.; Le Guenno, B.; Nabeth, P.; Kerstiëns, B.; Fleerackers, Y.; Kilmarx, P. H.; Rodier, G. R.; Nkuku, O.; Rollin, P. E.; Sanchez, A.; Zaki, S. R.; Swanepoel, R.; Tomori, O.; Nichol, S. T.; Peters, C. J.; Muyembe-Tamfum, J. J.; Ksiazek, T. G. "The reemergence of Ebola hemorrhagic fever, Democratic Republic of the Congo, 1995. Commission de Lutte contre les Epidémies à Kikwit". The Journal of Infectious Diseases. 179 Suppl 1: S76–86. doi:10.1086/514306. ISSN 0022-1899. PMID 9988168.
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  111. ↑ "WHO | End of Ebola outbreak in the Democratic Republic of the Congo". www.who.int. Retrieved 22 May 2018.
  112. ↑ "Congo declares its Ebola outbreak over". Reuters. November 15, 2014. Retrieved 22 May 2018.
  113. ↑ "Democratic Republic of the Congo Ebola virus" (PDF). World Health Organization. Retrieved 22 May 2018.
  114. ↑ "Ebola virus disease – Democratic Republic of the Congo: Disease outbreak news, 25 July 2018". ReliefWeb. Retrieved 26 July 2018.
  115. ↑ "Ebola Virus Disease Distribution Map: Cases of Ebola Virus Disease in Africa Since 1976 | 2014-2016 Outbreak West Africa | History | Ebola (Ebola Virus Disease) | CDC". www.cdc.gov. 22 May 2018. Retrieved 10 October 2018.
  116. ↑ "Outbreak Table | Marburg Hemorrhagic Fever | CDC". www.cdc.gov. Retrieved 10 October 2018.
  117. ↑ "EBOLA RDC - Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Lundi 8 octobre 2018". mailchi.mp. Retrieved 9 October 2018.

Further reading

  • Dokubo, Emily Kainne; Wendland, Annika; Mate, Suzanne E.; Ladner, Jason T.; Hamblion, Esther L.; Raftery, Philomena; Blackley, David J.; Laney, A. Scott; Mahmoud, Nuha; Wayne-Davies, Gloria; Hensley, Lisa; Stavale, Eric; Fakoli, Lawrence; Gregory, Christopher; Chen, Tai-Ho; Koryon, Augustine; Roth Allen, Denise; Mann, Jennifer; Hickey, Andrew; Saindon, John; Badini, Mehboob; Baller, April; Clement, Peter; Bolay, Fatorma; Wapoe, Yatta; Wiley, Michael R.; Logue, James; Dighero-Kemp, Bonnie; Higgs, Elizabeth; Gasasira, Alex; Williams, Desmond E.; Dahn, Bernice; Kateh, Francis; Nyenswah, Tolbert; Palacios, Gustavo; Fallah, Mosoka P. (23 July 2018). "Persistence of Ebola virus after the end of widespread transmission in Liberia: an outbreak report". The Lancet. Infectious Diseases. 18 (9): 1015–1024. doi:10.1016/S1473-3099(18)30417-1. ISSN 1474-4457. PMID 30049622.
  • Nanclares, Carolina; Kapetshi, Jimmy; et al. (2016). "Ebola Virus Disease, Democratic Republic of the Congo, 2014". Emerging Infectious Diseases. 22 (9): 1579–1586. doi:10.3201/eid2209.160354. ISSN 1080-6040. PMC 4994351. PMID 27533284.
  • "Experimental Ebola vaccines elicit year-long immune response/NIH reports final data from large clinical trial in West Africa". National Institutes of Health (NIH). NIH.gov. 11 October 2017.
  • Kuhn, Jens H.; et al. (24 November 2014). "Nomenclature- and Database-Compatible Names for the Two Ebola Virus Variants that Emerged in Guinea and the Democratic Republic of the Congo in 2014". Viruses. 6 (11): 4760–4799. doi:10.3390/v6114760. ISSN 1999-4915. PMC 4246247. PMID 25421896.
  • Jones-Konneh, Tracey Elizabeth Claire; Suda, Tomomi; Sasaki, Hiroyuki; Egawa, Shinichi (2018). "Agent-Based Modeling and Simulation of Nosocomial Infection among Healthcare Workers during Ebola Virus Disease Outbreak in Sierra Leone". The Tohoku Journal of Experimental Medicine. 245 (4): 231–238. doi:10.1620/tjem.245.231. ISSN 1349-3329. PMID 30078788.
  • "International travel and health". World Health Organization. WHO. Retrieved 16 August 2018.
  • "Rising to the Ebola challenge, again". Nature Microbiology. 3 (9): 965. 16 August 2018. doi:10.1038/s41564-018-0243-2. ISSN 2058-5276. PMID 30115963. Retrieved 16 August 2018.
  • Lévy, Yves; Lane, Clifford; Piot, Peter; Beavogui, Abdul Habib; Kieh, Mark; Leigh, Bailah; Doumbia, Seydou; D'Ortenzio, Eric; Lévy-Marchal, Claire; Pierson, Jerome; Watson-Jones, Deborah; Nguyen, Vinh-Kim; Larson, Heidi; Lysander, Julia; Lacabaratz, Christine; Thiebaut, Rodolphe; Augier, Augustin; Ishola, David; Kennedy, Stephen; Chêne, Geneviève; Greenwood, Brian; Neaton, James; Yazdanpanah, Yazdan (August 2018). "Prevention of Ebola virus disease through vaccination: where we are in 2018". The Lancet. 0 (10149): 787–790. doi:10.1016/S0140-6736(18)31710-0. ISSN 0140-6736. PMC 6128979. PMID 30104048. Retrieved 17 August 2018.
  • Dhama, Kuldeep; Karthik, Kumaragurubaran; Khandia, Rekha; Chakraborty, Sandip; Munjal, Ashok; Latheef, Shyma K.; Kumar, Deepak; Ramakrishnan, Muthannan Andavar; Malik, Yashpal Singh; Singh, Rajendra; Malik, Satya Veer Singh; Singh, Raj Kumar; Chaicumpa, Wanpen (2018). "Advances in Designing and Developing Vaccines, Drugs, and Therapies to Counter Ebola Virus". Frontiers in Immunology. 9: 1803. doi:10.3389/fimmu.2018.01803. ISSN 1664-3224. PMC 6095993. PMID 30147687.
  • West, Brandyn R.; Moyer, Crystal L.; King, Liam B.; Fusco, Marnie L.; Milligan, Jacob C.; Hui, Sean; Saphire, Erica Ollmann (11 September 2018). "Structural Basis of Pan-Ebolavirus Neutralization by a Human Antibody against a Conserved, yet Cryptic Epitope". mBio. 9 (5). doi:10.1128/mBio.01674-18. ISSN 2150-7511. Retrieved 18 September 2018.
  • Nakkazi, Esther (August 2018). "DR Congo Ebola virus outbreak: responding in a conflict zone". The Lancet. 392 (10148): 623. doi:10.1016/S0140-6736(18)31981-0. ISSN 1474-547X. Retrieved 2 October 2018.
  • Juan-Giner, Aitana; Tchaton, Marie; Jemmy, Jean-Paul; Soumah, Aboubacar; Boum, Yap; Faga, Elisabetta Maria; Cisse, Mohamed; Grais, Rebecca F. (25 September 2018). "Safety of the rVSV ZEBOV vaccine against Ebola Zaire among frontline workers in Guinea". Vaccine. doi:10.1016/j.vaccine.2018.09.009. ISSN 1873-2518. Retrieved 6 October 2018.
  • Claude, Kasereka Masumbuko; Underschultz, Jack; Hawkes, Michael T (October 2018). "Ebola virus epidemic in war-torn eastern DR Congo". The Lancet. 0 (0). doi:10.1016/S0140-6736(18)32419-X. ISSN 0140-6736. Retrieved 7 October 2018.
  • De Nys, Helene M.; Kingebeni, Placide Mbala; Keita, Alpha K.; Butel, Christelle; Thaurignac, Guillaume; Villabona-Arenas, Christian-Julian; Lemarcis, Thomas; Geraerts, Mare; Vidal, Nicole; Esteban, Amandine; Bourgarel, Mathieu; Roger, François; Leendertz, Fabian; Diallo, Ramadan; Ndimbo-Kumugo, Simon-Pierre; Nsio-Mbeta, Justus; Tagg, Nikki; Koivogui, Lamine; Toure, Abdoulaye; Delaporte, Eric; Ahuka-Mundeke, Steve; Tamfum, Jean-Jacques Muyembe; Mpoudi-Ngole, Eitel; Ayouba, Ahidjo; Peeters, Martine (December 2018). "Survey of Ebola Viruses in Frugivorous and Insectivorous Bats in Guinea, Cameroon, and the Democratic Republic of the Congo, 2015–2017". Emerging Infectious Diseases. 24 (12). doi:10.3201/eid2412.180740. ISSN 1080-6040. Retrieved 14 October 2018.
  • World Health Organization Democratic Republic of the Congo crisis information
  • World Health Organization Ebola situation reports
  • "Ebola outbreak: timeline". Médecins Sans Frontières/Doctors Without Borders.

Video

  • "Donning PPE: Perform Hand Hygiene Personal Protective Equipment (PPE) | Ebola (Ebola Virus Disease) | CDC". www.cdc.gov. Centers for Disease Control and Prevention. Retrieved 15 September 2018.
  • "Contact tracing/U.S. Department of Health and Human Services Centers for Disease Control and Prevention". cdc.gov. Retrieved 15 September 2018.

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