Morbidity and Mortality Weekly Report Early Release / Vol. 63 December 16, 2014

Update: Ebola Virus Disease Epidemic — West Africa, December 2014

Incident Management System Ebola Epidemiology Team, CDC; Interministerial Committee for Response Against the Ebola Virus; World Health Organization; CDC Guinea Response Team; Liberia Ministry of Health and Social Welfare; CDC Liberia Response Team; Ministry of Health and Sanitation; CDC Sierra Leone Response Team; Viral Special Pathogens Branch, National Center for Emerging and Zoonotic Infectious Diseases, CDC

CDC is assisting ministries of health and working with other affected. During both periods, counts of reported Ebola organizations to end the ongoing epidemic of Ebola virus cases were highest in the area around Monrovia, including disease (Ebola) in West Africa (1). The updated data in this Grand Cape Mount, Liberia; the Western Area and northwest report were compiled from situation reports from the Guinea districts of Sierra Leone, particularly Bombali and Port Loko; Interministerial Committee for Response Against the Ebola and , Guinea (Figure 3). Virus, the World Health Organization, the Liberia Ministry of As of December 6, the highest cumulative incidence rates Health and Social Welfare, and the Sierra Leone Ministry of (>100 cases per 100,000 population) were reported by two Health and Sanitation. Total case counts include all suspected, prefectures in Guinea (Guéckédou and Macenta), six counties probable, and confirmed cases, which are defined similarly by in Liberia (Bong, Grand Cape Mount, Lofa, and, particularly, each country (2). These data reflect reported cases, which make Bomi, Margibi, and Montserrado, with cumulative incidence up an unknown proportion of all cases, and reporting delays of >300 cases per 100,000 population), and six districts that vary from country to country. in Sierra Leone (Bombali, Kailahun, Kenema, Port Loko, According to the latest World Health Organization update Tonkolili, and Western Area) (Figure 4). Evidence of decreasing on December 10, 2014 (3), a total of 17,908 Ebola cases have incidence in Lofa and Montserrado, Liberia, has been described been reported as of December 7 from three West African coun- elsewhere (6–8), though cases continue to be reported from tries (Guinea, Liberia, and Sierra Leone) where transmission is these counties, especially Montserrado. widespread and intense. The highest reported case counts were The latest updates on the 2014 Ebola epidemic in from Sierra Leone (7,897cases) and Liberia (7,719), followed West Africa, including case counts, are available at http://www. by Guinea (2,292). Peaks in the number of new cases occurred cdc.gov/vhf/ebola/outbreaks/2014-west-africa/index.html. in Liberia (509 cases), Sierra Leone (748 cases), and Guinea The most up-to-date infection control and clinical guidelines (292 cases) at epidemiologic weeks 38 (September 14–20), on the 2014 Ebola epidemic in West Africa are available at 46 (November 9–15), and 41 (October 5–11), respectively http://www.cdc.gov/vhf/ebola/hcp/index.html. (Figures 1 and 2). A total of 6,373 deaths have been reported. Acknowledgments Investigation of localized transmission in two locations in Mali (Kourémalé and Bamako) is ongoing, with a current total of World Health Organization. Geospatial Research, Analysis, and eight cases and six deaths reported (4). Transmission was inter- Services Program, CDC. Situational Awareness Team, Office of rupted successfully in Nigeria (October 19) and prevented in Public Health Preparedness and Response, CDC. Senegal (October 17) (3). References There were 4,281 new Ebola cases reported during the 1. Dixon MG, Schafer IJ. Ebola viral disease outbreak—West Africa, 2014. 4-week period of November 9–December 6, compared with MMWR Morb Mortal Wkly Rep 2014;63:548–51. the 2,705 new cases reported during the 3-week period of 2. World Health Organization. Case definition recommendations for Ebola October 19–November 8 (5). Cases were widely distributed or Marburg virus diseases. Available at http://www.who.int/csr/resources/ publications/ebola/ebola-case-definition-contact-en.pdf. geographically among districts in all three countries, with 3. World Health Organization. Ebola response roadmap situation report, the prefecture of Mamou in Guinea reported to be newly 10 December 2014. Geneva, Switzerland: World Health Organization; 2014. Available at http://www.who.int/csr/disease/ebola/situation-reports/en.

U.S. Department of Health and Human Services Centers for Disease Control and Prevention Early Release

4. CDC. 2014 Ebola Outbreak in West Africa—case counts. Available at http:// 6. Sharma A, Heijenberg N, Peter C, et al. Evidence for a decrease in transmission www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html. of Ebola virus—Lofa County, Liberia, June 8–November 1, 2014. MMWR 5. Incident Management System Ebola Epidemiology Team, CDC; Ministries Morb Mortal Wkly Rep 2014;63:1067–71. of Health of Guinea, Sierra Leone, Liberia, Nigeria, and Senegal; Viral 7. Nyenswah TG, Westercamp M, Ashraf Kamali A, et al. Evidence for Special Pathogens Branch, National Center for Emerging and Zoonotic declining numbers of Ebola cases—Montserrado County, Liberia, June– Infectious Diseases, CDC. Ebola virus disease outbreak—West Africa, October 2014. MMWR Morb Mortal Wkly Rep 2014;63:1072–6. October 2014. MMWR Morb Mortal Wkly Rep 2014;63:978–81.​ 8. Nyenswah T, Fahnbulleh M, Massaquoi M, et al. Ebola epidemic— Liberia, March–October 2014. MMWR Morb Mortal Wkly Rep 2014;​ 63:1082–6.

FIGURE 1. Cumulative number of Ebola virus disease cases reported, by epidemiologic week — three countries, West Africa, March 29– November 30, 2014 8,000

Liberia* 7,000 Sierra Leone Guinea 6,000

5,000

4,000

No. of reported cases No. 3,000

2,000

1,000

0 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 Epidemiologic week * A change in reporting source data at week 43 resulted in an adjustment of cumulative cases in Liberia.

FIGURE 2. Number of new Ebola virus disease cases reported, by epidemiologic week — three countries, West Africa, March 29–November 30, 2014 800

Liberia 700 Sierra Leone Guinea 600

500

400

300 No. of reported new cases 200

100

0 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 Epidemiologic week

2 MMWR / December 16, 2014 / Vol. 63 Early Release

FIGURE 3. Number of new cases of Ebola virus disease reported — Guinea, Liberia, and Sierra Leone, November 9–30, 2014

SENEGAL Koundara

GUINEA-BISSAU Mali

Koubia Siguiri MALI Gaoual Lélouma Dinguiraye Tougué Labé Boké Télimélé Dalaba Pita Kouroussa Dabola Mandiana GUINEA Fria Mamou Boffa Kankan Dubréka Kindia Faranah

Coyah Conakry ^ Forécariah Koinadugu Conakry SIERRA Kissidougou Kérouané Bombali Kambia LEONE Beyla Port Guéckédou Loko Kono Tonkolili Macenta Western Area^ Kailahun Bo Lofa Lola Moyamba Nzérékoré CÔTE Kenema Yamou D'IVOIRE New cases reported Bonthe Gbarpolu 1–10 Pujehun Grand Cape 11–50 Bong Mount Nimba 51–100 Bomi Margibi 101–150 Montserrado LIBERIA 151–300 ^ Grand Bassa 301–840 Monrovia Grand Gedeh Rivercess Area with no new cases reported River Previously una ected area Sinoe Gee Area with no reported cases Grand Kru Maryland

FIGURE 4. Cumulative incidence of Ebola virus disease — Guinea, Liberia, and Sierra Leone, November 30, 2014

SENEGAL

Koundara

GUINEA-BISSAU Mali MALI Koubia Siguiri Gaoual Lélouma Dinguiraye Tougué Labé Boké Télimélé Dalaba Pita Kouroussa Dabola Mandiana GUINEA Fria Mamou Boffa Kankan Dubréka Kindia Faranah

Coyah Conakry ^ Forécariah Koinadugu Conakry Kissidougou Kérouané Bombali SIERRA Kambia LEONE Beyla Port Guéckédou Tonkolili Kono Freetown Loko Macenta Western Area^ Kailahun Bo Lofa Lola Moyamba Nzérékoré

Kenema Yamou Bonthe Gbarpolu CÔTE Pujehun D'IVOIRE Grand Cape Bong Mount Nimba Cumulative incidence Bomi Margibi per 100,000 population Montserrado LIBERIA ^ Grand Bassa 0.0 Monrovia Grand Gedeh 0.1–10.0 Rivercess

10.1–100.0 River 100.1–300.0 Sinoe Gee 300.1–600.0 Grand Kru Maryland

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