title: Retrospective Analysis of the 2014-2015 Ebola Epidemic in Liberia.
abstract: The 2014-2015 Ebola epidemic has been the most protracted and devastating in the history of the disease. To prevent future outbreaks on this scale, it is imperative to understand the reasons that led to eventual disease control. Here, we evaluated the shifts of Ebola dynamics at national and local scales during the epidemic in Liberia. We used a transmission model calibrated to epidemiological data between June 9 and December 31, 2014, to estimate the extent of community and hospital transmission. We found that despite varied local epidemic patterns, community transmission was reduced by 40-80% in all the counties analyzed. Our model suggests that the tapering of the epidemic was achieved through reductions in community transmission, rather than accumulation of immune individuals through asymptomatic infection and unreported cases. Although the times at which this transmission reduction occurred in the majority of the Liberian counties started before any large expansion in hospital capacity and the distribution of home protection kits, it remains difficult to associate the presence of interventions with reductions in Ebola incidence.
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut katherine.atkins@lshtm.ac.uk.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Atkins
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Pandey
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Natasha S
authors.initials: NS
authors.lastname: Wenzel
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Laura
authors.initials: L
authors.lastname: Skrip
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Dan
authors.initials: D
authors.lastname: Yamin
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Tolbert G
authors.initials: TG
authors.lastname: Nyenswah
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Mosoka
authors.initials: M
authors.lastname: Fallah
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Luke
authors.initials: L
authors.lastname: Bawo
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Jan
authors.initials: J
authors.lastname: Medlock
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Townsend
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Martial L
authors.initials: ML
authors.lastname: Ndeffo-Mbah
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Alison P
authors.initials: AP
authors.lastname: Galvani
mesh_terms: D017714:Community-Acquired Infections / Q000453:epidemiology / Q000635:transmission; D003428:Cross Infection / Q000453:epidemiology / Q000635:transmission; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D007988:Liberia / Q000453:epidemiology; D015233:Models, Statistical; D012189:Retrospective Studies