title: Understanding the emergence of ebola virus disease in sierra leone: stalking the virus in the threatening wake of emergence.
abstract: Since Ebola Virus Disease (EVD) was first identified in 1976 in what is now the Democratic Republic of Congo, and despite the numerous outbreaks recorded to date, rarely has an epidemic origin been identified. Indeed, among the twenty-one most documented EVD outbreaks in Africa, an index case has been identified four times, and hypothesized in only two other instances. The initial steps of emergence and spread of a virus are critical in the development of a potential outbreak and need to be thoroughly dissected and understood in order to improve on preventative strategies. In the current West African outbreak of EVD, a unique index case has been identified, pinpointing the geographical origin of the epidemic in Guinea. Herein, we provide an accounting of events that serve as the footprint of EVD emergence in Sierra Leone and a road map for risk mitigation fueled by lessons learned.
authors.affiliation: Sorbonne Université, UPMC, Paris, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Wauquier
authors.affiliation: Metabiota Inc., Freetown, Sierra Leone.
authors.forename: James
authors.initials: J
authors.lastname: Bangura
authors.affiliation: Tulane University, New Orleans, Louisiana, USA.
authors.forename: Lina
authors.initials: L
authors.lastname: Moses
authors.affiliation: Ministry of Heath and Sanitation, Sierra Leone.
authors.forename: Sheik
authors.initials: S
authors.lastname: Humarr Khan
authors.affiliation: Metabiota Inc., Kenema Government Hospital, Kenema, Sierra Leone.
authors.forename: Moinya
authors.initials: M
authors.lastname: Coomber
authors.affiliation: Metabiota Inc., Freetown, Sierra Leone; Ministry of Heath and Sanitation, Sierra Leone.
authors.forename: Victor
authors.initials: V
authors.lastname: Lungay
authors.affiliation: Tulane University, New Orleans, Louisiana, USA; Ministry of Heath and Sanitation, Sierra Leone.
authors.forename: Michael
authors.initials: M
authors.lastname: Gbakie
authors.affiliation: Ministry of Heath and Sanitation, Sierra Leone.
authors.forename: Mohammed S K
authors.initials: MS
authors.lastname: Sesay
authors.affiliation: Ministry of Heath and Sanitation, Sierra Leone.
authors.forename: Ibrahim A K
authors.initials: IA
authors.lastname: Gassama
authors.affiliation: Ministry of Heath and Sanitation, Sierra Leone.
authors.forename: James L B
authors.initials: JL
authors.lastname: Massally
authors.affiliation: Metabiota Inc., Freetown, Sierra Leone.
authors.forename: Aiah
authors.initials: A
authors.lastname: Gbakima
authors.affiliation: Ministry of Heath and Sanitation, Sierra Leone.
authors.forename: James
authors.initials: J
authors.lastname: Squire
authors.affiliation: Ministry of Heath and Sanitation, Sierra Leone.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Lamin
authors.affiliation: Tulane University, New Orleans, Louisiana, USA.
authors.forename: Lansana
authors.initials: L
authors.lastname: Kanneh
authors.affiliation: Ministry of Heath and Sanitation, Sierra Leone.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Yillah
authors.affiliation: Metabiota Inc., Freetown, Sierra Leone.
authors.forename: Kandeh
authors.initials: K
authors.lastname: Kargbo
authors.affiliation: Metabiota Inc., Freetown, Sierra Leone; Ministry of Heath and Sanitation, Sierra Leone.
authors.forename: Willie
authors.initials: W
authors.lastname: Roberts
authors.affiliation: Ministry of Heath and Sanitation, Sierra Leone.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Vandi
authors.affiliation: Directorate of Disease Prevention and Control, DPC Ministry of Health and Sanitation, Freetown, Sierra Leone.
authors.forename: David
authors.initials: D
authors.lastname: Kargbo
authors.affiliation: Metabiota Inc., Silver Spring and San Francisco, USA.
authors.forename: Tom
authors.initials: T
authors.lastname: Vincent
authors.affiliation: Ministry of Heath and Sanitation, Sierra Leone.
authors.forename: Amara
authors.initials: A
authors.lastname: Jambai
authors.affiliation: Metabiota Inc., Silver Spring and San Francisco, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Guttieri
authors.affiliation: Fondation Mérieux USA, Washington DC, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Fair
authors.affiliation: UMRD 190 Emergence des Pathologies Virales, IRD, Aix-Marseille University, Vientiane, Laos.
authors.forename: Marc
authors.initials: M
authors.lastname: Souris
authors.affiliation: Metabiota Inc., Silver Spring and San Francisco, USA.
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Gonzalez
keywords: Ebola Virus Disease; Sierra Leone; emergence; index case