Researchers believe that a two-year-old boy named Emile Ouamouno is the index case of the current Ebola virus disease epidemic (New England Journal of Medicine, April 16, 2014). He died in December 2013 (date unknown) in the village of Meliandou, Guéckédou Prefecture. His mother, sister, and grandmother then became ill with similar symptoms and also died. Although Ebola represents a significant public health problem in sub-Saharan Africa and was documented in Tai Forest chimpanzees, only one case had been reported in humans in West Africa. With this background and in the context of poor public health systems, the early cases were mis-diagnosed as diseases more common to the area. Thus Ebola virus disease spread for several months before it was recognised as such. (Jump to March on the timeline for more information.)
Cases of haemorrhagic fever are reported in southern Guinea, notably in Kissidougou, Guéckédou, Macenta and Nzérékoré.
Guinean health authorities ask for MSF’s support to investigate several deaths from unknown causes in the south of the country. After several medical staff die, health authorities in Macenta and Guéckédou request MSF’s support to investigate the deaths from unknown causes.
MSF sends blood samples received from the Guinean Ministry of Health to the Pasteur Insitute in Lyon. A first MSF team, including staff with expertise in managing haemorrhagic fevers, reaches Guéckédou.
The Government of Guinea declares an outbreak of Ebola. Twenty-four MSF doctors, nurses, logisticians and hygiene and sanitation experts are already in the country, while additional staff will strengthen the team in the coming days. MSF has set up an isolation unit for suspected cases in Guéckédou, in collaboration with the Ministry of Health, and is currently doing the same in the town of Macenta, also in the Nzérékoré region in the south of the country.
MSF establishes the first Ebola isolation centre in West Africa to respond to the epidemic.
MSF scales up its intervention: a 30-strong team is in the country, and MSF opens a treatment centre in the grounds of Donka hospital in Conakry. Ten patients are admitted to the centre in Guéckédou. Teams are training health staff, identifying people who have had contact with sick people, and educating local communities on the precautions to be taken.
The first cases of Ebola in Guinea's capital, Conakry, are reported.
The first two cases of Ebola are confirmed in Lofa and Nimba counties. The patient in Lofa county died on the day of her diagnosis, becoming the first death in Liberia.
MSF describes mobilising “against an unprecedented Ebola epidemic”. “We are facing an epidemic of a magnitude never seen before in terms of the geographical spread of cases in the area: Guéckédou, Macenta, Kissidougou, Nzerekore and now Conakry," says Mariano Lugli, MSF coordinator in Conakry.
WHO head of social media and public relations declares that MSF is exaggerating the situation by describing the geographic distribution of Ebola cases as “unprecedented”. here
Guinea: MSF suspends activities in Macenta , Guinea, after a demonstration during which stones were thrown at MSF’s health facilities and vehicles. This is triggered by rumours that MSF had brought Ebola to Macenta. Activities resume on 14 April. In an article published on MSF websites, MSF emergency coordinator in Conakry, Anja Wölz, says: “We are mobilising all our available resources, but the response to combat this epidemic has to scale up effectively. Other actors have to mobilise.”
The outbreak has caused more than 100 deaths: 95 in Guinea and seven in Liberia.
In a press conference in Geneva, the WHO declare the outbreak in West Africa to be "one of the most challenging Ebola outbreaks that we have ever faced”
MSF's first Ebola survivor in the current outbreak, 18-year-old Rose, is discharged from our Guéckédou centre.
MSF resumeds activities in its Macenta treatment centre after being forced to suspend work on 4th April.
MSF has some 350 staff, including 60 international staff, working in southern Guinea and Liberia. More than 40 tons of supplies have been shipped to the region. MSF’s treatment centre in Donka hospital in Conakry has 30 beds. The centre in Guéckédou has 20 beds. In Liberia, MSF teams are working in the Lofa region and in the capital, Monrovia, supporting the Ministry of Health to respond if a major crisis is to reach Liberia.
Guinea's Ministry of Health reports 221 suspected and confirmed cases as well as 146 deaths in Guinea alone. Of the 221, 26 are health workers.
Despite a decrease of the number of new patients, MSF declares that “the epidemic is not over and we must remain vigilant”.
Cases are again reported in Conakry, a city with a population of around two million people.
The last new case was reported on 9th April, and WHO declares that in the absence of new cases the epidemic can be declared over on 22nd May.
WHO reports the first cases and deaths in Sierra Leone, in Kailahun district. They are traced back to the funeral of a widely respected traditional healer from Kailahun who had contracted the disease after treating Ebola patients from across the border in Guinea.
By the end of May, WHO statistics show 383 cases and 211 deaths across West Africa.
A new case is reported in Liberia, the first since 6th April.
MSF raises the alarm about a “resurgence of the Ebola outbreak in west Africa”. While patients numbers are declining, new cases are being reported in Guinea and Sierra Leone. The virus has already infected more than 300 people in west Africa. “Resistance by local communities and cross-border monitoring of people who had contact with patients are the main challenges we face on the ground,” says Marie-Christine Ferir, MSF’s programme manager.
Sierra Leone closes its borders with Liberia and Guinea. It closes a number of schools around the country
New cases are reported in Liberia's capital, Monrovia.
Ninety-seven cases are reported in Sierra Leone
In the month between 18 May and 17 June, the number of cases in Guinea, Sierra Leone and Liberia increased from 156 to 504. Since the beginning of the epidemic, a total of 318 deaths from Ebola have been reported.
MSF declares the second wave of the outbreak "totally out of control" and calls for a massive influx of resources and reinforcements to be sent to West Africa.
MSF opens a transit centre for suspected Ebola cases in Gondama.
MSF opens a management centre in Kailahun.
WHO statistics show 779 cases and 481 deaths overall.
WHO officials, health ministers from 11 West African countries, and NGOs meet in Accra to implement an emergency plan to combat the epidemic and to establish an emergency fund.
MSF’s Ebola management centre in Kailahun is increased from 32 to 65 beds, and 70 patients are receiving care. MSF says it is concerned about a “possible increase in cases in the coming weeks”. Teams are concerned that many people suffering from Ebola are remaining hidden within their communities. “I fear that we have discovered only the visible part of the iceberg,” says Anja Wölz, MSF emergency coordinator.
The number of Ebola cases in Sierra Leone surpasses those of Liberia and Guinea at 442.
Patrick Sawyer, a top government official in the Liberian Ministry of Finance, dies at a local Nigerian hospital. He is the first American/Liberian to die in what officials are calling "deadliest Ebola outbreak in history."
The first case in Freetown is recorded. The city has a population of over one million people. In Kenema, Sierra Leone, riots break out and demonstrators attack the city’s hospital.
President Ellen Johnson Sirleaf declares the country's borders closed. There are some exceptions such as Roberts International Airport remaining open with the addition of screening centres. Sirleaf also announces that football events are to be banned, schools and universities closed, and the worst-affected areas of Liberia to be placed under quarantine.
Dr Sheik Humarr Khan, who was overseeing Ebola care at Kenema Government Hospital in Sierra Leone, dies from complications of the disease.
A state of emergency is declared. The government allows the deployment of troops to maintain quarantines in the country.
The Peace Corps announces it is removing its volunteers from Liberia, Sierra Leone and Guinea.
One international staff member of US NGO Samaritan's Purse, Kent Brantley, is infected with Ebola and flown back to the US to recover in Nebraska. He is discharged on 21st August.
MSF opens a new Ebola management centre in Foya.
Another international staff member of the US NGO Samaritan’s Purse, Nancy Writebol, is infected with Ebola and transferred to the US for medical care. She is declared cured on 21st August. The infections cause Samaritan's Purse to withdraw all nonessential personnel from Liberia.
President Sirleaf announces that a state of emergency is to be enforced in Liberia, remarking that "certain rights and privileges" would be sacrificed in doing so.
MSF has more than 650 staff working in Guinea, Sierra Leone and Liberia. Since the beginning of the epidemic, MSF has provided medical care to nearly 300 patients confirmed with Ebola.
WHO declares the outbreak an “international public health emergency”. MSF calls for this statement to urgently “be translated into action”.
After some debate, the WHO gives its cautious blessing to the use of experimental drugs to treat Ebola. The fact that there were no approved drugs available points to the lack of financial incentive to develop such interventions previously.
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