Table of Contents
Table of Contents
Introduction
Historical Occurrences of Ebola
Countries Affected by the Current Outbreak
How the Ebola Virus Spreads
Current Level of Infection
The Response to the Crisis
i. Internally by the local government ii. The role of UN agencies iii. The role of Non governmental agencies iv. The role of the International community
v. Canada’s role to date
Canada’s Preparedness for a Mass Epidemic
Conclusion
Bibliography

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EBOLA HAEMORRHAGIC
FEVER
Introduction
This report will attempt to disseminate current and accurate information regarding the status of the Ebola Haemorrhagic fever. While western Africa is currently experiencing the largest outbreak of the Ebola virus in history, this severe and often fatal disease is also affecting thousands of innocent people across our world. Never has the medical community had to deal with such an outbreak. Not only do the medical professionals not know how to treat and handle afflicted patients, they are unable to contain this virus that is spreading at a violent speed. This report will discuss the following issues surrounding Ebola: Historical Occurences, Countries Currently
Affected, How the Virus Spreads, Current Level of Infection, Response to the Crisis and
Canada’s preparedness for a mass epidemic.

Historical Occurrences of Ebola
Ebola virus disease, or Ebola haemorrhagic fever first appeared in 1976, in
Nzara, Sudan and Yambuku, Democratic Republic of Congo. The epidemic in the
Democratic Republic of Congo was one of the deadliest outbreaks with 318 cases and a case fatality ratio of 88%. In that specific case, the disease was spread through close personal contact as well as the use of contaminated needles and syringes in hospitals.
The disease then proceeded to spread to a village near the Ebola river, from which the virus got its name. There forward, there were then 26 outbreaks of Ebola in the following countries of Africa: Uganda, South Africa, Congo, Guinea, Cote d’Ivoire,
Gabon, Sierra Leone and Liberia. As shown in Figure 1 below, there have been many historical occurrences of the Ebola virus since 1976.

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Year

Country

Human
Cases

Number of Deaths and CFR

Situation

1976 Zaire (DRC)

318 280(88%)

Spread by close personal contact and use of contaminated needles and syringes in clinics and hospitals. 1976 Sudan
(South
Sudan)

284 151(53%)

Spread through mainly personal contact within hospitals . Many of the medical care personnel were effected. 1976 England

1

1977 Zaire (DRC)

1 1(100%)

1979 Sudan
(South
Sudan)

0 Infection from accidental prick from contaminated needle. Found in the village of Tandala.

34 22(65%)

Outbreak found in the same site as the outbreak in
1976.

1989 USA

0

0 Seen in monkeys imported from the Philippines to quarantine facilities.

1990 USA

4

0 Monkeys were again introduced to quarantine facilities from the Philippines and four humans developed antibodies without becoming sick.

3

0 Three workers from the primate facility responsible for shipping animals to the US developed antibodies without becoming sick.

0

0 Introduced by monkey imported from the same facility from the Philippines in Sienna, Italy,

19891990

Philippines

1992 Italy
1994 Gabbon
1994 Ivory Coast
1995 DRC

52 31(60%)
1

Occurred in Mékouka and gold mining camps.
0 A scientist was found ill after doing an autopsy on a chimpanzee in the Tai Forest.

315 250(81%)

Came from a patient that worked in a forest adjoining to the city and was passed on through families and hospitals. 1996 Gabbon
(Jan to
April)

37 21(57%)

Nineteen people that were involved in eating a chimpanzee from the forrest were found sick and the rest of them were family members.

1996 Gabbon
(July to Jan)

60 45(74%)

Started with a patient that was a hunter that lived in a forest camp. It was spread through close contact with infected persons.

1996 South Africa

2 1(50%)

A medical professional travelled to Johannesburg after treating infected patients and when then hospitalized with the virus. The nurse that took care of him then got sick and died.

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Year

Country

Human
Cases

Number of Deaths and CFR

Situation

1996 USA

0

0 Ebola-Reston was introduced in Texas by monkeys coming from the Philippines.

1996 Philippines

0

0 A monkey showed the Ebola-Reston symptoms at a facility in the Philippines.

1996 Russia

1 1(100%)

This was caused by an accidental laboratory contamination. 2000
2001

Uganda

425 224(53%)

Oct
2001March
2002

Gabbon

65 53(82%)

Occurred on the border of Gabon and of the Republic of the Congo.

Oct
2001March
2002

Republic of
Congo

57 43(75%)

First time Ebola was reported in the Republic of
Congo.

Dec
2002April
2003

Republic of
Congo

143 128(89%)

Occurred in the districts of Mbomo and Kéllé in
Cuvette Ouest Département.

NovDec
2003

Republic of
Congo

35 29(83%)

Occurred in Mbomo and Mbandza villages.

17 7(41%)

Current with and outbreak of measles in the same areas and some suspected Ebola cases were later categorized as measles cases.

264 187(71%)

Occurred in Kasa Occidental Province and declared over on November 20th.

149 37(25%)

Occurred in Bundibugyo District and the first reported occurrence of the new strain.

2004 Sudan
(South
Sudan)
2007 DRC
Dec
2007Jan
2008

Uganda

Nov
2008

Philippines

Dec
2008Feb
2009

DRC

6
32 15(47%)

This was passed on easily through providing medical care without protective measures, having close contact and by attending funerals of a patient with the Ebola virus. 0 Six workers from a pig farm developed antibodies from affected pigs but did not become sick.
Occurred in Mweka and Luebo Health Zones.

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Page 5 of 16

Year

Country

May
2011

Uganda

1 1(100%)

JuneOct
2102

Uganda

11 4(36.4%)

JuneDRC
Nov
Figure 1.
2012

Human
Cases

Number of Deaths and CFR

Situation

A patient with suspected Ebola died on May 6th, 2011.
Occurred in Kibaale District of Uganda.

36 13(36.1%) Occurred in the DRC’s Province Orientale. It had no link to the previous Ebola Outbreak in Kibaale.

Source of Information:

Nov
Uganda
6 3(50%)
Occurred
Outbreaks Chronology: Ebola Virus Disease. (2014, in the Luwero District and was assisted by
October 10). Centers for Disease Control
2012the CDC in the epidemiological and diagnostic tests of and Prevention. Retrieved October 12, 2014, from http://www.cdc.gov/vhf/ebola/outbreaks/
Jan
the outbreak histo://www.cdc.gov/vhf/ebola/outbreaks/history/chronology.html://www.cdc.gov/vhf/ebola/ 2013

outbreaks/history/chronology.html://www.cdc.gov/vhf/ebola/outbreaks/history/chronology.html

Countries Affected by the Current Outbreak
The current outbreak of the Ebola virus disease (EVD) began in December of
2013 and continues to evolve. The first cases of this outbreak were reported in
Guéckédou Prefecture, a forested region in the south-eastern side of Guinea.
The country of Guinea is at its turning point after its decades of authoritarian ruling. Guinea is located in Western Africa, bordering Sierra Leone, Guinea-Bissau and the North Atlantic Ocean. As of July 2014, Guinea’s population is 11,474,383 and has a
2.63% growth rate. Although Guinea is a poor country, it has many major agricultural commodities. It is the second largest producer of bauxite but is unable to profit from this potential because of its political uncertainty, shaky infrastructure and rampant corruption. 47% of the population lives under the poverty line and the total school life expectancy is around 9 years from primary to tertiary eduction. In addition, Guinea has a health expenditure of 6% and only 0.1 physicians per 1,000 people. Ebola has been an ongoing issue in Guinea since March 2014. Civil unrest and violence against the aid workers has become a situation connected to the virus as well. After this outbreak first appeared in Guinea, the spread of the virus began to slow down until about August of
2012 when it became the largest Ebola virus disease outbreak ever reported. It has also been said that many residents of the country are afraid to be treated in hospitals for fear of being poisoned by the doctors. As of October 7th, there were approximatively
1298 cases and 768 deaths reported in Guinea. The outbreak then spread form Guinea to Liberia, Sierra Leone, Nigeria and Senegal.
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Liberia is located in Western Africa, bordering the North Atlantic Ocean, Cote d’Ivoire and Sierra Leone. As of July 2014, there is a population of 4,092,310 in Liberia and it is ranked 128 in the world in terms of population. The eduction expenditure is 2.8
% of the Gross Domestic Profit and the school life expectancy is approximatively 11 years from primary to tertiary eduction. In addition, 60.8% of the population over 15 can also read and write. Liberia is a very low income country that relies on foreign assistance. 80% of Liberians are categorized at below the poverty line and there is an
85% unemployment rate. Finally, 19.5% of the Liberian GDP goes towards Health expenditures and there is only 0.01 physicians per 1,000 people and 0.8 hospital beds per 1,000 people. Just as in Guinea, the current Ebola outbreak has been present in
Liberia since March 2014. Approximatively 3924 cases have presented in Liberia and
2210 deaths have been reported. The government of Liberia has recently evoked many measures to make it very difficult to travel to, from and throughout the country.
Sierra Leone is located in Western Africa, bordering the North Atlantic Ocean,
Guinea and Liberia. Democracy is beginning to reappear in the country after the civil war that ended in 2002 and the country’s priorities are to create jobs and further development. Sierra Leone has a population of 5,743,725 and a 2.33% population growth rate. 2.9% of the GDP is spend on education expenditures and 43.3% of those over the age of 15 can read and write. The school life expectancy from primary to tertiary education is an average of 7 years. Sierra Leone is known to be extremely poor and it relies on external assistance to meet its budgetary needs. Approximatively 70.2% of the population lives under the poverty line. In Sierra Leone, 18.8% of the GDP is spent on health expenditures and there is one 0.02 physicians per 1000 people. In addition, there is only 0.4 hospital beds per 1,000 people. The current Ebola outbreak has been present in Sierra Leone since May 2014 and has had about 2789 cases with
879 deaths.
Nigeria became Africa’s most populated country after the 19th century. It is located in Western Africa, bordering the Gulf of Guinea, Benin and Cameroon. Nigeria has a population of around 177,155,754 and a 2.47% population growth rate. It has a school life expectancy of approximatively 9 years from primary to tertiary education.
Around 61.3% of the total population over15 years old can read and write. Since April
2014, Nigeria has became Africa’s largest economy. The Nigerian economy continues to grow by 6-8% per year because of it growth in telecommunications, services and agriculture. 70% of the population is categorized as being under the poverty line and there is an unemployment rate of approximatively 23.9%. About 5.3% of the GDP is spent on health expenditures and there are 0.4 physicians per 1000 people. The Ebola outbreak in Nigeria is currently only categorized as a Level 1 alert as the risk of Ebola has decreased in the country. Many of the patients that had Ebola in Nigeria, have either died or recovered at this point in time. The first case of Ebola in Nigeria was on
June 25, 2014 and as of September 26, 2014 many of those suspected with having the disease have passed the 21 day monitoring period.

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Senegal continues to remain one of the most stable international democracies involved in peacekeeping and mediation. Just as the other countries in Africa currently affected by Ebola, Senegal is in Western Africa , bordering the North Atlantic Ocean. It is also located between Guinea-Bissau and Mauritania. It has a population of approximatively 13,635,927 and a 2.48% population growth rate. About 49.7% of those age 15 and over can read and write and their school life expectancy is about 8 years.
Senegal is economically supported by agriculture and this is the primary source of the populations’ employment. The unreliable power supply and rising living costs are continuing to cause the economy of Senegal to suffer. About 54% of the population is considered below the poverty line and there is a 48% unemployment rate. In terms of healthcare, only 6% of the GDP is spent on health expenditures and there are only 0.06 physicians per 1000 of the people. The first Ebola case reported in Senegal, was on
August 29th but the outbreak has been relatively well contained in the country at this point in time. Only about 67 of those in close contacts to the initial case were monitored twice daily and all tested negatively for the virus.
In addition to the above mentioned countries that have been and are affected by the current outbreak, the United States hospitalized a man in Dallas with Ebola, and he has since died of the virus. Approximatively 100 of those that could have been in contact with the man were closely monitored for any symptoms for the 21 day incubation period and all had negative results. A nursing assistant who cared for two
Ebola patients has also been diagnosed with Ebola in Spain. According to the Ministry of Health, she cared for two missionaries who were infected with the disease then was flown back to Spain for medical care. Both of the missionaries that travelled back to
Spain for treatment have recently died of the virus.

How the Ebola Virus Spreads
Ebola Haemorrhagic fever is a member of the Filoviridae family. The five different Ebola strains that have been identified to this day include the Zaire Ebola virus, the Sudan Ebola virus, the Tai Forest Ebola virus, Ebola-Reston and the Bundibugyo
Ebola virus. Ebola is a filamentous elongated virus that each contains a single strand of viral genomic RNA. It can vary between 800-10000 nm in length and may take on several distinct shapes. EVD or the Ebola Virus Disease still has no natural reservoir host that is known to our researchers. The manner in which the virus first appears is unknown but researchers believe that the infected patient becomes exposed by an infected animal. The most likely host of this disease is bats. Direct contact with organs, secretions, blood or any other bodily fluids in a living or dead infected person/animal/ material contaminated with the infected fluids cause transmission of the disease. It could also be transmitted through unprotected sexual contact with those currently having or recently having had the virus. Those that have recovered from Ebola can no longer pass on the virus but it has been seen in Semen for up to 3 months after recovery. It is also possible to receive the virus through objects such as needles and medical equipment. Ebola cannot be spread through water or air but it has been noted that, in Africa, Ebola could be spread as a result of handling bushmeat and or contact
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with infected bats. So far, there have been no known insects that contract the disease and it is only mammals that can do so. Those who care for a sick person or bury someone who has had the virus, often contract the disease afterwards. There are some controversies that state that the virus is not only passed through bodily fluids. For example, the University of Illinois states that the virus could potentially be transmitted through infectious aerosol particles from an infected person. The conspiracy theorists are stating that the government could be hiding the possibility of the disease being airborne in order to prevent a craze. It has been reported that, the Public Health
Agency of Canada has also deleted information from its website that stated that the airborne spread of Ebola was highly suspected by many health authorities.
Early on, Ebola’s symptoms can resemble those of a common flu or other illnesses. After 2 to 21 days after infection, the symptoms will begin to appear in patients. Once the Ebola virus enters the host cells through endocytosis, they begin to replicate through the patients cytoplasm. After this, the virus will then affect the host blood and immune defence system which will then lead to immunosuppression with is a process that reduces the efficacy of the immune system. The common symptoms of
Ebola are: high fever, headache, sore throat, weakness, stomach pain, lack of appetite and joint and muscle aches. Once the disease further affects the patient, it causes bleeding on the interior and exterior of the body. It causes bleeding inside of the body and also from the eyes, ears and nose. Occasionally people will vomit and cough up blood, get a rash or have bloody diarrhea. It is sometimes hard to diagnose if a patient has Ebola from the symptoms themselves. In order to diagnose the disease many doctors will test for Cholera and Malaria to rule out those diseases. Blood and tissue test can also diagnose whether or not one has Ebola. In terms of treatment, there has been no drug or vaccine that has been FDA approved in order to treat Ebola. There have been experimental treatments and vaccines for Ebola that are under development but they haven't been completely tested for their safety or effectiveness. Chances of survival can significantly be improved by providing intravenous fluids and by balancing ones electrolytes. Maintaining a good blood pressure and oxygen status are also great ways to improve survival rates. Infections and other symptoms of Ebola are treated as they appear when and if they occur. Antibodies to the virus have been found in the serum of guinea pigs as well as in wild rodents. They have also been identified in some bat species which push researchers to believe that the bat may have the Ebola’s natural reservoir. The Ebola virus only spreads when the patient is showing symptoms and will not be contagious during the incubation period. If one has come into contact with an infected Ebola patient and they have not shown any symptoms after 21 days, then they will not get sick with Ebola.

The Current Level of Infection
As of October 10th, 2014 there have been 8399 total cases of Ebola, 4655 laboratory-confirmed cases and 4033 deaths. The current 2014 Ebola epidemic is the largest in history affecting not only multiple countries in West Africa but also being
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Figure 1
Source:2014 Ebola Outbreak in West Africa - Outbreak Distribution Map. (2014, October
10). Centers for Disease Control and Prevention. Retrieved October 11, 2014, from http:// www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/distribution-map.html spread in small pockets to other countries such as the United States and Spain. As illustrated in Figure 1, there are large amounts of Western Africa covered in active transmission levels. Sierra Leone and Liberia have been hit the most in terms of large spread of active transmission levels.
Although the disease was at its deadliest when it was first discovered, that is because no one knew the best way to deal with it at that time. The huge error in terms of this disease was that it went unchecked for at least three months before the World Heath
Organization became involved in the situation. Since we have developed so many strategies such as protective equipment, quarantine and contact tracing, we may have been able to halt or contain the virus from spreading so vastly if the virus had been reported earlier on. In addition, the virus has made huge insteps into many Western
African countries that do not have the medical infrastructure to deal with the virus which is another reason it is such a deadly current problem. The medical world knows how to stop Ebola from killing more than a handful of people but only when it is caught early on.
Now that it has already killed so many people, it is almost inevitable that the cases will be carried on to further people. The medical world has had no experience with this type of outbreak and situation which is causing such chaos. Since there is so much current chaos, many people across the world are turning to racist demagoguery. Many African immigrants are being turned away from their jobs and even restaurants because of people’s fear of the disease. Instead of campaigns to unite them and help those suffering, citizens are turning to discrimination. Another large issue that has appeared is the denial of health care to those without insurance. Thomas Eric Duncan, a man who travelled from Africa to visit his family in the United States, was turned away from
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the Texas Health Presbyterian Hospital in Dallas after going there with many Ebola like symptoms. Hospitals are required to admit anyone no matter their nationality, race or ability to pay, though, due to financial pressures in the US, relegating the poor without insurance is popular across the United States. Since the US media is owned by large corporations trying to cover up the stories, they turned the racist blame game where they began to target Thomas Duncan himself, who has recently died of Ebola. As evident in Figure 3, the forecast for future cases of Ebola continue to rise. If the current conditions persist, the predicted number of cases for November 16th is approximatively
13, 720.

Figure 3
Source:Alfred, C. (2014, September 26). These Interactive Graphs Show What The
Future Of The Ebola Outbreak May Look Like. The Huffington Post. Retrieved
October 13, 2014, from http://www.huffingtonpost.com/2014/09/26/ebola-forecast-

The Response to the Crisis
i. Internally by the local governments
The presidents of Guinea, Liberia and Sierra Leone, along side the World Health
Organization have launched a $100 million campaign to try and bring the Ebola virus under control in Western Africa. Sierra Leone has recently deployed many army soldiers to quarantine neighbourhoods that have been hit with the virus since Liberia has now closed schools and put all state employees on a leave. President Ernest Bai
Koroma of Sierra leone has cancelled any public meetings for at least 60 days except

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for public education about the virus. The country has also closed most of their border crossings and have banned all public gatherings. ii. The role of UN agencies
The UN Mission for Ebola Emergency Response has been put into effect by the
United Nations in response to the current outbreak. The mission will use a singular strategic objective to work with others to stop the Ebola outbreak. The UN Mission for
Ebola Emergency Response will work hand in hand with governments and national structures in the affected countries , in the civil and private sector. The World Health
Organization will be in charge of all the health strategizing while the UN agencies will act in their area of expertise and lead the Mission towards it’s goal. In addition theUN is doing many other things to contain the disease. In Liberia, the UN is providing communication equipment to ensure contact between borders and the central UN command centre in Monrovia. They are also training police and security officers to prevent the spread in public areas and in prisons. In Guinea, the UN is focusing on reorientating the country’s socio-economic crisis by making cash transfers for the continuation of essential services, ensuring the security and also engaging the community to stop the disease from spreading. In Sierra Leone, they are focusing on giving the basic goods for survival, educating how to seek treatment and also teaching the community how to prevent the infection. iii. The role of Non governmental agencies
Ebola is an epidemic that the world first ignored when serious warnings were first issued in March of 2014. It is still an epidemic that many health charities are still unwilling to help tackle. The International Medical Corps is just one of the two Western based health groups that are running Ebola treatment centres in Liberia. Since so few
Westerners are volunteering, they have been obliged to recruit doctors from developing worlds. After the 2010 earthquake of Haiti, over 400 US doctors volunteered but fewer than 10 have volunteered to help in the Ebola stricken areas. Many of the relief organizations are overestimating the risks of Ebola with so many safety measures put in place for their safety. There have been hundreds of volunteers that have worked with
Doctors without Borders in Ebola treatment centres in Africa and only of one those people have caught the virus. The humanitarian aid organization of Médecins Sans
Frontières (Doctors Without Borders) is the leading organization that s responding to the crisis. It currently has produced five treatment centres and are staffed by 210 international volunteers in collaboration with 1650 staff members of the affected areas.
The Economic Community of West African States has also donated about $250,000 to deal with the outbreak and the European Union has committed about 150 million Euros in order to fight the outbreak. Hundreds of millions of dollars have been pledged by organizations such as the World Bank and the US aid agency but still little of the international health agencies have come to help with such funds. iv. The role of the International community
Many governments across the world have put measures in place to help protect their populations form Ebola and to stop the outbreak from spreading in Western Africa.
To begin, Australia has committed a total of AUS$15 million for the support of the British governments response, Doctors without Borders, and the World Health Organizations
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programs to help stop the spread. The request of the World Health Organization for international aid pushed Brazil to donate many medical kits to the affected countries.
Each kit has the supplies to treat 500 patients for a duration of three months. China has send a second donation of supplies to Guinea, Liberia and Sierra Leone recently. The value of these supplies is approximatively $4.9 million US dollars to provide protective clothes, medicines and disinfectants. They have also sent expert teams to specialize in the disinfection and protection. Cuba will be sending 165 doctors and nurses to Sierra
Leone for six month rotations and France has committed 70 million Euros to help aid the epidemic. The German government has reached a total of 17 million Euros to contribute to the cause and Ghana has announced that they will help serve as a base for air lifting magical materials needed to be supplied to the affected Ebola outbreak areas. Japan has given $520,000 through UNICEF and another $1.5 million to Red
Cross, The World Health Organization and UNICEF in order to prevent infections and provide medical supplies. They also announced that they would be willing to give the countries access to an anti-influenza drug under development to attempt the treat EVD patients. The United Kingdom had a quick response to help with the research innovation of the Ebola outbreaks by donating 6.5 million Euros and by sending troops, medics and equipment to help in the prevention and treatment. They have also recently announced that they will be donating another 120 million Euros to create a command and control centre, treatment beds and other methods of support. Finally the United
States is showing a lot of aid for the current outbreak. The key elements of their response are those of deploying medical personnel, equipment and military equipment, construction of treatment and training centres, as well as screening incoming travellers to prevent the spread of the disease.
v. Canada’s role to date
Canada has heavily tried to help the current Ebola epidemic in Western Africa.
The Public Health Agency of Canada announced that they would donate from 800 to
1000 doses of an untested vaccine for Ebola to the World Health Organization. Canada has also donated an estimated $5,195,000 to security, public health and also humanitarian needs. The Public Health Agency of Canada has also established 3 mobile laboratory’s with teams of scientists along side them.

Canada’s Preparedness for a mass epidemic (Ebola, or otherwise)
PHAC or the Public Health Agency of Canada is working with all levels of government in order to prevent the spread of Ebola in Canada. To begin, Canada has issued many travel health notices to advise Canadians of the many risks of travelling to countries that are effected with Ebola outbreaks. They are also enforcing the
Quarantine Act, at all points of international entry into Canada that will help to identify any possible sick travellers entering the country. Canada is also working with international partners such as the World Health Organization, the Global Public Health
Intelligence Network and the United States Centers for Disease Control and Prevention to monitor the Ebola outbreak. Canada is also supporting the infection control systems
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that are in Canadian hospitals as well as creating infection guidelines specific to Ebola.
This refers to the correct measures to take for airplanes, trains and other modes of transportations. Canada is working with all of its provinces and territories in order to create proper guidelines for the front-line health workers as well as working with Foreign
Affairs to identify safe medical evacuation in case a Canadian becomes ill abroad.
Although the risk of Ebola to the Canadian public is very low, the health officials state that Canada is very well prepared. Canadian hospitals have many infection control systems that limit the spread of infection and the National Microbiology Laboratory in
Winnipeg as well as provincial labs are ready to detect and respond to the virus quickly.

Conclusion
The Ebola Hemorragic Fever will forever change the way we do business. It has had a huge impact on not only the Canadian health system but also our international security system. From the controversies about how the virus is spread to the involvement of many governments, Ebola has made it’s footprint on our world. The international society has never had to deal with such an issue on such a magnitude and
I do not believe that it will be solved quickly. It is my belief that the virus will not only continue to grow but that it will grow at a violent speed before it is contained. The international responses to medical issues will remain forever changed albeit improved.
The Ebola crisis illustrates how interrelated our global issues are and how important it is that we work together and stay informed about world issues in order to react in a timely and appropriate manner.

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West African Ebola epidemic. (n.d.). Ebola response in West Africa. Retrieved October
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