CDC Releases Detailed History of the 2014-2016 Ebola Response in MMWR

The Centers for Disease Control and Prevention (CDC) today will release a detailed account of the agency’s work on the largest, longest outbreak response in the agency’s history: the Ebola epidemic of 2014-2016. The series of articles, in a special supplement to CDC’s Morbidity and Mortality Weekly Report (MMWR), comes on the second anniversary of the official activation of the agency’s emergency response to Ebola.

“The Ebola epidemic in West Africa killed thousands and directly or indirectly harmed millions of people living in the region,” said CDC Director Tom Frieden, M.D., M.P.H. “The resilience of those affected; the hard work by ministries of health and international partners; and the dedication, hard work, and expertise of mission-driven CDC employees helped avoid a global catastrophe. We must work to ensure that a preventable outbreak of this magnitude never happens again.”

The 2014-2016 Ebola epidemic was the first and largest epidemic of its kind, with widespread urban transmission and a massive death count of more than 11,300 people in Guinea, Liberia, and Sierra Leone. The epidemic took a devastating toll on the people of West Africa. Ending it took an extraordinary international effort in which the U.S. government played a major role.

CDC’s response was directed simultaneously at controlling the epidemic in West Africa and strengthening preparedness for Ebola in the United States. The new MMWR Ebola special supplement primarily focuses on the agency’s work during the first year and a half of the response. CDC activated its Emergency Operations Center (EOC) for the Ebola response on July 9, 2014. On August 5, 2014, CDC elevated the EOC to a Level 1 activation, its highest level. On March 31, 2016, CDC officially deactivated the EOC for the 2014-2016 Ebola response.

“The world came together in an unprecedented way—nations, organizations, and individuals—to respond to this horrible epidemic,” said Inger Damon, M.D., Ph.D., who served as incident manager for the CDC Ebola response during its first eight months. “CDC staff performed heroically and were an integral part of the U.S. all-government response, which involved many other agencies and branches of government.”

By the end of the CDC 2014-2016 Ebola response on March 31, 2016, more than 3,700 CDC staff, including all 158 Epidemic Intelligence Service Officers, had participated in international or domestic response efforts. There were 2,292 total deployments to Guinea, Liberia, and Sierra Leone and 3,544 total deployments overall (domestic and international) to support the response. Approximately 1,558 CDC responders have deployed to Guinea, Liberia, and Sierra Leone since the start of the response in July 2014 to the close of the response at the end of March 2016 – including 454 responders with repeat deployments. Even after the deactivation of the CDC 2014-2016 Ebola response, CDC continues its work to better understand and combat the Ebola virus and to assist Guinea, Liberia and Sierra Leone in the aftermath of the 2014-2016 Ebola epidemic; currently, CDC staff remain in CDC country offices in Guinea, Liberia, and Sierra Leone to help support the Global Health Security Agenda.

Experience responding to approximately 20 Ebola outbreaks since 1976 provided CDC and other international responders with an understanding of the disease and how to stop its spread. But unlike those shorter, self-limited outbreaks, the 2014-2016 Ebola epidemic in West Africa presented new and formidable challenges.

“This outbreak is a case study in why the Global Health Security Agenda is so important,” said Beth Bell, M.D., M.P.H., director of CDC’s National Center for Emerging and Zoonotic Infectious Diseases. “By the time the world understood there was an outbreak, it was already widespread – and had ignited the world’s first urban Ebola epidemic, with devastating results.”

This supplement tells the story of CDC’s contributions and shows the importance of partnerships among the international community. Some of the key CDC key activities detailed in this supplement include:

• In West Africa
  • Establishing CDC teams in Guinea, Liberia, and Sierra Leone that transitioned into permanent CDC country offices in support of the Global Health Security Agenda and supporting the incident management systems in each of the affected countries
  • Improving case detection and contact tracing; maintaining infection control in Ebola treatment units and general health care facilities; conducting detailed epidemiologic analyses of Ebola trends and transmission patterns
  • Promoting the use of safe and dignified burial services to help stop spread of Ebola
  • Fostering hope for a long-term solution for Ebola, including rollout of the STRIVE (Sierra Leone Trial to Introduce a Vaccine against Ebola) trial
  • Strengthening surveillance and response capacities in surrounding, at-risk countries, and working with international partners to establish exit and entry risk assessment procedures at borders

• In the United States
  • Reducing the likelihood of spread of Ebola through travel, including working with federal and state health officials to establish entry risk assessment procedures
  • Establishing entry screening and monitoring of all travelers entering the U.S. from Ebola-affected areas
  • Assisting state health departments in responding to domestic Ebola concerns
  • Establishing trained and ready hospitals in the United States capable of safely caring for possible Ebola patients
  • Forming CDC Rapid Ebola Preparedness (REP) response teams that could provide assistance within 24 hours to a health care facility managing a patient with Ebola.
  • Identifying and distributing to state and local public health laboratories a laboratory assay that could reliably detect infection with the Ebola virus strain circulating in West Africa, and working with the Food and Drug Administration, the U.S. Department of Defense, and the Association of Public Health Laboratories to rapidly introduce and validate the assay in public health laboratories across the United States

• At CDC
  • Modeling, in real time, predictions for the course of the epidemic that helped galvanize international support and generated estimates on various topics related to the response in West Africa and the risk for importation of cases into the United States
  • Providing logistics support for the most ambitious CDC deployment in history
  • Supporting laboratory needs at CDC’s Atlanta headquarters and transferring CDC laboratory expertise to the field
  • Creating risk communication materials designed to help change behavior, decrease rates of transmission, and confront stigma, in West Africa and the United States

“This outbreak highlighted how much more we have to learn about Ebola, and it demonstrated that all countries are connected. An outbreak in one country is not just a national emergency, but a global one. This supplement’s detailed review of the 2014-2016 Ebola epidemic and CDC’s response, with many partners, shows the importance of preparedness. It is vital that countries are ready to quickly detect and respond to infectious disease outbreaks, and the international community is committed to increasing that readiness through the Global Health Security Agenda,” Dr. Frieden said. “Through our newly established country offices in Guinea, Liberia, and Sierra Leone, CDC will continue to help West Africa prevent an outbreak of this magnitude from happening again.”

The full MMWR Supplement on the response to the 2014-2016 Ebola virus disease epidemic and related information on the individual chapters available at http://www.cdc.gov/mmwr/ind2016_su.html.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES