THE EBOLA EPIDEMIC
IN WEST AFRICA
Proceedings of a Workshop
Allison Mack, Megan Reeve Snair, and Carmen Mundaca-Shah, Rapporteurs
Forum on Microbial Threats
Board on Global Health
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This project was supported by contracts between the National Academy of Sciences and American Society for Microbiology; Burroughs Wellcome Fund; Infectious Diseases Society of America; the Merck Company Foundation; Pfizer Inc.; Sanofi Pasteur; the U.S. Agency for International Development; the U.S. Department of Defense, Department of the Army: Defense Threat Reduction Agency, Global Emerging Infections Surveillance and Response System, and Medical Research and Materiel Command; the U.S. Department of Health and Human Services: Centers for Disease Control and Prevention, Food and Drug Administration, National Institute of Allergy and Infectious Diseases, and National Institutes of Health; the U.S. Department of Homeland Security; and the U.S. Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for this project.
International Standard Book Number-13: 978-0-309-45006-5
International Standard Book Number-10: 0-309-45006-3
Digital Object Identifier: 10.17226/23653
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. The Ebola Epidemic in West Africa: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/23653.
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PLANNING COMMITTEE FOR THE WORKSHOP ON THE EBOLA EPIDEMIC IN WEST AFRICA1
CHRIS BEYRER, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
REINHARD BURGER, Robert Koch Institute, Berlin, Germany
DAVID HEYMANN, Chairman, Public Health England, London, UK
JAMES HUGHES, Professor of Medicine and Public Health, Emory University, Atlanta, GA
RIMA KHABBAZ, Centers for Disease Control and Prevention, Atlanta, GA
LONNIE KING, College of Veterinary Medicine, The Ohio State University, Columbus, OH
MARK KORTEPETER, Uniformed Services University of the Health Sciences, Bethesda, MD
DAVID RELMAN, Professor of Immunology and Microbiology, Stanford University, CA
Health and Medicine Division Staff
EILEEN CHOFFNES, Scholar and Forum Director (until November 2015)
CARMEN MUNDACA-SHAH, Forum Director (from April 2016)
KATHERINE McCLURE, Associate Program Officer (until July 2015)
V. AYANO OGAWA, Associate Program Officer (from November 2015)
REBEKAH HUTTON, Research Associate (until July 2015)
PRIYANKA NALAMADA, Senior Program Assistant (until March 2015)
ELAINE HYNDS, Senior Program Assistant (from May 2016)
THU ANH TRAN, Senior Program Assistant (from August 2016)
PATRICK KELLEY, Director, Board on Global Health (until August 2016)
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
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Reviewers
This Proceedings of a Workshop has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published Proceedings of a Workshop as sound as possible and to ensure that the Proceedings of a Workshop meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this Proceedings of a Workshop:
Daniel G. Bausch, Tulane University
Joseph Fair, Fondation Mérieux USA
David Fitter, Centers for Disease Control and Prevention
James W. LeDuc, University of Texas Medical Branch
Suzet M. McKinney, Illinois Medical District
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the proceedings of a workshop before its release. The review of this Proceedings of a Workshop was overseen by Mel Worth. He was responsible for making certain that an independent examination of this Proceedings of a Workshop was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this Proceedings of a Workshop rests entirely with the rapporteurs and the institution.
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Acknowledgments
The Forum on Microbial Threats staff and planning committee deeply appreciate the many valuable contributions from individuals who assisted with this project. First, we offer our profound thanks to all of the presenters and discussants at the workshop who gave so generously of their time and expertise. These individuals are listed in full in the workshop agenda in Appendix E. We are also grateful to Carissa Etienne and her staff, including Fredy Aviles, Cesar Guevara, Bruce Leech, Alex Romero, and Lourdes Withrow, for graciously hosting the workshop at the Pan American Health Organization’s headquarters building.
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Contents
Learning from the Ebola Epidemic in West Africa
Organization of the Proceedings of the Workshop
Lessons from Previous Ebola Outbreaks
Differences with Previous Ebola Outbreaks
3 GLOBAL PREPAREDNESS AND RESPONSE EFFORTS
First Response: Médecins Sans Frontières’ Experience and Perspective
Other In-Country Response Efforts
The U.S. Public Health Response
Preparedness for an Ebola-Like Disease
Box, Figures, and Table
BOX
FIGURES
2-1 Confirmed Ebola cases in the three most affected countries as of March 1, 2015
3-1 MSF’s Ebola outbreak response scheme
4-1 Development process for a global health risk framework
C-1 Flowchart for medical doctors in Germany aiding in the recognition of probable cases of EVD
TABLE
2-1 Comparison of Previous Ebola Outbreaks to the 2014 West African Ebola Epidemic
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Acronyms and Abbreviations
AFRO | World Health Organization Regional Office for Africa |
BARDA | Biomedical Advanced Research and Development Authority |
BSL | biosafety level |
CDC | U.S. Centers for Disease Control and Prevention |
CSM | cerebral spinal meningitis |
DART | Disaster Assistance Response Team |
DoD | U.S. Department of Defense |
DRC | Democratic Republic of Congo |
ELISA | enzyme-linked immunoabsorbent assay |
EMT | emergency medical technician |
EMTALA | Emergency Medical Treatment and Labor Act |
EOC | Emergency Operation Center |
ETU | Ebola treatment unit |
EVD | Ebola virus disease |
FDA | U.S. Food and Drug Administration |
GP | glycoprotein |
GSK | GlaxoSmithKline |
HDI | human development index |
HEPA | high-efficiency particulate air filter |
HIV | human immunodeficiency virus |
HMD | Health and Medicine Division |
Ig | immunoglobulin |
IHR | International Health Regulations |
IOM | Institute of Medicine |
MAb | monoclonal antibody |
MERS-CoV | Middle East respiratory syndrome coronavirus |
MSF | Médecins Sans Frontières |
MVA | modified vaccine Ankara |
NAM | National Academy of Medicine |
NGO | nongovernmental organization |
NHP | nonhuman primate |
NIAID | National Institute of Allergy and Infectious Diseases |
NIH | National Institutes of Health |
PAHO | Pan American Health Organization |
PCR | polymerase chain reaction |
PHEIC | public health emergency of international concern |
PPE | personal protective equipment |
PUI | person under investigation |
qRT-PCR | quantitative reverse transcriptase polymerase chain reaction |
RITE | rapid isolation and treatment of Ebola |
RKI | Robert Koch Institute |
rNAP c2 | recombinant nematode anticoagulant protein c2 |
RT-LAMP | reverse transcription loop-mediated isothermal amplification |
SARS | severe acute respiratory syndrome |
sGP | truncated glycoprotein isoform |
siRNA | small interfering RNA |
UN | United Nations |
USAID | U.S. Agency for International Development |
USAMRIID | U.S. Army Medical Research Institute of Infectious Diseases |
VIC | Viral Hemorrhagic Fever Immunotherapeutic Consortium |
VP | viral protein |
VSV | vesicular stomatitis virus |
WHO | World Health Organization |