List of Ebola outbreaks

This list of Ebola outbreaks records the occurrence of Ebola hemorrhagic fever throughout the history. Pathogens of the disease are the five ebolaviruses recognized by International Committee on Taxonomy of Viruses: Ebola virus (EBOV), Sudan virus (SUDV), Reston virus (RESTV), Taï Forest virus (TAFV), and Bundibugyo virus (BDBV),^{[1][2][3][4][5][6]} of which the Reston species has only caused the illness on other primates.^[7][8] Transmission between natural reservoirs and humans is rare, and outbreaks of Ebola virus disease are often traceable to a single case where an individual has handled the carcass of a gorilla, chimpanzee, or duiker.^[9] The virus then spreads person-to-person, especially within families, hospitals, and during some mortuary rituals where contact among individuals becomes more likely.^[10] Before outbreaks are confirmed in areas of weak surveillance on the local or regional levels, Ebola is often mistaken for malaria, typhoid fever, dysentery, influenza, or various bacterial infections which may be endemic to the region.

Learning from failed responses, such as that to the 2000 Uganda outbreak, public health measures including the WHO's Global Outbreak and Response Network were instituted in areas at high risk. Field laboratories were established in order to confirm cases, instead of shipping samples to South Africa.^[11] Outbreaks are closely followed by the United States Centers for Disease Control and Prevention (Special Pathogens Branch) as well.^[12] Nigeria was the first country in West Africa to successfully curtail the virus within record time and its method also served as a model for other countries to follow.^[13][14][15]

On December 29, 2015, 42 days after the last Ebola patient in Guinea tested negative for a second time, that country was declared free of Ebola transmission by the UN World Health Organization.^[16] At that time, a 90-day period of "heightened surveillance" commenced in Guinea. "This is the first time that all three countries – Guinea, Liberia and Sierra Leone – have stopped the original chains of transmission ...", the organization stated in a news release.^[17]

Events

Major or massive cases

Larger outbreaks^[18]

Year	Country[note 1]	Virus	Human cases	Human deaths	Case fatality rate	Description
1976	Sudan	SUDV	284	151	53%	Occurred in Nzara, Maridi and surrounding areas between June and November 1976.[19] Mainly spread by personal contact in hospitals. Many medical care personnel were infected.[20]
1976	Zaire	EBOV	318	280	88%	Occurred in Yambuku and surrounding areas in August. Spread by personal contact and use of contaminated needles and syringes in hospitals/clinics.[21]
1979	Sudan	SUDV	34	22	65%	Occurred in Nzara, Maridi. Recurrent outbreak at the same site as the 1976 Sudan epidemic.[22]
1994	Gabon	EBOV	52	31	60%	Occurred in Mékouka and other gold-mining camps deep in the rain forest. Thought to be yellow fever until 1995.[23]
1995	Zaire	EBOV	315	254	81%	Occurred in Kikwit and surrounding areas. Traced to index case-patient who worked in forest adjoining the city. Epidemic spread through families and admission to a hospital.[24][25]
1996	Gabon	EBOV	37	21	57%	Occurred in Mayibout area between January and April. A chimpanzee found dead in the forest was eaten by people hunting for food. Nineteen people who were involved in the butchery of the animal became ill; other cases occurred in family members.[23]
1996–1997	Gabon	EBOV	60	45	75%	Occurred in Booué area with transport of patients to Libreville between July 1996 and January 1997. Index case-patient was a hunter who lived in a forest camp. Disease was spread by close contact with infected persons. A dead chimpanzee found in the forest at the time was determined to be infected.[23]
2000–2001	Uganda	SUDV	425	224	53%	Occurred in Gulu, Masindi, and Mbarara districts of Uganda. The three greatest risks associated with Sudan virus infection were attending funerals of case-patients, having contact with case-patients in one's family, and providing medical care to case-patients without using adequate personal protective measures.[26]
2001–2002	Gabon  Republic of the Congo	EBOV	122	96	79%	Occurred over the border of Gabon and the Republic of the Congo between October 2001 and July 2002. First reported occurrence of Ebola virus disease in the Republic of the Congo.[27]
2002–2003	Republic of the Congo	EBOV	143	128	90%	Occurred in the districts of Mbomo and Kéllé in Cuvette Ouest Département between December 2002 and April 2003.[28]
2003	Republic of the Congo	EBOV	35	29	83%	Occurred in Mbomo and Mbandza villages located in Mbomo district, Cuvette Ouest Département, between November and December.[29]
2004	Sudan	SUDV	17	7	41%	Occurred in Yambio county in Western Equatoria of southern Sudan. This outbreak was concurrent with an outbreak of measles in the same area, and several suspected EVD cases were later reclassified as measles cases.[30]
2007	Democratic Republic of the Congo	EBOV	264	187	71%	Occurred in Kasai-Occidental Province. The outbreak was declared over on November 20. Last confirmed case on October 4 and last death on October 10.[31]
2007–2008	Uganda	BDBV	149	37	25%	First recognition of BDBV. Occurred in Bundibugyo District in western Uganda between December 2007 and January 2008[2][3][4]
2008–2009	Democratic Republic of the Congo	EBOV	32	14	45%	Occurred in the Mweka and Luebo health zones of the Province of Kasai-Occidental between December 2008 and February 2009[32]
2012	Uganda	SUDV	24	17	71%	Occurred in the Kibaale District between June and August.[33]
2012	Democratic Republic of the Congo	BDBV	77	36	47%	Occurred in Province Orientale between June and November.[18][34]
2013–2016	Widespread:  Liberia  Sierra Leone  Guinea Limited and local:  Nigeria  Mali  United States  Senegal  Spain  United Kingdom  Italy	EBOV	28,647[35]	11,322	70-71% (General) [36][37][38][note 2] 57-59% (Among hospitalized patients)[39]	The most severe Ebola outbreak recorded in regards to both the number of human cases and fatalities began in Guéckédou, Guinea, in December 2013, and spread abroad.[40][41][42] Although the epidemic is no longer out of control, flare-ups of the disease have continued into 2016, and the WHO has warned that this may continue for some time.[43]
2014	Democratic Republic of the Congo	EBOV	66[44]	49[44]	74%	Occurred in Équateur Province. Outbreak detected 24 August and according to the WHO, as of 28 October 2014 twenty days had passed since the last reported case was discharged and no new contacts were being followed.[44][45] Declared over on 15 November 2014.[46]

Minor or single cases

Year	Country[note 1]	Virus	Human cases	Human deaths	Description
1976	United Kingdom	SUDV or EBOV[note 3]	1	0	Laboratory infection by accidental stick of contaminated needle.[47][48]
1977	Zaire	EBOV	1	1	Noted retroactively in the village of Tandala.[48][49][50][51]
1989–1990	Philippines	RESTV	3[note 4]	0	High mortality among crab-eating macaques in a primate facility responsible for exporting animals in the USA.[52] Three workers in the facility developed antibodies but did not get sick.[53]
1989	United States	RESTV	0	0	RESTV was introduced into quarantine facilities in Virginia and Pennsylvania by monkeys imported from the Philippines. No human cases.[54]
1990	United States	RESTV	4[note 4]	0	RESTV was introduced into quarantine facilities in Virginia and Texas by monkeys imported from the Philippines. Four humans developed antibodies but did not get sick.[55]
1992	Italy	RESTV	0	0	RESTV was introduced into quarantine facilities in Siena by monkeys imported from the same facility in the Philippines as the 1989 and 1990 US outbreaks. No human cases.[56]
1994	Côte d'Ivoire[note 5]	TAFV	1	0	First and thus far only recognition of TAFV. Approximately one week after conducting necropsies on infected western chimpanzees in Taï National Park, a scientist contracted the virus and developed symptoms similar to those of dengue fever. She was discharged from a Swiss hospital two weeks later, and fully recovered after six weeks.[57]
1995	Côte d'Ivoire		1	0	One person, fleeing the civil war in neighboring Liberia, identified as an Ebola case in Gozon.[58][59]
1996	South Africa	EBOV	2	1	A medical professional traveled from Gabon to Johannesburg, South Africa, in October 1996 after having treated Ebola virus-infected patients. He was hospitalized, and the nurse that took care of him became infected and died.[60]
1996	United States	RESTV	0	0	RESTV was introduced into a quarantine facility in Texas by monkeys imported from the same facility in the Philippines as the 1989 and 1990 US outbreaks. No human cases.[61]
1996	Philippines	RESTV	0	0	RESTV was identified at a monkey export facility in the Philippines. No human cases.[62]
1996	Russia	EBOV	1	1	Laboratory contamination.[63]
2004	Russia	EBOV	1	1	Laboratory contamination.[64]
2008	Philippines	RESTV	6[note 4]	0	First recognition of RESTV in pigs. Strain closely similar to earlier strains. Occurred in November. Six workers from the pig farm and slaughterhouse developed antibodies but did not become sick.[65][66]
2015	Philippines	RESTV	0	0	On 6 September the department of health reported an outbreak of the Reston Ebola virus in a research breeding facility under primates. Twenty five workers were tested for the virus. All of the workers tested negative for the disease.[67]

See also

• List of Ebola patients
• List of epidemics

Notes

1. In accordance with the sovereignty at the time.
2. The mortality rate (death/case ratio) recorded in Liberia up to 26th August 2014 was 70%.^[37] However, the general estimated case fatality rate (70.8%) for this ongoing epidemic differs from the ratio of the number of deaths divided by that of cases due to the estimation method used. Current infections have not run their course, and the estimate may be poor if reporting is biased towards severe cases.
3. The Centers for Disease Control chronology notes this infection as "Sudan virus", whereas the 1977 British Medical Journal (BMJ) article refers to it as "Ebola virus". In 1977, there was not yet a distinction between different ebolaviruses. The BMJ article only notes that the patient received "convalescent serum from the Sudan" following similar serum from Zaire.
4. All cases were asymptomatic.
5. The case was repatriated to Switzerland for medical treatment.^[57]

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